Hyperinsulinaemia is associated with increased long-term mortality following acute myocardial infarction in non-diabetic patients

Charlotte Kragelund, Ole Snorgaard, Lars Køber, Bruno Bengtsson, Michael Ottesen, Søren Højberg, Claus Olesen, Jens-Jørgen Kjaergaard, Jan Carlsen, Christian Tobias Torp-Pedersen, TRACE Study Group

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Abstract

AIMS: To study the impact of disturbances in glucose metabolism on total mortality in non-diabetic patients with acute myocardial infarction. METHODS AND RESULTS: Four hundred and ninety four patients with a verified myocardial infarction and no history of diabetes were studied. The study population comprised a subgroup of patients screened for participation in the Trandolapril Cardiac Evaluation (TRACE) study. At baseline, fasting insulin, fasting glucose, glycosylated haemoglobin (HbA1c), and urinary albumin excretion were measured. Survival status was determined after 6-8 years. Patients with hyperinsulinaemia were more obese and more frequently suffered from hypertension, previous myocardial infarction and congestive heart failure. In a univariate regression analysis, values in the upper quartile of insulin, glucose, HbA1c, and urinary albumin were associated with an excess mortality risk (RR=1.8 (1.2-2.7), p=0.002; RR=1.6 (1.2-2.1), p=0.001; RR= 1.9 (1.3-2.9), p=0.001; RR=1.6 (1.2-2.1), p=0.02 respectively). However, only a high insulin level remained significant in a multivariable analysis (RR=1.54 (1.03-2.31), p=0.04) including baseline variables, left ventricular systolic function and in-hospital complications. CONCLUSIONS: High fasting plasma insulin is an independent risk factor of all-cause mortality in non-diabetic patients with acute myocardial infarction. This justifies future intervention studies aiming at reducing insulin resistance and using fasting insulin as the target variable.
Original languageEnglish
JournalEuropean Heart Journal
Volume25
Issue number21
Pages (from-to)1891-7
Number of pages6
ISSN0195-668X
DOIs
Publication statusPublished - 2004

Bibliographical note

Keywords: Aged; Aged, 80 and over; Albuminuria; Blood Glucose; Female; Hemoglobin A, Glycosylated; Humans; Hyperinsulinism; Insulin; Male; Middle Aged; Myocardial Ischemia; Regression Analysis; Risk Factors

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