Hyperinsulinemia as an independent risk factor for ischemic heart disease
Open accessAbstract
BACKGROUND: Prospective studies suggest that hyperinsulinemia may be an important risk factor for ischemic heart disease. However, it has not been determined whether plasma insulin levels are independently related to ischemic heart disease after adjustment for other risk factors, including plasma lipoprotein levels. METHODS: In 1985 we collected blood samples from 2103 men from suburbs of Quebec City, Canada, who were 45 to 76 years of age and who did not have ischemic heart disease. A first ischemic event (angina pectoris, acute myocardial infarction or death from coronary heart disease) occurred in 114 men (case patients) between 1985 and 1990. Each case patient was matched for age, body-mass index, smoking habits, and alcohol consumption with a control selected from among the 1989 men who remained free of ischemic heart disease during follow-up. After excluding men with diabetes, we compared fasting plasma insulin and lipoprotein concentrations at base line in 91 case patients and 105 controls. RESULTS: Fasting insulin concentrations at base line were 18 percent higher in the case patients than in the controls (P<0.001). Logistic-regression analysis showed that the insulin concentration remained associated with ischemic heart disease (odds ratio for ischemic heart disease with each increase of 1 SD in the insulin concentration, 1.7; 95 percent confidence interval, 1.3 to 2.4) after adjustment for systolic blood pressure, use of medications, and family history of ischemic heart disease. Further adjustment by multivariate analysis for plasma triglyceride, apolipoprotein B, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol concentrations did not significantly diminish the association between the insulin concentration and the risk of ischemic heart disease (odds ratio, 1.6; 95 percent confidence interval, 1.1 to 2.3). CONCLUSIONS: High fasting insulin concentrations appear to be an independent predictor of ischemic heart disease in men.
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Population studies have shown that fasting insulin concentration predicts future risk of ischemic heart disease events.
“Population studies have shown that fasting insulin concentration predicts future risk of ischemic heart disease events (507).”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [507]
Earlier studies may not have controlled well for undiagnosed diabetes, glycemic measures, BMI, or other confounders.
“Earlier studies may not have controlled well for undiagnosed diabetes, glycemic measures, BMI, or other confounders (507).”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [507]
The Discussion (page unavailable) says previous prospective studies did not identify insulin as an independent predictor after adjustment for other risk factors, but it does not say their control of confounding was inadequate. Matching Procedures describes this study’s matching on BMI and exclusion of men with reported diabetes; no passage found assesses earlier studies’ handling of undiagnosed diabetes, glycemic measures, BMI, or other confounders. (LLM, conf=0.75)
Experimental — accuracy not yet measuredPublished evidence reveals that increased concentrations of insulin and/or proinsulin in nondiabetic individuals predict the development of coronary artery disease.
“In particular, published evidence reveals that increased concentrations of insulin and/or proinsulin in nondiabetic individuals predict the development of coronary artery disease (362).”
From Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus (2011) · cites this paper as [362]
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- Authors
- Després, J.-P., Lamarche, B., Mauriège, P., Cantin, B., Dagenais, G. R., Moorjani, S., & Lupien, P.-J.
- Affiliations
- Université Laval (CA)
- Université de Montréal (CA)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1996-04-11
- Volume
- 334
- Issue
- 15
- Pages
- 952-958
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2337133379
- Cited by
- 1,699
- References
- 37
- Citations by year
- 2026: 8 · 2025: 15 · 2024: 14 · 2023: 22 · 2022: 16 · 2021: 24 · 2020: 32 · 2019: 24 · 2018: 20 · 2017: 25 · 2016: 24 · 2015: 33 · 2014: 35 · 2013: 45 · 2012: 40
- FWCI
- 70.53
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Heart and Stroke Foundation of Canada
- Medical Research Council Canada
- Medical Research Council
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Keywords
- hyperinsulinemia, fasting insulin, ischemic heart disease, coronary heart disease risk, lipoproteins, apolipoprotein B, LDL cholesterol, HDL cholesterol, triglycerides, men, independent risk factor
- MeSH terms
- Aged, Apolipoproteins B, Cholesterol, Humans, Insulin, Male, Middle Aged, Risk Factors, Triglycerides, Cohort Studies, Logistic Models, Odds Ratio, Case-Control Studies, Myocardial Ischemia
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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