Hyperinsulinemia in a normal population as a predictor of non-insulin-dependent diabetes mellitus, hypertension, and coronary heart disease: The barilla factory revisited

The study was initiated to evaluate the ability of hyperinsulinemia (as a s urrogate measure of insulin resistance) to predict the development in a pre viously healthy population of three putative outcomes of this abnormality-g lucose intolerance, hypertension, and coronary heart disease (CHD). The stu dy involved defining the incidence at which these changes occurred between 1981 and 1993 to 1996 in 647 individuals who were free of any disease when initially studied. The study population consisted of approximately 90% of t he subjects evaluated in 1981, divided into quartiles on the basis of the p lasma insulin response to a glucose challenge as determined in 1981. The re sults indicated that the 25% of the population with the highest insulin res ponse in 1981 had significant (P < .001) increases in the incidence of impa ired glucose tolerance (IGT) or type 2 diabetes (eightfold), hypertension ( twofold), or CHD (threefold). Furthermore, the ability of hyperinsulinemia to predict the three clinical endpoints was independent of differences in a ge, gender, or body mass index (BMI). Finally, if CHD is considered the cli nical endpoint, multiple logistic regression analysis indicates that the va lues for plasma triglyceride (TG) and mean arterial blood pressure ([MAP] a s measured in 1981) also predict the development of CHD. These results indi cate that the untoward clinical effects of insulin resistance and/or compen satory hyperinsulinemia, glucose intolerance, hypertension, and CHD clearly can develop in less than 15 years. Copyright (C) 1999 by W.B. Saunders Com pany.