Circulation, Vol 82, 27-36, Copyright © 1990 by American Heart Association
MI Uusitupa, LK Niskanen, O Siitonen, E Voutilainen and K Pyorala
The 5-year incidence of myocardial infarction and claudication was examined
in a group of middle-aged patients (n = 133, 70 men and 63 women) with
newly diagnosed non-insulin-dependent diabetes and nondiabetic control
subjects (n = 144, 62 men and 82 women). The effects of general risk
factors, plasma insulin level, and lipoprotein abnormalities on the
incidence of myocardial infarction and claudication were also evaluated by
univariate analyses in both diabetic patients and nondiabetic subjects and
by multivariate analyses combining both groups. The age-adjusted incidence
of myocardial infarction was higher both in diabetic men (19.4%) and
diabetic women (11.0%) than in nondiabetic men (3.2%, p = 0.009) and
nondiabetic women (3.0%, p = 0.047). Similarly, the age-adjusted incidence
of claudication was higher among the diabetic patients (20.3% vs. 8.0% for
men, p = 0.06; 21.8% vs. 4.2% for women, p = 0.003). None of the general
risk factors (i.e., low density lipoprotein [LDL] cholesterol, blood
pressure, smoking, and high density lipoprotein [HDL] cholesterol) showed
an association with the risk of myocardial infarction either in the
diabetic or nondiabetic groups of subjects, but an ischemic
electrocardiographic abnormality at the baseline examination predicted
myocardial infarction in diabetic men. In univariate analyses in diabetic
subjects, high serum total cholesterol, low HDL cholesterol, high very low
density lipoprotein (VLDL) cholesterol, and high total, LDL and VLDL
triglycerides, and in nondiabetic subjects, high VLDL cholesterol and LDL
triglycerides were associated with the appearance of claudication. In
multivariate analyses including both diabetic and control subjects, only
diabetes had an independent association with myocardial infarction, whereas
smoking, high LDL triglycerides or VLDL cholesterol, and high fasting
plasma insulin showed independent relations to claudication. The present
results indicate that changes in lipoprotein composition characteristic of
non-insulin-dependent diabetes are atherogenic and increase the risk of
atherosclerotic vascular disease. Furthermore, high plasma insulin might
also be involved in atherogenesis, independent of lipoprotein
abnormalities.
ARTICLES
5-year incidence of atherosclerotic vascular disease in relation to general risk factors, insulin level, and abnormalities in lipoprotein composition in non-insulin-dependent diabetic and nondiabetic subjects
Department of Medicine, University of Kuopio, Finland.
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