From the Institutes for Research in Extramural Medicine and
Endocrinology, Reproduction, and Metabolism, and the Department of
Epidemiology and Biostatistics, Vrije Universiteit, Amsterdam, Netherlands.
Correspondence to Johannes Ruige, Institute for Research in Extramural Medicine, Vrije Universiteit, Van der Boechorststr 7, 1081 BT, Amsterdam, The Netherlands. E-mail jb.ruige.emgo{at}med.vu.nl
Background—Our purposes were to
estimate the strength of the longitudinal relationship between
hyperinsulinemia and cardiovascular
diseases (CVD) from the available literature and to identify study
characteristics that modify this relationship.
Methods and Results—Articles were identified by means of a
MEDLINE and Embase search and citation tracking. Eligible studies were
prospective population-based cohort studies and nested case-control
studies on the relationship between, on the one hand, fasting or
nonfasting insulin levels and, on the other hand, myocardial
infarction, death from coronary heart disease, and/or ECG
abnormalities. Data were extracted pertaining to insulin measurements,
type of outcome studied, adjustment for confounding, sex, mean age of
the study population, follow-up period, insulin assay, and ethnic
background (white or nonwhite). Associations of insulin and CVD were
reexpressed in a uniform manner, an estimate of relative risk (RR) and
95% CI, to be used in meta–regression analyses. Twelve of 17
potentially eligible articles provided sufficient information. Overall,
a weak positive association was found. The meta-analysis
resulted in an estimated summary RR (95% CI) of 1.18 (1.08 to 1.29)
for differences in insulin level, equivalent to the difference between
the 75th and the 25th percentiles of the general population in the
Netherlands. Ethnic background and type of insulin assay modified the
relationship between insulin and CVD with borderline significance.
Conclusions—Hyperinsulinemia is a weak risk
indicator for the occurrence of CVD. The relationship between
hyperinsulinemia and CVD was modified by ethnic
background and by the type of insulin assay involved.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Insulin and Risk of Cardiovascular Disease
A Meta-Analysis
Key Words: insulin • cardiovascular diseases • follow-up studies • meta-analysis • epidemiology
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