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Geriatrics (Basel). 2018;3(2). pii: 22. doi: 10.3390/geriatrics3020022. Epub 2018 Apr 22.

The Association of Fasting Glucose, Insulin, and C-Peptide, with 19-Year Incidence of Coronary Heart Disease in Older Japanese-American Men; the Honolulu Heart Program.

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CK Hui Heart Centre, Division of Cardiology, Royal Alexandra Hospital, University of Alberta, Rm 6S132A Robbins Pavillion, 10240 Kingsway Avenue, Edmonton, AB T5H 3V9, Canada.
Department of Research, Kuakini Medical Center, 347 N. Kuakini St, Honolulu, Hawaii, 96817, USA.
Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Hale Pulama Mau, 9th Floor, 347 N. Kuakini St, Honolulu, Hawaii, 96817, USA.
Pacific Health Research and Education Institute, 3375 Koapaka Street, Suite I-540, Honolulu, Hawaii 96819, USA.
Escuela de Medicina, Tecnologico de Monterrey, Avenida Morones Prieto 3000, Monterrey, NL, 64710, Mexico.


The role of fasting glucose, insulin levels, and C-peptide in coronary heart disease (CHD) in non-diabetic individuals remains uncertain. We examined the association between fasting glucose, insulin and C-peptide with the long-term incidence of CHD in Japanese-American men. In 1980-1982, from a random sample of the Honolulu Heart Program men (n = 1378), aged 61-81 years, data on several CHD and metabolic risk factors were obtained to examine the relation of fasting glucose, insulin and C-peptide to 19-year CHD incidence. Age-adjusted incidence of CHD increased with increasing quintiles of glucose, insulin and C-peptide. Age-adjusted CHD rates in the glucose quintiles were 11.9, 11.6, 14.4, 18.1 and 24.1 per 1000 person-years (trend p < 0.001). In individual Cox models (lowest quintiles of glucose, insulin and C-peptide as reference) the relative risks (95% confidence interval) of CHD incidence for the glucose quintiles adjusting for age, smoking, hypertension, cholesterol, physical activity, and body mass index, were 0.9 (0.6-1.4), 1.2 (0.8-1.8), 1.4 (0.9-2.2), and 1.7 (1.1-2.6), respectively (trend p = 0.004). Insulin and C-peptide were not significantly associated with CHD on multivariate analysis. Fasting glucose remained the only significant predictor of increased CHD risk (p = 0.003) in a model combining all 3 metabolic variables. In this cohort, only fasting glucose independently predicts long-term incidence of CHD. Age-adjusted insulin and C-peptide levels were associated with CHD incidence, but after adjustment for other risk factors, do not independently predict CHD.


coronary disease; diabetes mellitus; follow-up studies; glucose; insulin

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