Elevated Fasting Plasma Insulin in a General Aged Population: An Innocent Companion of Cardiovascular Diseases

Lindberg, O.; Tilvis, Reijo S.; Strandberg, Timo; Valvanne, Jaakko; Sairanen, Sirpa; Ehnholm, Christian; Tuomilehto, Jaakko

doi:10.1111/j.1532-5415.1997.tb05163.x

Cited by 19 publications

(15 citation statements)

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“…A positive association between insulin and CHD risk was observed in 10 studies, 8 -21 and in 8 of them, the association was found to be independent of other cardiovascular risk factors. 8 -19 Nine studies found no association [22][23][24][25][26][27][28] or even an inverse association 29,30 between insulin and the risk of CHD or cardiovascular disease.…”

Section: Discussionmentioning

confidence: 99%

“…The results of other subsequent prospective epidemiological studies on this subject, however, have been conflicting. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] A positive association of plasma insulin level 31 and insulin resistance [32][33][34] to ultrasonographically assessed atherosclerosis has been observed in cross-sectional studies. Some evidence has also accumulated from studies on the cell biology of the arterial wall and animal experiments, suggesting that insulin might have a direct enhancing effect on atherogenesis.…”

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Hyperinsulinemia Predicts Coronary Heart Disease Risk in Healthy Middle-aged Men

et al. 1998

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Background-The Helsinki Policemen Study is one of the first prospective epidemiological studies demonstrating an association of hyperinsulinemia to the risk of coronary heart disease (CHD). The aim of the present study was to investigate the predictive value of hyperinsulinemia with regard to CHD risk during a 22-year follow-up of the Helsinki Policemen Study population. Methods and Results-The study was based on a cohort of 970 men who were 34 to 64 years of age and free of CHD, other cardiovascular disease, and diabetes. Risk factor measurements at baseline examination included an oral glucose tolerance test (OGTT) with blood glucose and plasma insulin measurements at 0, 1, and 2 hours. Area under the plasma insulin response curve (AUC insulin) during OGTT was used as a composite variable reflecting plasma insulin levels. During the 22-year follow-up, 164 men had a major CHD event (CHD death or nonfatal myocardial infarction). Age-adjusted hazard ratios for a major CHD event comparing men in the highest AUC insulin quintile with those in the combined 4 lower quintiles during 5-, 10-, 15-, and 22-year follow-up periods were 3.29 (95% CI, 1.56 to 6.91), 2.72 (95% CI, 1.67 to 4.42), 2.14 (95% CI, 1.43 to 3.21), and 1.61 (95% CI, 1.14 to 2.27), respectively. Further adjustment for other risk factors attenuated these hazard ratios to 2.36 (95% CI, 1.00 to 5.57), 2.29 (95% CI, 1.31 to 4.02), 1.76 (95% CI, 1.09 to 2.82), and 1.32 (95% CI, 0.89 to 1.97), respectively. Conclusions-Hyperinsulinemia predicted CHD risk in Helsinki policemen over the 22-year follow-up, and to a large extent independently of other CHD risk factors, but its predictive value diminished with lengthening follow-up time.(Circulation. 1998;98:398-404.)

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Hyperinsulinemia Predicts Coronary Heart Disease Risk in Healthy Middle-aged Men

et al. 1998

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“…A weakening of the predictive value of hyperinsulinemia with regard to cardiovascular and coronary mortality with lengthening follow-up time was also observed in the Busselton Study (17,18) and the Paris Prospective Study (16). In contrast to these findings, 2 prospective studies on elderly subjects-the Finnish study of elderly men and women (15) and the Rancho Bernardo Study (19)-found no association between insulin and cardiovascular mortality or even an inverse association in some subgroups.…”

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confidence: 92%

“…In the Busselton Study, a significant positive association between insulin and all-cause mortality was observed in older men, but the association was inverse in younger men, and there was no association in women (14). In a Finnish study of elderly men and women, a significant inverse association was observed between insulin and all-cause mortality in the oldest age-group and a trend to a positive association in the youngest age-group (15). In the Paris Prospective Study, the association between insulin and all-cause mortality was U-shaped and independent of other risk factors (16).…”

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Plasma insulin and all-cause, cardiovascular, and noncardiovascular mortality: the 22-year follow-up results of the Helsinki Policemen Study.

et al. 2000

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Abbreviations: AUC glucose, area under the blood glucose response curve; AUC insulin, area under the plasma insulin response curve; CHD, coronary heart disease; HR, hazard ratio; OGTT, oral glucose tolerance test.A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. Plasma Insulin and All-Cause, Cardiovascular, and Noncardiovascular MortalityThe 22-year follow-up results of the Helsinki Policemen StudyOBJECTIVE -To investigate the association of plasma insulin with all-cause, cardiovascular, and noncardiovascular mortality.RESEARCH DESIGN AND METHODS -We studied 22-year mortality data from the Helsinki Policemen Study. The study population comprised 970 men, 34-64 years of age, who were free of coronary heart disease, other cardiovascular disease, and diabetes. Area under the insulin response curve (AUC insulin) during an oral glucose tolerance test was used to reflect plasma insulin levels.RESULTS -During the follow-up period, 276 men died: 130 from cardiovascular and 146 from noncardiovascular causes. The hazard ratio (HR) for hyperinsulinemia (highest AUC insulin quintile vs. combined lower quintiles) with regard to all-cause mortality, adjusting for age, was 1.94 (95% CI 1.20-3.13) during the first 10 years of the follow-up period and 1.51 (1.15-1.97) during the entire 22 years; adjusting for other risk factors, the HR was 1.88 (1.08-3.30) and 1.37 (1.00-1.87) during 10 and 22 years, respectively. The corresponding HRs for cardiovascular mortality during 10 and 22 years were 2.67 (1.35-5.29) and 1.73 (1.19-2.53), respectively, for age-adjusted and 2.30 (1.03-5.12) and 1.39 (0.90-2.15), respectively, for multiple-adjusted HRs. A U-shaped association was observed between insulin and noncardiovascular mortality; multiple-adjusted HRs for lowest and highest versus middle AUC insulin quintiles were 1.85 (1.20-2.86) and 1.43 (0.91-2.24), respectively.CONCLUSIONS -Hyperinsulinemia was associated with increased all-cause and cardiovascular mortality in Helsinki policemen independent of other risk factors, although these associations weakened with the lengthening of the follow-up period. The association of insulin with noncardiovascular mortality was U-shaped.

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“…An association between elevated plasma insulin, fasting or oral glucose load, and the risk of CHD or atherosclerotic CVD has been found in many [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16] but not in all [17,18,19,20,21] prospective studies. Among the studies showing the positive association between plasma insulin and CVD, the effect of adjustment for other risk factors has varied.…”

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confidence: 99%

Plasma insulin and cardiovascular mortality in non-diabetic European men and women: a meta-analysis of data from eleven prospective studies

Nissinen¹,

Pekkanen²,

Tuomilehto³

et al. 2004

Diabetologia

137

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Aims/hypothesis. We examined the association between plasma insulin and cardiovascular mortality in non-diabetic European men and women based on data from eleven prospective studies. Methods. The study population comprised 6156 men and 5351 women aged 30-89 years. Baseline measurements included oral glucose tolerance test, fasting and 2-h plasma insulin, and conventional risk factors. Cox models were used to calculate hazard ratios (HRs) and their 95% confidence intervals, and overall HRs were assessed by meta-analyses. Results. During the 8.8-year follow-up, 362 men and 70 women died from cardiovascular disease. The ageand smoking-adjusted overall HR of cardiovascular mortality for the highest vs the lower quartiles of fasting insulin was 1.58 (95% CI: 1.26-1.97) in men and 2.64 (1.54-4.51) in women. Adjusting for other risk factors in addition, the HR was 1.54 (1.16-2.03) in men and 2.66 (1.45-4.90) in women. For 2-h insulin these HRs were 1.28 (0.99-1.66), 1.87 (0.87-4.02), and 0.85 (0.60-1.21), 1.36 (0.53-3.45). The overall HRs for interquartile ranges for fasting and 2-h insulin, with full adjustment, were 1.13 (1.05-1.22) and 1.11 (1.01-1.23) in men, and 1.25 (1.08-1.45) and 1.11 (0.91-1.36) in women. Conclusions/interpretation. Hyperinsulinaemia, defined by the highest quartile cut-off for fasting insulin, was significantly associated with cardiovascular mortality in both men and women independently of other risk factors. Associations between high 2-h insulin and cardiovascular mortality were weaker and non-significant. Weak positive associations of fasting and 2-h insulin with cardiovascular mortality over interquartile ranges were, however, more similar. Diabetologia (2004) 47:1245-1256 DOI 10.1007/s00125-004-1433 Plasma insulin and cardiovascular mortality in non-diabetic European men and women: a meta-analysis of data from eleven prospective studies The DECODE Insulin Study Group IntroductionThe role of hyperinsulinaemia as an independent risk factor for cardiovascular disease (CVD) has previously been debated. An association between elevated plasma insulin, fasting or oral glucose load, and the risk of CHD or atherosclerotic CVD has been found in many [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16] but not in all [17,18,19,20,21] prospective studies. Among the studies showing the positive association between plasma insulin and CVD, the effect of adjustment for other risk factors has varied. In several studies the association remained statistically significant, although attenuated [1,2,3,5,6,7,9,10,12,13,15,16] , whereas in other studies it became non-significant [4,8,11,14]. The majority of the published Corresponding author of the DECODE Insulin Study Group: G. Hu, Diabetes and Genetic Epidemiology Unit, Department of Epidemiology and Health Promotion, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland, Phone: +358-9-19127366, Fax: +358-9-19127313, e-mail: hu.gang@ktl.fi Members of the DECODE Insulin Study Group are listed at the end of the paper studies were carried...

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Elevated Fasting Plasma Insulin in a General Aged Population: An Innocent Companion of Cardiovascular Diseases

Abstract: Albeit fasting plasma insulin appeared to be secondarily associated with cardiovascular disease in this general aged population, it was related to a fair or favorable survival prognosis.

Cited by 19 publications

References 32 publications

Hyperinsulinemia Predicts Coronary Heart Disease Risk in Healthy Middle-aged Men

Hyperinsulinemia Predicts Coronary Heart Disease Risk in Healthy Middle-aged Men

Plasma insulin and all-cause, cardiovascular, and noncardiovascular mortality: the 22-year follow-up results of the Helsinki Policemen Study.

Plasma insulin and cardiovascular mortality in non-diabetic European men and women: a meta-analysis of data from eleven prospective studies

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