Date: 28 Sep 2012
Insulin and cardiovascular disease: biomarker or association?
In the 1980s prospective studies using whole populations suggested a relationship between insulin and cardiovascular disease, and these studies proposed that both metabolic and haemodynamic factors were associated with cardiovascular events. The initial analysis of the Paris Prospective Study (Diabetologia 19: 205–210), published in 1980, showed a positive correlation between insulin and cardiovascular events in healthy middle-aged policemen after a 5 year follow-up. In the Bedford Survey (Diabetologia 22: 79–84), also performed in the 1980s, a higher cardiovascular risk was demonstrated in diabetic patients and in those with borderline diabetes; however, in contrast to the Paris Prospective Study, insulin was negatively correlated to cardiovascular endpoints in the Bedford Survey. The initial enthusiasm for insulin as a cardiovascular risk marker was dampened when the 15 year follow-up data of the Paris Prospective Study (Diabetologia 34: 356–361) showed that the correlation between insulin and cardiovascular risk subsided with increased duration of follow-up. Despite the fact that hyperinsulinaemia was always strongly associated with other classical cardiovascular risk factors, univariate analyses usually failed to show a strong correlation between insulin and cardiovascular risk. The San Antonio Heart Study (Diabetologia 34: 416–422) performed in a bi-ethnic population that included a large proportion of Mexican-American participants again emphasised that insulin resistance may be the underlying factor associated with a cluster of metabolic and haemodynamic abnormalities. However, recently performed meta-analyses that included larger studies have not been able to confirm a critical role for insulin levels in cardiovascular risk. Indeed, it has been suggested that proinsulin or other factors may be better markers than insulin per se.
Jarrett RJ, McCartney P, Keen H (1982) The Bedford Survey: ten year mortality rates in newly diagnosed diabetics, borderline diabetics and normoglycaemic controls and risk indices for coronary heart disease in borderline diabetics. Diabetologia 22:79–84PubMed
Pyorala K, Savolainen E, Kaukola S, Haapakoski J (1985) Plasma insulin as coronary heart disease risk factor: relationship to other risk factors and predictive value during 9 1/2-year follow-up of the Helsinki Policemen Study population. Acta Med Scand Suppl 701:38–52PubMed
Stout RW (1973) The role of insulin in the development of atherosclerosis. Adv Metab Disord 2(Suppl 2):41–47PubMed
Stout RW (1981) The role of insulin in atherosclerosis in diabetics and nondiabetics: a review. Diabetes 30:54–57PubMed
O’Hare JP (1920) Glucose tolerance in chonic vascular hypertension. Am J Med 160:366–369CrossRef
Major SG (1929) Blood pressure in diabetes mellitus: a statistical study. Arch Int Med 44:797–812CrossRef
Gordon T, Castelli WP, Hjortland MC, Kannel WB, Dawber TR (1977) Diabetes, blood lipids, and the role of obesity in coronary heart disease risk for women. The Framingham study. Ann Intern Med 87:393–397PubMed
Welin L, Eriksson H, Larsson B, Ohlson LO, Svardsudd K, Tibblin G (1992) Hyperinsulinaemia is not a major coronary risk factor in elderly men. The study of men born in 1913. Diabetologia 35:766–770PubMed
Hu G, Qiao Q, Tuomilehto J, Eliasson M, Feskens EJ, Pyorala K (2004) Plasma insulin and cardiovascular mortality in non-diabetic European men and women: a meta-analysis of data from eleven prospective studies. Diabetologia 47:1245–1256PubMed
Mykkanen L, Laakso M, Pyorala K (1993) High plasma insulin level associated with coronary heart disease in the elderly. Am J Epidemiol 137:1190–1202PubMed
- Insulin and cardiovascular disease: biomarker or association?
Volume 55, Issue 12 , pp 3145-3151
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Cardiovascular disease
- Insulin resistance
- Risk factors
- Industry Sectors