PERSISTENT ELEVATION OF PLASMA-INSULIN LEVELS IS ASSOCIATED WITH INCREASED CARDIOVASCULAR RISK IN CHILDREN AND YOUNG-ADULTS - THE BOGALUSA HEART-STUDY

Background Hyperinsulinemia has been considered to be a potent cardiov ascular risk factor. The present investigation examines persistently e levated fasting insulin levels from childhood to young adulthood and i ts influence on cardiovascular risk factors. Methods and Results A lon gitudinal cohort was constructed from two cross-sectional surveys in a community-based population over an 8-year period: 1606 individuals (3 9% were black) aged 5 to 23 years participated in the first survey. St ability in rankings (persistence) of insulin levels was shown by the p resence of significant correlations between year 1 and year 8 values ( r=.23 to .36, P<.0001), with a greater magnitude in older subjects. Co mpared with subjects with levels of insulin consistently in the lowest quartile, those with levels always in the highest quartile showed hig her (P<.001) levels of body mass index (+9 kg/m(2)), triglycerides (+5 8 mg/dL), LDL cholesterol (+11 mg/dL), VLDL cholesterol (+8 mg/dL), gl ucose (+9 mg/dL), systolic blood pressure (+7 mm Hg), and diastolic bl ood pressure (1-3 mm Hg); lower (P<.001) levels of HDL cholesterol (-4 mg/dL); and higher (P<.05) prevalence of parental history of diabetes (3.3-fold) and hypertension (1.2-fold). There were 739 young adults a ged 20 to 31 years at follow-up. As adults, individuals with consisten tly elevated insulin versus those with consistently decreased insulin had increased (P<.05) prevalence of obesity (36-fold), hypertension (2 .5-fold), and dyslipidemia (3-fold), which was attributed to both base line insulin and change of insulin from baseline to follow-up. In addi tion, clustering of these risk factors was stronger (P<.05) in adults with persistent insulin elevation. Conclusions Elevated insulin levels persist from childhood through young adulthood, resulting in a clinic ally relevant adverse cardiovascular risk profile in young adults.