A PROSPECTIVE-STUDY AT CORONARY HEART-DISEASE IN RELATION TO FASTING INSULIN, GLUCOSE, AND DIABETES - THE ATHEROSCLEROSIS RISK IN COMMUNITIES (ARIC) STUDY

OBJECTIVE - To determine the association of coronary heart disease (CH D) incidence with diabetes, fasting serum glucose, and insulin in a bi racial cohort of middle-aged men and women. RESEARCH DESIGN AND METHOD S - We examined a population-based sample (n = 13,446 free of baseline CHD) from four U.S. communities in 1987-1989. We defined diabetes on the basis of baseline fasting glucose concentration (greater than or e qual to 7.8 mmol/l), medical history, and current medications. A centr al laboratory measured fasting insulin with a nonspecific radioimmunoa ssay. After 4-7 years, 209 men and 96 women developed CHD. RESULTS - A fter adjustment for sociodemographic characteristics, smoking status, ethanol intake, sports participation, and hormone replacement therapy, the relative risk of CHD for people with diabetes versus those withou t diabetes was 3.45 (95% CI 2.16-5.50) among women and 2.52 (1.78-3.56 ) among men. Relative risks of CHD with diabetes were somewhat lower i n blacks than non-blacks, but because diabetes was more than twice as prevalent in blacks, the percentage of CHD cases attributable to diabe tes (population attributable risk) was 27% for black women, 15% for no n-black women, 8% for black men, and 12% for non-black men. Among peop le without diabetes, fasting glucose was not independently associated with CHD incidence. Among women without diabetes, there was a positive association between fasting insulin and CHD; multivariable adjusted r elative risks of CHD across quintiles of fasting insulin were 1.00, 0. 76, 2.08, 2.08, and 2.82 (P for linear trend = 0.02). However, among m en without diabetes, fasting insulin and CHD were not associated. CONC LUSIONS - Diabetes conveys a high risk of CHD in black and non-black m iddle-aged men and women. Fasting insulin, however, is a CHD risk fact or only among women in this cohort.