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Some researchers have tried to determine whether stress, which can be measured using the ratio cortisol:testosterone, affects insulin resistance. In the prospective study by George Davey Smith and colleagues from the University of Bristol in the United Kingdom, cortisol:testoterone ratio was positively associated with IHD (ischemic heart disease) mortality and incidence. Adjustment for potential socioeconomic and behavioral confounding variables had little influence on these associations, but they appeared to be mediated by components of the insulin resistance syndrome (elevated blood pressure, triglyceride levels, body mass index, total cholesterol, HDL cholesterol, and impaired glucose tolerance). This suggests that methods of reducing the cortisol:testoterone ratio may improve insulin resistance and reduce the risk of ischemic heart disease (IHD). But, it does not suggest that reducing stress can reduce the risk of diabetes.