Insulin as a predictor of coronary heart disease: Interaction with apolipoprotein E phenotype A report from the multiple risk factor intervention trial

Trevor J. Orchard, June Eichner, Lewis H. Kuller, Dorothy J. Becker, Lisa M. McCallum, Gregory A. Grandits

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108 Scopus citations

Abstract

The objective of this study was to examine whether fasting serum insulin is a predictor of coronary heart disease in high-risk US men, and whether any such predictive role explains the enhanced cardiovascular risk seen in subjects with the apolipoprotein (Apo) E 3 2 phenotype. This was a nested case-control study of participants in the Multiple Risk Factor Intervention Trial. Ninety-four subjects who died from coronary heart disease (post-trial follow-up) and 114 case patients with myocardial infarction (during trial) were compared to control subjects (n = 414) matched (1 : 2) by age, center, randomization date, and intervention group. Overall, fasting serum insulin at baseline was not associated with case-control status. (Means for cases versus controls: 16.8 and 16.6 μU/mL), although serum insulin showed significant correlations with low-density-lipoprotein cholesterol, triglycerides, and uric acid. When stratified by the three Apo E phenotypes, 3 2, 3 3, 3 4, a significant association of fasting insulin with case-control status was seen for Apo E 3 2 individuals (19.9 versus 14.5 μU/mL; P = 0.02) but not for those with the other two phenotypes. Though fasting insulin is not a risk factor overall in this high-risk male population, it appears to contribute to cardiovascular risk in those with the Apo E 3 2 phenotype but does not explain the increased risk seen in these subjects. This new finding, if confirmed, may throw further light on the role of insulin in atherosclerosis.

Original languageEnglish (US)
Pages (from-to)40-45
Number of pages6
JournalAnnals of epidemiology
Volume4
Issue number1
DOIs
StatePublished - Jan 1994

Keywords

  • Cardiovascular disease
  • apoprotein E
  • cardiovascular disease death
  • genetics
  • hyperinsulinemia
  • insulin resistance
  • myocardial infarction

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