Hyperinsulinemia and the Risk of Cardiovascular Death and Acute Coronary and Cerebrovascular Events in Men

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Abstract
THE ROLE of hyperinsulinemia as a cardiovascular risk factor is controversial.1,2 Hyperinsulinemia has been associated with an increased incidence of coronary heart disease (CHD) and with increased CHD or cardiovascular disease (CVD) mortality in 3 older prospective population-based studies.3-5 In these studies,3-8 however, the predictive value of hyperinsulinemia diminished with extended follow-up. Two recent prospective population-based studies have also suggested that the association between hyperinsulinemia and increased risk of CHD may be independent.9,10 However, most studies in the 1990s have not reconfirmed that hyperinsulinemia is an independent risk factor for CVD.11-22 Few studies are available concerning the association between hyperinsulinemia and the risk of stroke. Hyperinsulinemia was not independently associated with the risk of stroke in the extended follow-up of the Helsinki Policemen Study.23 Neither did hyperinsulinemia predict stroke incidence in nondiabetic subjects without a previous stroke in a study of elderly men and women in Kuopio, Finland.24 Furthermore, few study groups have reported the relationship of hyperinsulinemia with all major CVD events, eg, CVD or CHD death, acute coronary events, and stroke.3,6,23

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