[Diabetes, hyperglycemia, hyperinsulinemia and risk of cardiovascular mortality. Findings of the Paris Prospective Survey, 10 years later].

The Paris Prospective Study is a long-term investigation of coronary heart disease (CHD) conducted on 7038 working men, aged 43-54 years and followed 11.2 years in mean. The first examination included a 0-2 h 75 g OGTT with measurement of plasma insulin and glucose levels, beside the major CHD risk factors. 651 deaths (CHD = 126) were recorded. The annual CHD mortality rates were respectively 1.4, 2.7 and 3.5 per 1000 for the 6055 normoglycaemic, 690 impaired glucose tolerance and 293 new and known diabetic subjects (1980 WHO classification) (p less than 0.001). It showed that the fasting plasma insulin was positively associated with risk independent of the other factors (p less than 0.05), whereas glucose tolerance, including overt diabetes, was not significantly associated. Thus, high insulin levels may constitute a more sensitive predictor of CHD than the degree of glucose intolerance and it could be useful to avoid excessive insulin plasma concentration, and even to lower its levels.