Hyperinsulinemia does not increase the risk of fatal cardiovascular disease in elderly men or women without diabetes: the Rancho Bernardo Study, 1984-1991.
The relation of fasting and 2-hour serum insulin to the risk for fatal cardiovascular disease was examined in men and women without diabetes. Between 1984 and 1987, 80% of all surviving local members of the Rancho Bernardo Study cohort had measures of insulin and glucose levels obtained before and after a 75-g oral glucose tolerance test. Over the next 5 years, there were 24 cardiovascular disease deaths among 538 men and 21 cardiovascular disease deaths among 705 women. Fasting insulin was unrelated to cardiovascular disease death in men or women; 2-hour insulin was significantly lower in men (but not in women) who died from cardiovascular disease. In men, a 1-standard deviation increase in 2-hour insulin was associated with a 36% reduction in cardiovascular disease mortality (p = 0.01). The significant inverse association of 2-hour insulin with cardiovascular disease death persisted in multiply adjusted models (relative hazard = 0.68; 95% confidence interval 0.47-0.96). Patterns were similar when the analysis was repeated, including men with non-insulin-dependent diabetes mellitus or heart disease at baseline. These findings were not explained by antihypertensive drug use or cigarette smoking. Hyperinsulinemia was not a risk factor for cardiovascular disease in these older men or women. The role of insulin as a cardiovascular disease risk factor requires further investigation.
Ferrara
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Department of Family and Preventive Medicine, University of California, San Diego, School of Medicine, La Jolla 92093-0607.
Barrett-Connor
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Edelstein
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D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality*; D015331:Cohort Studies; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D006946:Hyperinsulinism / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D012307:Risk Factors; D014481:United States / Q000453:epidemiology