Hyperinsulinemia as an Independent Risk Factor for Ischemic Heart Disease

Background. Prospective studies suggest that hyperinsulinemia may be an important risk factor for ischemic heart disease. However, it has not been deter- mined 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 consump- tion with a control selected from among the 1989 men who remained free of ischemic heart disease during fol- low-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 con- trols (P ? 0.001). Logistic-regression analysis showed that the insulin concentration remained associated with ische- mic 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 ad- justment for systolic blood pressure, use of medications, and family history of ischemic heart disease. Further ad- justment 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 ap- pear to be an independent predictor of ischemic heart disease in men. (N Engl J Med 1996;334:952-7.)