title: Demographic and cardiovascular risk factors modify association of fasting insulin with incident coronary heart disease and ischemic stroke (from the Atherosclerosis Risk In Communities Study).
abstract: Previous studies have reported an association between circulating insulin and incident cardiovascular disease, but limited knowledge is available on the association across subgroups. We examined the associations of fasting insulin with incident coronary heart disease (CHD) and ischemic stroke in multiple subgroups of a biracial, middle-age cohort. A total of 12,323 subjects were included in the analysis. The incidence of CHD (n = 960) and ischemic stroke (n = 445) through 2005 was determined through annual interviews, repeat examinations, and community surveillance. Serum insulin was measured at baseline. Cox regression analysis was used to estimate the hazard ratios by quintile of fasting insulin at baseline and to determine the significance of effect modification. In the minimally adjusted models (age, gender, race, and field center), the baseline fasting insulin quintile was positively associated with both incident CHD (hazard ratio per quintile insulin = 1.12, p-trend <0.0001) and ischemic stroke (hazard ratio per quintile insulin = 1.11, p = 0.0018). The adjustment for high-density lipoprotein completely attenuated the association of insulin with CHD but not with stroke. The associations of insulin with CHD were stronger in nonsmokers (p-interaction = 0.018) and in those without hypertension (p-interaction = 0.0087). The associations of insulin with stroke were stronger in women (p-interaction = 0.037), whites (compared to blacks; p-interaction = 0.036), and those without hypertension (p-interaction = 0.0027).
authors.affiliation: Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA. rasm0218@umn.edu
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Rasmussen-Torvik
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yatsuya
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Selvin
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Folsom
mesh_terms: D017677:Age Distribution; D044383:Black People / Q000706:statistics & numerical data; D001786:Blood Glucose / Q000032:analysis; D015331:Cohort Studies; D016001:Confidence Intervals; D003327:Coronary Disease / Q000097:blood* / Q000453:epidemiology*; D005215:Fasting; D005260:Female; D006801:Humans; D015994:Incidence; D007328:Insulin / Q000097:blood* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D017678:Sex Distribution; D020521:Stroke / Q000097:blood* / Q000453:epidemiology*; D014481:United States; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American
chemical_list: D001786:Blood Glucose; D007328:Insulin
references.citation: Am J Epidemiol. 1989 Apr;129(4):687-702
references.pmid: 2646917
references.citation: Stroke. 1999 Apr;30(4):736-43
references.pmid: 10187871
references.citation: Arch Intern Med. 2000 Apr 24;160(8):1160-8
references.pmid: 10789610
references.citation: Am J Cardiol. 1995 Jun 15;75(17):1233-8
references.pmid: 7778546
references.citation: Clin Chem. 1972 Jun;18(6):499-502
references.pmid: 4337382
references.citation: Int J Cardiol. 2006 Apr 4;108(2):189-96
references.pmid: 15925416
references.citation: J Intern Med. 2003 Feb;253(2):136-45
references.pmid: 12542553
references.citation: Clin Chem. 1983 Jun;29(6):1075-80
references.pmid: 6851096
references.citation: Stroke. 1994 Jun;25(6):1157-64
references.pmid: 8202973
references.citation: PLoS Med. 2007 Aug;4(8):e263
references.pmid: 17760500
references.citation: J Clin Epidemiol. 1996 Feb;49(2):223-33
references.pmid: 8606324
references.citation: Eur Heart J. 2007 Oct;28(20):2491-7
references.pmid: 17513304
references.citation: Diabetes Care. 1997 Jun;20(6):935-42
references.pmid: 9167103
references.citation: Stroke. 1998 Sep;29(9):1860-6
references.pmid: 9731609
references.citation: Arterioscler Thromb Vasc Biol. 1998 Mar;18(3):450-7
references.pmid: 9514414
references.citation: Arch Pathol Lab Med. 1994 May;118(5):496-500
references.pmid: 8192558
references.citation: J Clin Epidemiol. 2003 Sep;56(9):880-90
references.pmid: 14505774
references.citation: Diabetes Res Clin Pract. 2001 Mar;51(3):215-23
references.pmid: 11269894
references.citation: J Clin Chem Clin Biochem. 1984 Feb;22(2):165-74
references.pmid: 6716056
references.citation: Clin Chem. 1982 Jun;28(6):1379-88
references.pmid: 7074948
references.citation: Am J Epidemiol. 2004 Aug 1;160(3):259-69
references.pmid: 15257999
references.citation: Diabetes Care. 1999 Jul;22(7):1077-83
references.pmid: 10388971