title: Insulin as a predictor of coronary heart disease: interaction with apolipoprotein E phenotype. A report from the Multiple Risk Factor Intervention Trial.
abstract: The objective of this study was to examine whether fasting serum insulin is a predictor of coronary heart disease in high-risk US men, and whether any such predictive role explains the enhanced cardiovascular risk seen in subjects with the apolipoprotein (Apo) E 3/2 phenotype. This was a nested case-control study of participants in the Multiple Risk Factor Intervention Trial. Ninety-four subjects who died from coronary heart disease (post-trial follow-up) and 114 case patients with myocardial infarction (during trial) were compared to control subjects (n = 414) matched (1:2) by age, center, randomization date, and intervention group. Overall, fasting serum insulin at baseline was not associated with case-control status. (Means for cases versus controls: 16.8 and 16.6 microU/mL), although serum insulin showed significant correlations with low-density-lipoprotein cholesterol, triglycerides, and uric acid. When stratified by the three Apo E phenotypes, 3/2, 3/3, 3/4, a significant association of fasting insulin with case-control status was seen for Apo E 3/2 individuals (19.9 versus 14.5 microU/mL; P = 0.02) but not for those with the other two phenotypes. Though fasting insulin is not a risk factor overall in this high-risk male population, it appears to contribute to cardiovascular risk in those with the Apo E 3/2 phenotype but does not explain the increased risk seen in these subjects. This new finding, if confirmed, may throw further light on the role of insulin in atherosclerosis.
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA.
authors.forename: T J
authors.initials: TJ
authors.lastname: Orchard
authors.forename: J
authors.initials: J
authors.lastname: Eichner
authors.forename: L H
authors.initials: LH
authors.lastname: Kuller
authors.forename: D J
authors.initials: DJ
authors.lastname: Becker
authors.forename: L M
authors.initials: LM
authors.lastname: McCallum
authors.forename: G A
authors.initials: GA
authors.lastname: Grandits
mesh_terms: D000328:Adult; D053329:Apolipoprotein E2; D053318:Apolipoprotein E3; D053327:Apolipoprotein E4; D001057:Apolipoproteins E / Q000032:analysis* / Q000235:genetics; D016022:Case-Control Studies; D008078:Cholesterol, LDL / Q000097:blood; D003327:Coronary Disease / Q000097:blood* / Q000235:genetics / Q000401:mortality*; D005215:Fasting; D006801:Humans; D007328:Insulin / Q000097:blood*; D016015:Logistic Models; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000235:genetics / Q000401:mortality*; D010641:Phenotype; D011237:Predictive Value of Tests; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood
chemical_list: D053329:Apolipoprotein E2; D053318:Apolipoprotein E3; D053327:Apolipoprotein E4; D001057:Apolipoproteins E; D008078:Cholesterol, LDL; D007328:Insulin; D014280:Triglycerides