HIPERINSULINEMIA DOES NOT INFLUENCE ON CARDIOVASCULAR EVENTS AND DEATH IN THE MEN WITH HYPERTENSION AND CONFIRMED CORONARY ATHEROSCLEROSIS IN18 YEARS FOLLOW-UP.
The aim of study was to assess the predictive value of serum insulin concentration in patients with hypertension and diagnosed coronary atherosclerosis.
Material and methods: At the beginning we enrolled 103 men with hypertension coronary artery disease and impaired glucose tolerance, who underwent myocardial infarction, at the age of 47.1 (+/- 12.8). The study was completed by 27 men after 18 yrs of follow-up. Coronary angiography, which proved a coronary arteriosclerosis, and oral glucose tolerance test (OGTT) with insulin assessment were performed at the beginning of the study in all the patients. We assessed the fasting insulin level (FIn) as well as the area under the curve of insulin concentration (AUC-In) measured while OGTT as a representative of reactive insulinemia. Mild and moderate impairment of left ventricle was diagnosed by ventriculography (LV EF between 41-60%). During 18 yrs follow-up total mortality, hospitalizations and major cardiovascular events were evaluated. As a composed endpoint we use a sum of the mentioned above events. We analyzed the influence of FIn and AUC-In on the clinical outcome in our patients.
Results: Among patients who completed study we observed 9 deaths (33.3%), 18 episodes of major cardiovascular events (66.7%). At least 1 episod of hospitalization was noticed in 14 patients (51,9%). Composed endpoint was achieved by 19 pts (70.3%).
There was no significant differences in insulinemia, both fasting and measured during OGTT, between patients reaching or not composed endpoint assessed after 18 yrs follow-up. The major risk factors in studied patients were: age (HR 2.8:1), smoking (HR 4.7:1) and decrease level of HDL-cholesterol (HR 1.98:1).
- The level of insulinemia did not influence on clinical outcome after many years in men with hypertension, previously present coronary atherosclerosis and underwent myocardial infarct.
- Relative hiperinsulinemia seems not to be the risk factor for death and cardiovascular events in men with hypertension who previously developed coronary atherosclerosis and underwent myocardial infarctions.