title: Fasting insulin concentrations and coronary heart disease incidence in France and Northern Ireland: the PRIME Study.
abstract: BACKGROUND
  Reports about the relationships between insulin concentrations and CHD risk are controversial. The objective of this survey was to study the association between insulin levels and CHD risk in middle-aged male participants of the PRIME Study after 5 years of follow-up.
  
  
  METHODS
  Our study adopted a nested case-control design including 294 cases of CHD and 536 controls randomly selected among healthy participants from the PRIME cohort. Data were obtained by questionnaires (medical history, lifestyle), standardised clinical measurements (blood pressure, anthropometric measurements), and a blood sample was obtained for biological measurements. Odds-Ratios for associations of four ordered classes of insulin concentration with CHD risk after adjustment for confounding factors were estimated using conditional logistic regression.
  
  
  RESULTS
  In Belfast, a significant trend (p<0.03) was observed between insulin classes and CHD risk in bivariate analyses, but this association lost its significance after multiple adjustments. In the French centres, a high risk of CHD (OR=3.24 [1.80-5.85], p<0.0001) was observed only for the second class of insulin concentration (6.5 to 9.9 mIU/l), compared with the reference class (<6.5 mIU/l). After multiple adjustments, this association remained highly significant (OR=2.92 [1.44-5.92], p<0.005).
  
  
  CONCLUSIONS
  In Belfast (high-risk population), a significant trend was observed between insulin concentration classes and CHD risk but hyperinsulinaemia lost its association with CHD risk in multivariate analyses. In the French centres (lower risk population), slightly increased insulin concentrations were associated with a high risk of CHD, independently of cardiovascular risk factors and other features of the metabolic syndrome, but very high insulin concentrations were not.
authors.affiliation: INSERM U 558, Department of Epidemiology, Faculty of Medicine, Toulouse, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Bataille
authors.forename: Bertrand
authors.initials: B
authors.lastname: Perret
authors.forename: Judith
authors.initials: J
authors.lastname: Troughton
authors.forename: Philippe
authors.initials: P
authors.lastname: Amouyel
authors.forename: Dominique
authors.initials: D
authors.lastname: Arveiler
authors.forename: Jayne
authors.initials: J
authors.lastname: Woodside
authors.forename: Jean
authors.initials: J
authors.lastname: Dallongeville
authors.forename: Bernadette
authors.initials: B
authors.lastname: Haas
authors.forename: Annie
authors.initials: A
authors.lastname: Bingham
authors.forename: Pierre
authors.initials: P
authors.lastname: Ducimetière
authors.forename: Jean
authors.initials: J
authors.lastname: Ferrières
mesh_terms: D016022:Case-Control Studies; D015986:Confounding Factors, Epidemiologic; D003327:Coronary Disease / Q000097:blood* / Q000453:epidemiology*; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007328:Insulin / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009660:Northern Ireland / Q000453:epidemiology; D012307:Risk Factors
chemical_list: D007328:Insulin