Coronary Heart Disease Incidence and Cardiovascular Mortality in Busselton with Reference to Glucose and Insulin Concentrations

Abstract

In the 1966 study of the population of Busselton, Australia, blood sugar and serum insulin levels were measured one hour after an oral glucose load, in addition to the conventional cardiovascular risk factors. The six-year incidence of coronary heart disease (CHD) and the 12-yr mortality from CHD and from all cardiovascular diseases is described in relation to the initial baseline variables measured using the upper 20th percentile values (age-specific and sex-specific) to define the risk ratios. In younger subjects (ages less than 60 yr), elevated blood pressure levels for both sexes (risk ratios from 2.9 to 5.2) and elevated serum cholesterol concentrations for males (risk ratios from 3.0 to 3.3) were strong predictors of cardiovascular risk. In men aged 60 to 69 yr, those with upper range one-hour serum insulin concentrations showed marked associations with the six-year incidence of CHD, the 12-yr mortality from CHD, and the 12-yr mortality from all cardiovascular diseases (risk ratios were 2.0, 2.3, and 2.4, respectively). The relationship of elevated serum insulin and cardiovascular mortality persisted when males of all ages were analyzed, and it appeared to be independent of the other major risk factors. In females, no association between serum insulin and CHD or cardiovascular disease could be found. Although the age and sex specific upper 20th percentile values for one-hour blood sugar concentrations showed a low grade association in patients with subsequent cardiovascular disease end points, more noticeable risk ratios were demonstrated at the higher blood sugar level of 200 mg/100 ml or greater (in the age group 60 yr and over, risk ratios were 2.2 in males and 2.6 in females.

Association of plasma triglyceride and C-peptide with coronary heart disease in Japanese-American men with a high prevalence of glucose intolerance

“…Several prospective studies have also suggested this [3][4][5][6]. A recent study found normal glucose tolerant subjects with hyperinsulinaemia to have both elevated blood pressure and the lipid abnormalities often observed in glucose intolerant individuals, when compared to matched control subjects without hyperinsulinaemia [51].…”

“…The precise roles of many of these factors in the pathogenesis of coronary heart disease is still not completely understood. One factor that is associated with glucose intolerance and has been implicated as being relevant to coronary heart disease from epidemiological studies [3][4][5][6] and experimental studies [7] is hyperinsulinaemia. This relationship is thought to be mediated by insulin resistance [8].…”

Silent ischemia is more prevalent among hypertensive patients with microalbuminuria and salt sensitivity

“…62 In addition, we have observed that salt-sensitive subjects with essential hypertension manifest greater UAE than normotensive individuals. 63 Because hyperinsulinemia and insulin-resistance have been associated with a greater incidence of vascular disease, [64][65][66][67][68] and particularly coronary heart disease, [69][70][71] these associations could explain the greater incidence of ischemic events in patients with microalbuminuria and with salt sensitivity compared with those with normal UAE and saltresistance. Insulin levels and insulin sensitivity were not measured in this study.…”

Effect of glucose, sucrose and fructose on plasma glucose and insulin responses in normal humans: comparison with white bread

“…Knowledge about the relative effects of sugars on plasma insulin is important because it has been suggested that fructose increases plasma insulin without increasing plasma glucose (Reiser et al, 1987). High plasma insulin concentrations and insulin resistance are associated with increased risk of cardiovascular disease (Pyo Èra Èla È, 1978;Welborn & Wearne, 1979;Ducemetie Áre et al, 1980;DeFronzo & Ferrannini, 1991). Therefore, our purpose was to determine the effect of various doses of glucose, sucrose, fructose and white bread on plasma glucose and insulin responses in normal subjects.…”