Fasting hyperinsulinemia and cardiovascular disease risk factors in nondiabetic adults: Stronger associations in lean versus obese subjects

Azmi A. Nabulsi, Aaron R. Folsom, Gerardo Heiss, Samuel S. Weir, Lloyd E. Chambless, Robert L. Watson, John H. Eckfeldt, Risk in Communities Study Investigators Atherosclerosis Risk in Communities Study Investigators

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

Abstract

The association between hyperinsulinemia and atherogenic risk factors has not been well studied in blacks and may be different for obese versus lean individuals. To investigate this possibility and to confirm the associations of hyperinsulinemia with cardiovascular disease risk factors in blacks and whites, we analyzed the joint associations of fasting serum insulin and obesity with risk factors in the Atherosclerosis Risk in Communities (ARIC) Study (1,293 black men, 4,797 white men, 2,033 black women, and 5,445 white women). Insulin values ≥90th percentile (≥.21 μU/mL) constituted hyperinsulinemia; body mass index (BMI) values ≥27.3 kg/m2 for women and ≥27.8 for men constituted obesity. Participants with hyperinsulinemia in all four race-sex groups had more atherogenic levels of most risk factors studied than those with normoinsulinemia. Among black men and women, mean levels of triglycerides, low-density lipoprotein cholesterol (LDL-C), apolipoprotein (apo) B, glucose, and fibrinogen (men only) were higher in hyperinsulinemic lean participants as compared with the normoinsulinemic obese group. Furthermore, most associations between insulin level and risk factors were stronger among lean versus obese subjects. For example, among lean black men, the difference in mean triglyceride concentration between those with hyperinsulinemia and those with normoinsulinemia was 147 - 99 = 48 mg/dL; among obese black men, the difference was 155 - 121 = 34 mg/dL (P < .05 for the interaction). Generally, similar negative interactions between BMI and insulin concentration were also observed among whites. We conclude that the association between hyperinsulinemia and many atherogenic risk factors holds for both blacks and whites and is stronger among lean versus obese adults.

Original languageEnglish (US)
Pages (from-to)914-922
Number of pages9
JournalMetabolism
Volume44
Issue number7
DOIs
StatePublished - Jul 1995

Bibliographical note

Funding Information:
From the Division of Epidemiology, School of Pubfic Health, and Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN; Departments of Epidemiology and Biostatistics, School of Public Health, University of North Carolina, Chapel Hill, NC; and Division of Epidemiology, University of Mississippi Medical Center, Jackson, MS. Submitted June 7, 1994; accepted November 29, 1994. Supported by National Heart, Lung, and Blood Institute Contracts No. NO1-HC-55015, NO1-HC-55016, NO1-HC-55018, NO1-HC-55019, NO1-HC-55020, NO1-HC-55021, and NO1-HC-55022. Current address: A.A.N., Abbott Laboratories, Pharmaceutical Products Division, Epidemiology and Outcomes Research, One Abbott Park Road, D42J, AP6A-1, Abbott Park, 1L 60064-3500. Address reprint requests to Aaron R. Folsom, MD, Division of Epidemiology, School of Public Health, Universityo f Minnesota, 1300 S Second St, Suite 300, Minneapolis, MN 55454-1015. Copyright © 1995 by W.B. Saunders Company 0026-0495/95/4407-0013503.00/0

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