Original ArticlesEpidemiology of insulin resistance and its relation to coronary artery disease
Section snippets
Selected studies of insulin resistance and coronary artery disease risk factors
Hundreds of studies have assessed the effect of the insulin resistance syndrome on cardiovascular risk, particularly CAD. Some prospective studies examining the relation of insulin to cardiovascular disease are listed in Table I. Many of the key epidemiologic studies are cited or discussed below.
Zavaroni et al1 performed a cross-sectional study of the relation of hyperinsulinemia to CAD risk in pasta factory workers in Italy. Subjects were nondiabetic, nonobese persons who had impaired glucose
Insulin and the risk of cardiovascular disease
A recent meta-analysis of prospective population-based or nested case–control studies examined the relation between insulin and cardiovascular disease.8 Twelve of 17 studies provided sufficient information to be analyzed. The meta-analysis found that insulin was a weak but positive indicator of cardiovascular disease risk. Upon assessment of each study individually, one sees that the relation is stronger in middle-aged than in older persons. Studies in the elderly have generally yielded
Insulin resistance and diabetes
Recent data reveal that patients with type 2 diabetes mellitus have a risk of first myocardial infarction equal to that of nondiabetic individuals who have had a previous infarction.19 Diabetic patients who have had a previous infarction are at even higher risk. This equivalency of risk in nondiabetics with a history of infarction compared with diabetic patients without that history extends earlier observations of the increased risk of CAD in diabetes: Compared with the nondiabetic population,
Conclusion
Many studies have investigated the relation between cardiovascular disease and insulin resistance, hyperinsulinemia, and type 2 diabetes. It has been demonstrated that elevated insulin levels have a negative impact on both CAD risk factors and the risk of developing CAD itself. Still, it is clear that this association is complex, and the mechanistic pathways by which insulin effects these changes are still being studied. Ongoing trials need to elucidate these mechanisms, as well as determine
References (28)
- et al.
Insulin as a predictor of coronary heart diseaseinteraction with apolipoprotein E phenotype: a report from the Multiple Risk Factor Intervention Trial
Ann Epidemiol
(1994) - et al.
Insulin resistance implications for type II diabetes mellitus and coronary heart disease
Am J Med
(1997) - et al.
Risk factors for coronary artery disease in healthy persons with hyperinsulinemia and normal glucose tolerance
N Engl J Med
(1989) - et al.
Prospective analysis of the insulin-resistance syndrome (syndrome X)
Diabetes
(1992) - et al.
Risk variable clustering in the insulin resistance syndromethe Framingham Offspring Study
Diabetes
(1997) Role of insulin resistance in human disease
Diabetes
(1988)- et al.
Insulin resistance and hyperinsulinemia in individuals with small, dense, low density lipoprotein particles
J Clin Invest
(1993) Role of insulin resistance in human disease (syndrome X)an expanded definition
Annu Rev Med
(1993)- et al.
Relation between insulin resistance, hyperinsulinemia, postheparin plasma lipoprotein lipase activity, and postprandial lipemia
Arterioscler Thromb Vasc Biol
(1995) - et al.
Insulin and risk of cardiovascular diseasea meta-analysis
Circulation
(1998)