Circulation, Vol 84, 1165-1175, Copyright © 1991 by American Heart Association
M Modan, J Or, A Karasik, Y Drory, Z Fuchs, A Lusky, A Chetrit and H Halkin
BACKGROUND. The possibility that hyperinsulinemia may be involved in the
etiology of atherosclerotic cardiovascular disease (CVD) was first
suggested 20 years ago. During the last decade, this possibility has
received support from three large prospective studies. METHODS AND RESULTS.
In the present study, the association between CVD, glucose intolerance,
obesity, and hypertension (the GOH conditions) and hyperinsulinemia was
examined cross-sectionally in a representative sample (n = 1,263) of the
adult Jewish population aged 40-70 years in Israel. Previously known
diabetics were excluded. CVD comprising clinical or ECG evidence of
ischemic heart disease, as well as clinical evidence of cerebrovascular or
peripheral vascular disease, was identified in 97 men and 39 women. A
significant (p less than 0.01) hyperinsulinemia-sex interaction was found
for CVD rate, with the adjusted risk ratios (followed by 95% confidence
limits), relative to the rate in 298 normoinsulinemic women, being 1.15
(0.68-1.95) in 328 normoinsulinemic men, 0.85 (0.48-1.49) in 277
hyperinsulinemic women, and 2.27 (1.33-3.08) in 360 hyperinsulinemic men.
Age-adjusted CVD rates in men versus women were: a) similar and low among
all normoinsulinemic normotensives and hyperinsulinemics free of any of the
GOH conditions (all rates less than or equal to 6.5%); b) similar and high
among normoinsulinemic hypertensives (13.4% versus 10.4%); c) significantly
higher in men among hyperinsulinemic normotensives with glucose intolerance
and/or obesity (15.2% versus 3.3%; p = 0.02) and all hyperinsulinemic
hypertensives (21.5% versus 12.8%; p = 0.04). These trends remained
significant after adjusting for age, ethnic group, and blood lipids.
CONCLUSIONS. Therefore, hyperinsulinemia was associated with excess CVD
risk in men but not in women, and all excess CVD risk in men was confined
to hyperinsulinemic individuals in the presence of glucose intolerance,
obesity, or hypertension.
ARTICLES
Hyperinsulinemia, sex, and risk of atherosclerotic cardiovascular disease
Department of Clinical Epidemiology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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