Mykkänen L, Laakso M, Pyörälä K
Department of Medicine, University of Kuopio, Finland.
Am J Epidemiol. 1993 Jun 1;137(11):1190-202. doi: 10.1093/oxfordjournals.aje.a116621.
The relation between plasma insulin level and the prevalence of coronary heart disease was studied in a representative nondiabetic population sample of 396 men and 673 women aged 65-74 years in Kuopio, eastern Finland, in 1986-1988. No association between plasma insulin levels and the prevalence of previous myocardial infarction was seen, except for a positive relation between 2-hour insulin level and myocardial infarction in women (4.1, 4.1, and 11.9%, p < 0.01; insulin quintiles I+II, III+IV, and V, respectively). However, the prevalence of ischemic electrocardiographic changes increased by quintiles of fasting plasma insulin (not significant) and 2-hour plasma insulin (39.8, 50.6, and 59.5% in men, p < 0.01; 35.9, 39.0, and 53.0% in women, p < 0.01). Furthermore, the prevalence of angina pectoris increased by fasting insulin (19.3, 19.0, and 33.8%, in men, p < 0.05; not significant in women) and 2-hour insulin quintiles (11.2, 28.8, and 30.4% in men, p < 0.001; 17.0, 17.8, and 28.4% in women, p < 0.05). There was a marked clustering of risk factors, including high total triglyceride levels, low high density lipoprotein cholesterol levels, and hypertension in subjects in the highest insulin quintiles. The association between insulin levels and coronary heart disease, except for myocardial infarction in women, diminished in multivariate analyses. In conclusion, hyperinsulinemia was related to an increased prevalence of coronary heart disease in elderly subjects which may be due to in part to adverse alterations in other risk factors associated with hyperinsulinemia.
1986 - 1988年，在芬兰东部库奥皮奥，对396名男性和673名年龄在65 - 74岁的女性组成的具有代表性的非糖尿病人群样本，研究了血浆胰岛素水平与冠心病患病率之间的关系。除了女性2小时胰岛素水平与心肌梗死呈正相关（分别为4.1%、4.1%和11.9%，p<0.01；胰岛素五分位数I + II、III + IV和V）外，未发现血浆胰岛素水平与既往心肌梗死患病率之间存在关联。然而，空腹血浆胰岛素五分位数（无显著性差异）和2小时血浆胰岛素五分位数（男性分别为39.8%、50.6%和59.5%，p<0.01；女性分别为35.9%、39.0%和53.0%，p<0.01）时，缺血性心电图改变的患病率增加。此外，男性空腹胰岛素（分别为19.3%、19.0%和33.8%，p<0.05；女性无显著性差异）和2小时胰岛素五分位数（男性分别为11.2%、28.8%和30.4%，p<0.001；女性分别为17.0%、17.8%和28.4%，p<0.05）时，心绞痛患病率增加。在胰岛素最高五分位数的受试者中，存在包括高总甘油三酯水平、低高密度脂蛋白胆固醇水平和高血压在内的多种危险因素的明显聚集。在多变量分析中，除女性心肌梗死外，胰岛素水平与冠心病之间的关联减弱。总之，高胰岛素血症与老年受试者冠心病患病率增加有关，这可能部分归因于与高胰岛素血症相关的其他危险因素的不良改变。
