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Previous Volume 334:952-958 April 11, 1996 Number 15 Next

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ABSTRACT

Background Prospective studies suggest that hyperinsulinemia may be an important risk factor for ischemic heart disease. However, it has not been determined whether plasma insulin levels are independently related to ischemic heart disease after adjustment for other risk factors, including plasma lipoprotein levels.

Methods In 1985 we collected blood samples from 2103 men from suburbs of Quebec City, Canada, who were 45 to 76 years of age and who did not have ischemic heart disease. A first ischemic event (angina pectoris, acute myocardial infarction, or death from coronary heart disease) occurred in 114 men (case patients) between 1985 and 1990. Each case patient was matched for age, body-mass index, smoking habits, and alcohol consumption with a control selected from among the 1989 men who remained free of ischemic heart disease during follow-up. After excluding men with diabetes, we compared fasting plasma insulin and lipoprotein concentrations at base line in 91 case patients and 105 controls.

Results Fasting insulin concentrations at base line were 18 percent higher in the case patients than in the controls (P<0.001). Logistic-regression analysis showed that the insulin concentration remained associated with ischemic heart disease (odds ratio for ischemic heart disease with each increase of 1 SD in the insulin concentration, 1.7; 95 percent confidence interval, 1.3 to 2.4) after adjustment for systolic blood pressure, use of medications, and family history of ischemic heart disease. Further adjustment by multivariate analysis for plasma triglyceride, apolipoprotein B, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol concentrations did not significantly diminish the association between the insulin concentration and the risk of ischemic heart disease (odds ratio, 1.6; 95 percent confidence interval, 1.1 to 2.3).

Conclusions High fasting insulin concentrations appear to be an independent predictor of ischemic heart disease in men.

Source Information

From the Lipid Research Center, Laval University Hospital Research Center, Quebec (J.-P.D., B.L., P.M., B.C., S.M., P.-J.L.); and the Department of Medicine, University of Montreal, Montreal (G.R.D.) — both in Canada.

Address reprint requests to Dr. Després at the Lipid Research Center, CHUL Research Center, 2705 Laurier Blvd., Ste.-Foy, QC G1V 4G2, Canada.

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Hyperinsulinemia and the Risk of Coronary Heart Disease
Davidson F., Lakka T. A., Lakka H.-M., Salonen J. T., Després J.-P., Lamarche B., Dagenais G. R.
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N Engl J Med 1996; 335:976-977, Sep 26, 1996. Correspondence

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