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. 1989 Aug 26;299(6698):537–541. doi: 10.1136/bmj.299.6698.537

Disturbances of insulin in British Asian and white men surviving myocardial infarction.

L O Hughes 1, J K Cruickshank 1, J Wright 1, E B Raftery 1
PMCID: PMC1837390  PMID: 2507062

Abstract

OBJECTIVE--To examine the role of insulin as a cardiovascular risk factor in British Asian and white men. DESIGN--Case-controlled study of survivors of first myocardial infarction. SETTING--District general hospital. PATIENTS--Consecutive series of 76 white and 74 Asian men who survived first myocardial infarction compared with 58 white and 61 Asian male controls without coronary artery disease who were randomly sampled from the community. RESULTS--More Asians than white subjects had impaired glucose tolerance or overt diabetes as measured by the two hour glucose tolerance test (23/74 (32%) v 11/76 (15%) (p less than 0.001) among patients; 17/61 (28%) v 3/58 (6%) (p less than 0.001) among controls). Insulin and C peptide concentrations were higher in both patient groups than in respective controls (p less than 0.001) and higher in Asian than in white subjects, irrespective of their glucose tolerance. Triglyceride concentrations were higher in patients than in controls (1.92 (SD 1.05) v 1.43 (0.82) mmol/l among Asian men; 1.65 (0.83) v 1.3 (0.61) mmol/l among white subjects; p less than 0.001). Total cholesterol concentrations were lower in both groups of Asians than in respective white subjects (5.78 (0.99) v 6.22 (1.04) mmol/l (p less than 0.01) among patients; 5.54 (1.01) v 5.65 (1.11) mmol/l (p less than 0.6) among controls). High density lipoprotein cholesterol concentrations were lower in Asian than in white subjects. The ratio of total cholesterol to high density lipoprotein cholesterol was significantly higher (p less than 0.001) in both patient groups (6.69 (1.81) in Asian patients and 6.31 (1.91) in white patients) than in respective controls (5.24 (1.19) and 4.77 (1.43)). Regression analysis identified C peptide concentration and the ratio of total to high density lipoprotein cholesterol as powerful independent predictors of myocardial infarction in Asian and white men. Total cholesterol concentration predicted infarction in white but not in Asian men. CONCLUSIONS--Secretion and hepatic extraction of insulin are high in survivors of myocardial infarction and especially high in British Asians. Tissue resistance to the action of insulin, giving rise to increased pancreatic secretion, may be an important risk factor for coronary artery disease in both ethnic groups and may be partly responsible for the high incidence of diabetes and coronary artery disease in Asian populations.

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Selected References

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  1. Bachorik P. S., Walker R., Brownell K. D., Stunkard A. J., Kwiterovich P. O. Determination of high density lipoprotein-cholesterol in stored human plasma. J Lipid Res. 1980 Jul;21(5):608–616. [PubMed] [Google Scholar]
  2. Balarajan R., Bulusu L., Adelstein A. M., Shukla V. Patterns of mortality among migrants to England and Wales from the Indian subcontinent. Br Med J (Clin Res Ed) 1984 Nov 3;289(6453):1185–1187. doi: 10.1136/bmj.289.6453.1185. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Beckles G. L., Miller G. J., Kirkwood B. R., Alexis S. D., Carson D. C., Byam N. T. High total and cardiovascular disease mortality in adults of Indian descent in Trinidad, unexplained by major coronary risk factors. Lancet. 1986 Jun 7;1(8493):1298–1301. doi: 10.1016/s0140-6736(86)91221-3. [DOI] [PubMed] [Google Scholar]
  4. Brunzell J. D., Porte D., Jr, Bierman E. L. Abnormal lipoprotein-lipase-mediated plasma triglyceride removal in untreated diabetes mellitus associated with hypertriglyceridemia. Metabolism. 1979 Sep;28(9):901–907. doi: 10.1016/0026-0495(79)90089-1. [DOI] [PubMed] [Google Scholar]
  5. Castelli W. P., Doyle J. T., Gordon T., Hames C. G., Hjortland M. C., Hulley S. B., Kagan A., Zukel W. J. HDL cholesterol and other lipids in coronary heart disease. The cooperative lipoprotein phenotyping study. Circulation. 1977 May;55(5):767–772. doi: 10.1161/01.cir.55.5.767. [DOI] [PubMed] [Google Scholar]
  6. Castelli W. P., Garrison R. J., Wilson P. W., Abbott R. D., Kalousdian S., Kannel W. B. Incidence of coronary heart disease and lipoprotein cholesterol levels. The Framingham Study. JAMA. 1986 Nov 28;256(20):2835–2838. [PubMed] [Google Scholar]
  7. Cruickshank J. K., Beevers D. G., Osbourne V. L., Haynes R. A., Corlett J. C., Selby S. Heart attack, stroke, diabetes, and hypertension in West Indians, Asians, and whites in Birmingham, England. Br Med J. 1980 Oct 25;281(6248):1108–1108. doi: 10.1136/bmj.281.6248.1108. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Ducimetiere P., Eschwege E., Papoz L., Richard J. L., Claude J. R., Rosselin G. Relationship of plasma insulin levels to the incidence of myocardial infarction and coronary heart disease mortality in a middle-aged population. Diabetologia. 1980 Sep;19(3):205–210. doi: 10.1007/BF00275270. [DOI] [PubMed] [Google Scholar]
  9. Fossati P., Prencipe L. Serum triglycerides determined colorimetrically with an enzyme that produces hydrogen peroxide. Clin Chem. 1982 Oct;28(10):2077–2080. [PubMed] [Google Scholar]
  10. Grimm R. H., Jr, Leon A. S., Hunninghake D. B., Lenz K., Hannan P., Blackburn H. Effects of thiazide diuretics on plasma lipids and lipoproteins in mildly hypertensive patients: a double-blind controlled trial. Ann Intern Med. 1981 Jan;94(1):7–11. doi: 10.7326/0003-4819-94-1-7. [DOI] [PubMed] [Google Scholar]
  11. Hughes L. O., Raval U., Raftery E. B. First myocardial infarctions in Asian and white men. BMJ. 1989 May 20;298(6684):1345–1350. doi: 10.1136/bmj.298.6684.1345. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Jarrett R. J. Is insulin atherogenic? Diabetologia. 1988 Feb;31(2):71–75. doi: 10.1007/BF00395550. [DOI] [PubMed] [Google Scholar]
  13. Kannel W. B., McGee D. L. Diabetes and glucose tolerance as risk factors for cardiovascular disease: the Framingham study. Diabetes Care. 1979 Mar-Apr;2(2):120–126. doi: 10.2337/diacare.2.2.120. [DOI] [PubMed] [Google Scholar]
  14. Kessler I. I. Mortality experience of diabetic patients. A twenty-six-year follow-up study. Am J Med. 1971 Dec;51(6):715–724. doi: 10.1016/0002-9343(71)90299-3. [DOI] [PubMed] [Google Scholar]
  15. Mather H. M., Keen H. The Southall Diabetes Survey: prevalence of known diabetes in Asians and Europeans. Br Med J (Clin Res Ed) 1985 Oct 19;291(6502):1081–1084. doi: 10.1136/bmj.291.6502.1081. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. McKeigue P. M., Marmot M. G. Mortality from coronary heart disease in Asian communities in London. BMJ. 1988 Oct 8;297(6653):903–903. doi: 10.1136/bmj.297.6653.903. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. McKeigue P. M., Marmot M. G., Syndercombe Court Y. D., Cottier D. E., Rahman S., Riemersma R. A. Diabetes, hyperinsulinaemia, and coronary risk factors in Bangladeshis in east London. Br Heart J. 1988 Nov;60(5):390–396. doi: 10.1136/hrt.60.5.390. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Neusy A. J., Lowenstein J. Effects of prazosin, atenolol, and thiazide diuretic on plasma lipids in patients with essential hypertension. Am J Med. 1986 Feb 14;80(2A):94–99. doi: 10.1016/0002-9343(86)90166-x. [DOI] [PubMed] [Google Scholar]
  19. Nikkilä E. A., Kekki M. Plasma triglyceride transport kinetics in diabetes mellitus. Metabolism. 1973 Jan;22(1):1–22. doi: 10.1016/0026-0495(73)90024-3. [DOI] [PubMed] [Google Scholar]
  20. O'Rahilly S. P., Nugent Z., Rudenski A. S., Hosker J. P., Burnett M. A., Darling P., Turner R. C. Beta-cell dysfunction, rather than insulin insensitivity, is the primary defect in familial type 2 diabetes. Lancet. 1986 Aug 16;2(8503):360–364. doi: 10.1016/s0140-6736(86)90052-8. [DOI] [PubMed] [Google Scholar]
  21. Pedoe H. T., Clayton D., Morris J. N., Brigden W., McDonald L. Coronary heart-attacks in East London. Lancet. 1975 Nov 1;2(7940):833–838. doi: 10.1016/s0140-6736(75)90233-0. [DOI] [PubMed] [Google Scholar]
  22. Reaven G. M., Bernstein R., Davis B., Olefsky J. M. Nonketotic diabetes mellitus: insulin deficiency or insulin resistance? Am J Med. 1976 Jan;60(1):80–88. doi: 10.1016/0002-9343(76)90536-2. [DOI] [PubMed] [Google Scholar]
  23. Stähler F., Gruber W., Stinshoff K., Röschlau P. Eine praxisgerechte enzymatische Cholesterin-Bestimmung. Med Lab (Stuttg) 1977 Feb;30(2):29–37. [PubMed] [Google Scholar]
  24. Temple R. C., Carrington C. A., Luzio S. D., Owens D. R., Schneider A. E., Sobey W. J., Hales C. N. Insulin deficiency in non-insulin-dependent diabetes. Lancet. 1989 Feb 11;1(8633):293–295. doi: 10.1016/s0140-6736(89)91306-8. [DOI] [PubMed] [Google Scholar]
  25. Welborn T. A., Wearne K. Coronary heart disease incidence and cardiovascular mortality in Busselton with reference to glucose and insulin concentrations. Diabetes Care. 1979 Mar-Apr;2(2):154–160. doi: 10.2337/diacare.2.2.154. [DOI] [PubMed] [Google Scholar]

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