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(Circulation. 1999;100:e118.)
© 1999 American Heart Association, Inc.

Circulation Electronic Pages

Hyperinsulinemia Predicts Coronary Heart Disease Risk in Healthy Middle-Aged Men

Nóra Hosszúfalusi, MD, PhD; Pál Pánczél, MD, PhD; Lívia Jánoskuti, MD, PhD

3rd Department of Medicine, Semmelweis University of Medicine, Budapest, Hungary

	Introduction

 
To the Editor:

In a recent article, Pyörälä et al¹ have stated that hyperinsulinemia/area under the plasma insulin response curve (AUC insulin) during an oral glucose tolerance test (OGTT) was a statistically significant predictor of coronary heart disease (CHD) risk over the 22-year follow-up in the Helsinki Policemen Study. In addition, the authors had another interesting observation that AUC glucose also predicted CHD risk in the first 5 years of follow-up. However, subjects with diabetes mellitus were excluded, and it would seem that subjects with impaired glucose tolerance (IGT) might have been involved in the study. Besides plasma cholesterol level, AUC glucose was the only significant independent predictor of CHD risk during this period.

To assess major risk factors and to provide secondary prevention for patients with recent myocardial infarction, we performed OGTTs in 28 patients free of diabetes who had a fasting plasma glucose level <6.1 mmol/L (23 males, 5 females). Thirteen patients had IGT based on the 2-hour postload glucose level (7.8 mmol/L). Fifteen patients had normal glucose tolerance (NGT) according to World Health Organization and American Diabetes Association criteria.^{2 3} We also performed OGTTs in 14 age- and body mass index–matched control subjects free of CHD and diabetes who had a fasting plasma glucose level <6.1 mmol/L. None of these control subjects had IGT. AUC glucose was higher in the patients with CHD and NGT than in controls (15.9±2.9 versus 13.2±2.1 mmol · L^-1 · h^-1, P=0.013). Fasting plasma glucose level was also higher within . . . [Full Text of this Article]

Marja Pyörälä, MD; Heikki Miettinen, MD; Markku Laakso, MD; Kalevi Pyörälä, MD

Department of Medicine, University of Kuopio, Kuopio, Finland