Wanted!: A standardized measurement of plasma insulin concentration

The notion that insulin resistance is associated with a cluster of abnormalities that increase risk of coronary heart disease (CHD) was introduced in 1988,1 and this view continues to gain traction. The study by Robins et al2 provides additional support for the link between insulin resistance and CHD, but it also emphasizes that a good deal remains to be learned about this relationship. For example, because high triglyceride (TG) and low high-density lipoprotein cholesterol (HDL-C) concentrations are associated with insulin resistance,3 as well as being CHD risk factors, it might have been assumed that this dyslipidemia is the link between insulin resistance and CHD. Although these lipid changes may well contribute to this relationship, Robins et al2 demonstrate that the incidence of CHD was significantly increased in insulin-resistant individuals, whether or not their TG concentrations were higher or their HDL-C concentrations lower than the median value in the population studied. See accompanying article on page 1208 Given the apparent importance of insulin resistance as a CHD risk factor, as well as the emerging role it seems to play in the pathogenesis of a number of clinical syndromes,4 it would seem useful to identify insulin-resistant individuals before they \ldots