CLINICAL STUDIES
Relationship of glucose and insulin levels to the risk of myocardial infarction: a case-control study
Hertzel C. Gerstein, MD, MSc, FRCPC*  ,
Prem Pais, MD¶,
Janice Pogue, MA, MSc* and
Salim Yusuf, MBBS, DPh, FRCPC* 
* Preventive Cardiology and Therapeutics Research Program, Hamilton Civic Hospitals Research Centre, Hamilton, Ontario, Canada
Divisions of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada
Division of Cardiology, McMaster University, Hamilton, Ontario, Canada
¶ Department of Medicine, St. John’s Medical College, Bangalore, India
Manuscript received May 5, 1998;
revised manuscript received September 18, 1998,
accepted October 30, 1998.
Reprint requests and correspondence: Dr. H. C. Gerstein, Department of Medicine, Room 3V38, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada
gerstein{at}fhs.csu.mcmaster.ca
OBJECTIVE
To assess the relationship between dysglycemia and myocardial infarction in nondiabetic individuals.
BACKGROUND
Nondiabetic hyperglycemia may be an important cardiac risk factor. The relationship between myocardial infarction and glucose, insulin, abdominal obesity, lipids and hypertension was therefore studied in South Asians—a group at high risk for coronary heart disease and diabetes.
METHODS
Demographics, waist/hip ratio, fasting blood glucose (FBG), insulin, lipids and glucose tolerance were measured in 300 consecutive patients with a first myocardial infarction and 300 matched controls.
RESULTS
Cases were more likely to have diabetes (OR 5.49; 95% CI 3.34, 9.01), impaired glucose tolerance (OR 4.08; 95% CI 2.31, 7.20) or impaired fasting glucose (OR 3.22; 95% CI 1.51, 6.85) than controls. Cases were 3.4 (95% CI 1.9, 5.8) and 6.0 (95% CI 3.3, 10.9) times more likely to have an FBG in the third and fourth quartile (5.2–6.3 and >6.3 mmol/l); after removing subjects with diabetes, impaired glucose tolerance and impaired fasting glucose, cases were 2.7 times (95% CI 1.5–4.8) more likely to have an FBG >5.2 mmol/l. A fasting glucose of 4.9 mmol/l best distinguished cases from controls (OR 3.42; 95% CI 2.42, 4.83). Glucose, abdominal obesity, lipids, hypertension and smoking were independent multivariate risk factors for myocardial infarction. In subjects without glucose intolerance, a 1.2 mmol/l (21 mg/dl) increase in postprandial glucose was independently associated with an increase in the odds of a myocardial infarction of 1.58 (95% CI 1.18, 2.12).
CONCLUSIONS
A moderately elevated glucose level is a continuous risk factor for MI in nondiabetic South Asians with either normal or impaired glucose tolerance.
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Abbreviations and Acronyms
| | CAD | = coronary artery disease | | ECG | = electrocardiogram | | FBG | = fasting blood glucose | | HDL | = high density lipoprotein | | IFG | = impaired fasting glucose | | IGT | = impaired glucose tolerance | | LDL | = low density lipoprotein | | MI | = myocardial infarction | | OR | = odds ratio | | PPBG | = postprandial blood glucose | | ROC | = receiver operating curve |
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|
|
|
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|
|
|
|
|
|
|
References
Circulation,
December 17, 2002;
106(25):
3373 - 3421.
[Full Text]
|
|
|
|
|
|
|
N. Mikhail, J. A. Beckman, M. A. Creager, and P. Libby
Postprandial Hyperglycemia and Risk of Atherosclerosis
JAMA,
August 28, 2002;
288(8):
955 - 955.
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Tanaka, F. Kehl, W. Gu, J. G. Krolikowski, P. S. Pagel, D. C. Warltier, and J. R. Kersten
Isoflurane-induced preconditioning is attenuated by diabetes
Am J Physiol Heart Circ Physiol,
June 1, 2002;
282(6):
H2018 - H2023.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. A. Lell, V. G. Nielsen, D. C. McGiffin, F. E. Schmidt Jr, J. K. Kirklin, and A. W. Stanley Jr
Glucose-insulin-potassium infusion for myocardial protection during off-pump coronary artery surgery
Ann. Thorac. Surg.,
April 1, 2002;
73(4):
1246 - 1251.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. B. Sacks, D. E. Bruns, D. E. Goldstein, N. K. Maclaren, J. M. McDonald, and M. Parrott
Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus
Clin. Chem.,
March 1, 2002;
48(3):
436 - 472.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Yusuf, S. Reddy, S. Ounpuu, and S. Anand
Global Burden of Cardiovascular Diseases: Part I: General Considerations, the Epidemiologic Transition, Risk Factors, and Impact of Urbanization
Circulation,
November 27, 2001;
104(22):
2746 - 2753.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Mohan, R. Deepa, S. Shanthi Rani, and G. Premalatha
Prevalence of coronary artery disease and its relationship to lipids in a selected population in South India: The Chennai Urban Population Study (CUPS No. 5)
J. Am. Coll. Cardiol.,
September 1, 2001;
38(3):
682 - 687.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Raskin, M. Rendell, M. C. Riddle, J. F. Dole, M. I. Freed, and J. Rosenstock
A Randomized Trial of Rosiglitazone Therapy in Patients With Inadequately Controlled Insulin-Treated Type 2 Diabetes
Diabetes Care,
July 1, 2001;
24(7):
1226 - 1232.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. R. Kersten, W. G. Toller, E. R. Gross, P. S. Pagel, and D. C. Warltier
Diabetes abolishes ischemic preconditioning: role of glucose, insulin, and osmolality
Am J Physiol Heart Circ Physiol,
April 1, 2000;
278(4):
H1218 - H1224.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. R. SELL, N. R. KLEINMAN, and V. M. MONNIER
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FASEB J,
January 1, 2000;
14(1):
145 - 156.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
N. Hosszufalusi, P. Panczel, L. Janoskuti, M. Pyorala, H. Miettinen, M. Laakso, and K. Pyorala
Hyperinsulinemia Predicts Coronary Heart Disease Risk in Healthy Middle-Aged Men • Response
Circulation,
December 14, 1999;
100
(24):
e118 - e118.
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Tanaka, F. Kehl, W. Gu, J. G. Krolikowski, P. S. Pagel, D. C. Warltier, and J. R. Kersten
Isoflurane-induced preconditioning is attenuated by diabetes
Am J Physiol Heart Circ Physiol,
June 1, 2002;
282(6):
H2018 - H2023.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
