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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.

Author information

1
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.
2
Department of Research, Kuakini Medical Center, 347 N. Kuakini St, Honolulu, Hawaii, 96817, USA.
3
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.
4
Pacific Health Research and Education Institute, 3375 Koapaka Street, Suite I-540, Honolulu, Hawaii 96819, USA.
5
Escuela de Medicina, Tecnologico de Monterrey, Avenida Morones Prieto 3000, Monterrey, NL, 64710, Mexico.

Abstract

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.

KEYWORDS:

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

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