From the Department of Medicine, University of Kuopio, Kuopio, Finland.
Correspondence to Kalevi Pyörälä, MD, Department of Medicine, University of Kuopio, Puijonlaaksontie 2, PO Box 1627, 70211 Kuopio, Finland.
Background—The Helsinki Policemen
Study is one of the first prospective epidemiological studies
demonstrating an association of hyperinsulinemia to
the risk of coronary heart disease (CHD). The aim of the
present study was to investigate the predictive value of
hyperinsulinemia with regard to CHD risk during a
22-year follow-up of the Helsinki Policemen Study population.
Methods and Results—The study was based on a cohort of 970 men
who were 34 to 64 years of age and free of CHD, other
cardiovascular disease, and diabetes. Risk factor
measurements at baseline examination included an oral glucose tolerance
test (OGTT) with blood glucose and plasma insulin measurements at 0, 1,
and 2 hours. Area under the plasma insulin response curve (AUC insulin)
during OGTT was used as a composite variable reflecting plasma
insulin levels. During the 22-year follow-up, 164 men had a major CHD
event (CHD death or nonfatal myocardial infarction). Age-adjusted
hazard ratios for a major CHD event comparing men in the highest AUC
insulin quintile with those in the combined 4 lower quintiles during
5-, 10-, 15-, and 22-year follow-up periods were 3.29 (95% CI, 1.56 to
6.91), 2.72 (95% CI, 1.67 to 4.42), 2.14 (95% CI, 1.43 to 3.21), and
1.61 (95% CI, 1.14 to 2.27), respectively. Further adjustment for
other risk factors attenuated these hazard ratios to 2.36 (95% CI,
1.00 to 5.57), 2.29 (95% CI, 1.31 to 4.02), 1.76 (95% CI, 1.09 to
2.82), and 1.32 (95% CI, 0.89 to 1.97), respectively.
Conclusions—Hyperinsulinemia predicted CHD
risk in Helsinki policemen over the 22-year follow-up, and to a large
extent independently of other CHD risk factors, but its predictive
value diminished with lengthening follow-up time.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Hyperinsulinemia Predicts Coronary Heart Disease Risk in Healthy Middle-aged Men
The 22-Year Follow-up Results of the Helsinki Policemen Study
Key Words: coronary disease • epidemiology • insulin • risk factors
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|
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|
|
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|
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|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
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|
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|
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|
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|
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|
|
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