title: Hyperinsulinemia is a predictor of new cardiovascular events in Colombian patients with a first myocardial infarction.
abstract: BACKGROUND
  Acute Myocardial Infarction (AMI) is one of the main causes of mortality and disability in Colombia. The factors associated to a new event in surviving subjects to a first AMI in our population have not yet been fully identified.
  
  
  METHODS
  Two hundred and ninety five surviving subjects to a first AMI (58.8±12.6 years) were included in a prospective cohort study between 2000 and 2006. Lipid profile, glycemia and plasma insulin levels were measured. Deaths of cardiovascular origin, a new AMI, unstable angina, heart failure, stroke, new myocardial revascularization or angioplasty were considered new cardiovascular events.
  
  
  RESULTS
  The study included 61 (20.6%) women and 234 (79.4%) men. The mean follow up time was 50±30 months with a 38.9% incidence of new events. Fifty five patients (18.6%) were diabetic. Bi-varied analysis identified as risk factors for a new cardiovascular event the presence of: hypertension, anterior descending coronary artery stenosis, intrahospital cardiac failure, age over 55, low income, lack of education, Killip III-IV, heart rate over 76 bpm, pulse pressure over 80 mmHg, total cholesterol over 200 mg/dl and insulin over 10 IU/ml. After logistic regression analysis, the log values of insulin remained as the only significant predictor for new cardiovascular events.
  
  
  CONCLUSIONS
  Hyperinsulinism was the most important factor associated to the occurrence of new cardiovascular events in Colombian patients with AMI, which emphasizes the pivotal role of insulin resistance in the physiopathologic mechanisms of atherosclerosis, especially in undeveloped countries.
authors.affiliation: VILANO Group and Cardiology Group. Research Institute, Fundación Cardiovascular de Colombia, Floridablanca, Colombia.
authors.forename: Ronald G
authors.initials: RG
authors.lastname: García
authors.forename: Melvin Y
authors.initials: MY
authors.lastname: Rincón
authors.forename: William D
authors.initials: WD
authors.lastname: Arenas
authors.forename: Sandra Y
authors.initials: SY
authors.lastname: Silva
authors.forename: Laura M
authors.initials: LM
authors.lastname: Reyes
authors.forename: Silvia L
authors.initials: SL
authors.lastname: Ruiz
authors.forename: Fabián
authors.initials: F
authors.lastname: Ramirez
authors.forename: Paul A
authors.initials: PA
authors.lastname: Camacho
authors.forename: Carlos
authors.initials: C
authors.lastname: Luengas
authors.forename: José F
authors.initials: JF
authors.lastname: Saaibi
authors.forename: Sebastián
authors.initials: S
authors.lastname: Balestrini
authors.forename: Carlos
authors.initials: C
authors.lastname: Morillo
authors.forename: Patricio
authors.initials: P
authors.lastname: López-Jaramillo
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D003105:Colombia / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006946:Hyperinsulinism / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors