Aging Clinical and Experimental Research

, Volume 10, Issue 2, pp 137–140 | Cite as

Inverse association of serum cholesterol with plasma insulin in the elderly. Cross-sectional and prospective analyses

  • O. Lindberg
  • R. S. Tilvis
  • T. E. Strandberg
  • A. Lehtonen
  • C. Ehnholm
  • J. Tuomilehto
Original Article


Cross-sectional studies have suggested that high plasma insulin is associated with relatively low levels of low density lipoprotein (LDL)-cholesterol. The present study was aimed at re-testing this association in a 70-year-old age cohort (N=1023), and testing whether it could be caused by excessive mortality of hyperinsulinemic subjects with high LDL-cholesterol. A reverse U-shaped association between LDL-cholesterol and fasting plasma insulin was confirmed. LDL-cholesterol, HDL-cholesterol and total cholesterol were lowest in the highest insulin quarter. These associations remained after adjustment for diabetes, obesity and general health status. The combination of high LDL-cholesterol (>4.25 mmol/L, 75th percentile) and high insulin (>10 IU/L, 50th percentile) was not associated with excess 5-year mortality in this age cohort. Nor was it associated with excess mortality in four other elderly age cohorts (N=1188), in which similar associations of cholesterol and insulin have been demonstrated. Thus, the inverse association of LDL-cholesterol with fasting insulin in the elderly is not caused by selective over mortality.

Key words

Cholesterol elderly insulin lipids mortality risk factors 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Després J.P., Lamarche B., Mauriege P., Cantin B., Dagenais G.R., Moorjani S., Lupien P.J.: Hyperinsulinemia as an independent risk factor for ischemic heart disease. N. Engl. J. Med. 334: 952–957, 1996.PubMedCrossRefGoogle Scholar
  2. 2.
    Wingard D.L., Ferrara A., Barrett-Connor E.L.: Is insulin really a heart disease risk factor? Diabetes Care 18: 1299–1304, 1995.PubMedGoogle Scholar
  3. 3.
    Jarrett R.J.: Why is insulin not a risk factor for coronary heart disease. Diabetologia 37: 945–947, 1994.PubMedCrossRefGoogle Scholar
  4. 4.
    Strandberg T.E., Tilvis R.S., Lindberg O., Valvanne J., Sairanen S., Ehnholm C., Tuomilehto J.: High plasma insulin associates with lower LDL cholesterol in elderly individuals. Atherosclerosis 121: 267–273, 1996.PubMedCrossRefGoogle Scholar
  5. 5.
    Calori G., Garancini P., Ruotolo G., Ragogna F., Ruggeri P., Gallus G.: Relationship between insulinemia and LDL cholesterol in nondiabetic subjects: The Cremona population study. Diabetologia 38 (Suppl. 1): A248, 1995 (Abstract).Google Scholar
  6. 6.
    Friedewald W.T., Levy R.I., Fredrickson D.S.: Estimation of the concentration of low density lipoprotein cholesterol in plasma without use of the preparative ultracentrifuge. Clin. Chem. 18: 499, 1972.PubMedGoogle Scholar
  7. 7.
    Dixon W.J.: BMDP statistical software manual, Vol. I–II. University of California Press, Los Angeles, 1992.Google Scholar
  8. 8.
    Lindberg O., Iivanainen A., Strandberg T., Valvanne J., Tilvis R.: Low cholesterol, morbidity and mortality in the elderly: Experience from the Helsinki Ageing Study. Cardiovasc. Risk 5: 167–172, 1995.Google Scholar
  9. 9.
    Lindberg O., Tilvis R.S., Strandberg T.E., Valvanne J., Sairanen S., Ehnholm C., Tuomilehto J.: Elevated fasting plasma insulin in a general aged population: an innocent companion of cardiovascular diseases. J. Am. Geriatr. Soc. 45: 407–412, 1997.PubMedGoogle Scholar
  10. 10.
    Manolio T.A., Ettinger W.H., Tracy R.P., Kuller L.H., Borhani N.O., Lynch J.C., Fried L.P.: Epidemiology of low cholesterol levels in older adults: the Cardiovascular Health Study. Circulation 87: 728–737, 1993.PubMedCrossRefGoogle Scholar
  11. 11.
    Bosner M.S., Stenson W., Turnbough P., Block S., Kobayashi L., Schweitzer A., Ostlund R.E.: Percent cholesterol absorption in normal human subjects by negative ion gas chromatography mass spectrometry. J. Am. Coll. Card. 27: 413A, 1996.CrossRefGoogle Scholar
  12. 12.
    Gylling H., Miettinen T.A.: Cholesterol absorption, synthesis and LDL-metabolism in NIDDM. Diabetes Care 20: 90–95, 1997.PubMedCrossRefGoogle Scholar
  13. 13.
    Strandberg T.E., Salomaa V., Vanhanen H., Miettinen T.A.: Associations of fasting blood glucose with cholesterol absorption and synthesis in nondiabetic middle-aged men. Diabetes 45: 755–761, 1996.CrossRefGoogle Scholar
  14. 14.
    Chait A., Bierman E.L., Albers J.J.: Low density lipoprotein receptor activity in cultured fibroblasts. J. Clin. Invest. 64: 1309–1319, 1979.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Chait A., Bierman E.L., Albers J.J.: The regulatory role of insulin in the degradation of low density lipoprotein by cultured human fibroblasts. Biochim. Biophys. Acta 529: 292–299, 1978.PubMedCrossRefGoogle Scholar
  16. 16.
    Mazzone T., Foster D., Chait A.: In vivo stimulation of low-density lipoprotein degradation by insulin. Diabetes 33: 333–338, 1984.PubMedCrossRefGoogle Scholar
  17. 17.
    Selby J.V., Austin M.A., Newman B., Zhang D., Quesenberry C.P. Jr., Mayer E.J., Krauss R.M.: LDL subclass phenotypes and the insulin resistance syndrome in women. Circulation 88: 381–387, 1993.PubMedCrossRefGoogle Scholar
  18. 18.
    Reaven G.M., Chen Y-D.I., Jeppesen J., Krauss R.M.: Insulin resistance and hyperinsulinemia in individuals with small, dense, low density lipoprotein particles. J. Clin. Invest. 92: 141–146, 1993.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Lamarche B., Tchernof A., Moorjani S., Cantin B., Dagenais G., Lupien P.J., Després J.P.: Small, dense low-density lipoprotein particles as a predictor of the risk of ischemic heart disease in men. Circulation 95: 69–75, 1997.PubMedCrossRefGoogle Scholar
  20. 20.
    McKeigue P., Davey G.: Associations between insulin levels and cardiovascular disease are confounded by comorbidity. Diabetes Care 18: 1294–1298, 1995.PubMedGoogle Scholar

Copyright information

© Springer Internal Publishing Switzerland 1998

Authors and Affiliations

  • O. Lindberg
    • 1
  • R. S. Tilvis
    • 1
  • T. E. Strandberg
    • 1
  • A. Lehtonen
    • 2
  • C. Ehnholm
    • 3
  • J. Tuomilehto
    • 3
  1. 1.Division of Geriatrics, Department of MedicineUniversity of HelsinkiHelsinkiFinland
  2. 2.Turku City HospitalTurkuFinland
  3. 3.National Public Health InstituteHelsinkiFinland

Personalised recommendations