American Journal of Epidemiology Vol. 144, No. 3: 224-234
Copyright © 1996 by The Johns Hopkins University School of Hygiene and Public Health
other |
Serum Insulin and Incident Coronary Heart Disease in Middle-aged British Men
1Department of Public Health, The Royal Free Hospital School of Medicine, London, England
2Department of Medicine, University of Newcastle upon Tyne, Newcastle upon Tyne, England
Correspondence to: Dr. Ivan J. Perry, Department of Public Health, The Royal Free Hospital School of Medicine, Rowland Hill Street, London NW3 2PF, England.
Earlier studies have not resolved the question of whether elevated circulating insulin levels are independently related to the development of coronary heart disease. Previous studies have not used a specific insulin assay and in all but a minority of studies that have addressed this issue it has not been possible to adjust for possible confounding due to high density lipoprotein (HDL) cholesterol. The authors examined the relation between serum insulin concentration and major coronary disease events (fatal and non-fatal myocardial infarction) in the British Regional Heart Study. The data are based on 5, 550 men (aged 40–59 years) in 18 towns whose baseline, non-fasting serum samples were analyzed for insulin using a specific enzyme-linked immunoadsorbent assay (ELJSA) method. Known diabetics were excluded. At 11.5 years of follow-up, 521 major coronary disease events had occurred, 261 fatal and 260 non-fatal. A nonlinear relation between serum insulin and coronary disease events was observed with an almost twofold increased relative risk in the 10th decile of the serum insulin distribution (
33.8 mU/liter) relative to the 1st to the 9th deciles combined (age-adjusted relative risk (RR) = 1.9, 95% confidence interval (Cl) 1.6–2.4). There was some attenuation of this association on cumulative adjustment for a wide range of biologic and life-style coronary disease risk factors, including HDL cholesterol, though it remained significant in the fully adjusted proportional hazards model (RR = 1.6, 95% Cl 1.1–2.3). Similar associations between insulin and coronary disease events were seen in men with and without evidence of coronary disease at screening and in men with baseline serum glucose below the 80th percentile. These data are consistent with the hypothesis that a high level of serum insulin (hyperinsulinemia) is atherogenic, with a threshold effect. However, the markedly nonlinear form of the association and the attenuation in muttivariate analysis strongly suggest that elevated insulin levels may only be a marker for common etiologic factors in the development of both coronary disease and non-insulin-dependent diabetes mellitus. Am J Epidemiol 1996; 144: 224–34.
blood glucose; coronary disease; prospective studies
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  N. Engberding, A. San Martin, A. Martin-Garrido, M. Koga, L. Pounkova, E. Lyons, B. Lassegue, and K. K. Griendling Insulin-Like Growth Factor-1 Receptor Expression Masks the Antiinflammatory and Glucose Uptake Capacity of Insulin in Vascular Smooth Muscle Cells Arterioscler Thromb Vasc Biol, March 1, 2009; 29(3): 408 - 415. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.-P. Empana, F. Canoui-Poitrine, G. Luc, I. Juhan-Vague, P. Morange, D. Arveiler, J. Ferrieres, P. Amouyel, A. Bingham, M. Montaye, et al. Contribution of novel biomarkers to incident stable angina and acute coronary syndrome: the PRIME Study Eur. Heart J., August 2, 2008; 29(16): 1966 - 1974. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. E. Hirai, S. E. Moss, B. E.K. Klein, and R. Klein Relationship of Glycemic Control, Exogenous Insulin, and C-Peptide Levels to Ischemic Heart Disease Mortality Over a 16-Year Period in People With Older-Onset Diabetes: The Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) Diabetes Care, March 1, 2008; 31(3): 493 - 497. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Sarwar, N. Sattar, V. Gudnason, and J. Danesh Circulating concentrations of insulin markers and coronary heart disease: a quantitative review of 19 Western prospective studies Eur. Heart J., October 2, 2007; 28(20): 2491 - 2497. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. M. Ivey, A. S. Ryan, C. E. Hafer-Macko, A. P. Goldberg, and R. F. Macko Treadmill Aerobic Training Improves Glucose Tolerance and Indices of Insulin Sensitivity in Disabled Stroke Survivors: A Preliminary Report Stroke, October 1, 2007; 38(10): 2752 - 2758. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Kahn, J. Buse, E. Ferrannini, and M. Stern The Metabolic Syndrome: Time for a Critical Appraisal: Joint statement from the American Diabetes Association and the European Association for the Study of Diabetes Diabetes Care, September 1, 2005; 28(9): 2289 - 2304. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. A. Kronmal, J. I. Barzilay, R. P. Tracy, P. J. Savage, T. J. Orchard, and G. L. Burke The Relationship of Fasting Serum Radioimmune Insulin Levels to Incident Coronary Heart Disease in an Insulin-Treated Diabetic Cohort J. Clin. Endocrinol. Metab., June 1, 2004; 89(6): 2852 - 2858. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Rewers, D. Zaccaro, R. D'Agostino, S. Haffner, M. F. Saad, J. V. Selby, R. Bergman, and P. Savage Insulin Sensitivity, Insulinemia, and Coronary Artery Disease: The Insulin Resistance Atherosclerosis Study Diabetes Care, March 1, 2004; 27(3): 781 - 787. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Fonseca, C. Desouza, S. Asnani, and I. Jialal Nontraditional Risk Factors for Cardiovascular Disease in Diabetes Endocr. Rev., February 1, 2004; 25(1): 153 - 175. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. L. Watkins, A. Sherwood, M. Feinglos, A. Hinderliter, M. Babyak, E. Gullette, R. Waugh, and J. A. Blumenthal Effects of Exercise and Weight Loss on Cardiac Risk Factors Associated With Syndrome X Arch Intern Med, September 8, 2003; 163(16): 1889 - 1895. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. B. Rubins, S. J. Robins, D. Collins, D. B. Nelson, M. B. Elam, E. J. Schaefer, F. H. Faas, J. W. Anderson, and for the VA-HIT Study Group Diabetes, Plasma Insulin, and Cardiovascular Disease: Subgroup Analysis From the Department of Veterans Affairs High-Density Lipoprotein Intervention Trial (VA-HIT) Arch Intern Med, December 9, 2002; 162(22): 2597 - 2604. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. N. Kernan, S. E. Inzucchi, C. M. Viscoli, L. M. Brass, D. M. Bravata, and R. I. Horwitz Insulin resistance and risk for stroke Neurology, September 24, 2002; 59(6): 809 - 815. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S G Wannamethee, A G Shaper, I J Perry, and K G M M Alberti Alcohol consumption and the incidence of type II diabetes J Epidemiol Community Health, July 1, 2002; 56(7): 542 - 548. [Abstract] [Full Text]
|
|
|
|
 |
|
 L. Dow and S. Ebrahim Commentary: Lung function and risk of fatal and non-fatal stroke--The Copenhagen City Heart Study Int. J. Epidemiol., February 1, 2001; 30(1): 152 - 153. [Full Text] [PDF]
|
|
|
|
|
|
S. G. Wannamethee, A. G. Shaper, and K. G. M. M. Alberti Physical Activity, Metabolic Factors, and the Incidence of Coronary Heart Disease and Type 2 Diabetes Arch Intern Med, July 24, 2000; 160(14): 2108 - 2116. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H.-M. Lakka, T. A. Lakka, J. Tuomilehto, J. Sivenius, and J. T. Salonen Hyperinsulinemia and the Risk of Cardiovascular Death and Acute Coronary and Cerebrovascular Events in Men: The Kuopio Ischaemic Heart Disease Risk Factor Study Arch Intern Med, April 24, 2000; 160(8): 1160 - 1168. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. G. Wannamethee, I. J. Perry, and A. G. Shaper Nonfasting Serum Glucose and Insulin Concentrations and the Risk of Stroke Stroke, September 1, 1999; 30(9): 1780 - 1786. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S G Wannamethee, A G Shaper, P H Whincup, and M Walker Role of risk factors for major coronary heart disease events with increasing length of follow up Heart, April 1, 1999; 81(4): 374 - 379. [Abstract] [Full Text]
|
|
|
|
|
|
J. He, M. J. Klag, B. Caballero, L. J. Appel, J. Charleston, and P. K. Whelton Plasma Insulin Levels and Incidence of Hypertension in African Americans and Whites Arch Intern Med, March 8, 1999; 159(5): 498 - 503. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Pyorala, H. Miettinen, M. Laakso, and K. Pyorala Hyperinsulinemia and the Risk of Stroke in Healthy Middle-Aged Men : The 22-Year Follow-Up Results of the Helsinki Policemen Study Stroke, September 1, 1998; 29(9): 1860 - 1866. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Pyorala, H. Miettinen, M. Laakso, and K. Pyorala Hyperinsulinemia Predicts Coronary Heart Disease Risk in Healthy Middle-aged Men : The 22-Year Follow-up Results of the Helsinki Policemen Study Circulation, August 4, 1998; 98(5): 398 - 404. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Lamarche, A. Tchernof, P. Mauriege, B. Cantin, G. R. Dagenais, P. J. Lupien, and J.-P. Despres Fasting Insulin and Apolipoprotein B Levels and Low-Density Lipoprotein Particle Size as Risk Factors for Ischemic Heart Disease JAMA, June 24, 1998; 279(24): 1955 - 1961. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. B. Ruige, W. J. J. Assendelft, J. M. Dekker, P. J. Kostense, R. J. Heine, and L. M. Bouter Insulin and Risk of Cardiovascular Disease : A Meta-Analysis Circulation, March 17, 1998; 97(10): 996 - 1001. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. P. Stern The Effect of Glycemic Control on the Incidence of Macrovascular Complications of Type 2 Diabetes Arch Fam Med, March 1, 1998; 7(2): 155 - 162. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. M. Burchfiel, D. S. Sharp, J. D. Curb, B. L. Rodriguez, R. D. Abbott, R. Arakaki, and K. Yano Hyperinsulinemia and Cardiovascular Disease in Elderly Men : The Honolulu Heart Program Arterioscler Thromb Vasc Biol, March 1, 1998; 18(3): 450 - 457. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J W G Yarnell, C C Patterson, D Bainton, and P M Sweetnam Is metabolic syndrome a discrete entity in the general population? Evidence from the Caerphilly and Speedwell population studies Heart, March 1, 1998; 79(3): 248 - 252. [Abstract] [Full Text]
|
|