From the Department of Medicine, University of Kuopio (Finland).
Correspondence to Kalevi Pyörälä, MD, Department of Medicine, University of Kuopio, Puijonlaaksontie 2, PO Box 1627, 70211 Kuopio, Finland. E-mail kalevi.pyorala{at}uku.fi
Background and Purpose—Several
studies have shown that hyperinsulinemia is
associated with the risk of coronary heart disease, but
information on the association of hyperinsulinemia
with the risk of stroke is limited. We investigated the association of
hyperinsulinemia with the risk of stroke during a
22-year follow-up of the Helsinki Policemen Study population.
Methods—The study was based on a cohort of 970 men aged 34 to 64
years who were free of cerebrovascular disease, other
cardiovascular disease, or diabetes. Risk factor
measurements at baseline examination included an oral glucose tolerance
test with blood glucose and plasma insulin measurements at 0, 1, and 2
hours. Area under the insulin response curve during oral glucose
tolerance test was used as a composite variable reflecting plasma
insulin levels.
Results—During the 22-year follow-up, 70 men had a fatal or
nonfatal stroke. Hyperinsulinemia (highest area
under the insulin response curve quintile compared with the combined 4
lower quintiles) was associated with the risk of stroke (age-adjusted
hazard ratio, 2.12; 95% CI, 1.28 to 3.49), but not independently of
other risk factors (multiple-adjusted hazard ratio, 1.54; 95% CI, 0.90
to 2.62), which was mainly due to the impact of obesity, particularly
upper body obesity, with subscapular skinfold thickness used as an
index. Of other risk factors, upper body obesity, blood pressure, and
smoking were independent predictors of the risk of stroke.
Conclusions—Hyperinsulinemia was associated
with the risk of stroke in Helsinki policemen during the 22-year
follow-up, but not independently of other risk factors, particularly
upper body obesity.
© 1998 American Heart Association, Inc.
Original Contributions
Hyperinsulinemia and the Risk of Stroke in Healthy Middle-Aged Men
The 22-Year Follow-Up Results of the Helsinki Policemen Study
Key Words: epidemiology • insulin • risk factors • stroke onset
This article has been cited by other articles:
 |
|
 |
|
  D. Sander, K. Sander, and H. Poppert Review: Stroke in type 2 diabetes The British Journal of Diabetes & Vascular Disease, September 1, 2008; 8(5): 222 - 229. [Abstract] [PDF]
|
|
|
|
 |
|
 Z. T. Bloomgarden Cardiovascular Disease in Diabetes Diabetes Care, June 1, 2008; 31(6): 1260 - 1266. [Full Text] [PDF]
|
|
|
|
|
|
B. Boden-Albala, S. Cammack, J. Chong, C. Wang, C. Wright, T. Rundek, M. S.V. Elkind, M. C. Paik, and R. L. Sacco Diabetes, Fasting Glucose Levels, and Risk of Ischemic Stroke and Vascular Events: Findings from the Northern Manhattan Study (NOMAS) Diabetes Care, June 1, 2008; 31(6): 1132 - 1137. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. E. Hirai, S. E. Moss, B. E.K. Klein, and R. Klein Relationship of Glycemic Control, Exogenous Insulin, and C-Peptide Levels to Ischemic Heart Disease Mortality Over a 16-Year Period in People With Older-Onset Diabetes: The Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) Diabetes Care, March 1, 2008; 31(3): 493 - 497. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. M. Ivey, A. S. Ryan, C. E. Hafer-Macko, A. P. Goldberg, and R. F. Macko Treadmill Aerobic Training Improves Glucose Tolerance and Indices of Insulin Sensitivity in Disabled Stroke Survivors: A Preliminary Report Stroke, October 1, 2007; 38(10): 2752 - 2758. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. B. Goldstein, R. Adams, M. J. Alberts, L. J. Appel, L. M. Brass, C. D. Bushnell, A. Culebras, T. J. DeGraba, P. B. Gorelick, J. R. Guyton, et al. Primary Prevention of Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline. Circulation, June 20, 2006; 113(24): e873 - e923. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Goldstein, R. Adams, M. J. Alberts, L. J. Appel, L. M. Brass, C. D. Bushnell, A. Culebras, T. J. DeGraba, P. B. Gorelick, J. R. Guyton, et al. Primary Prevention of Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline. Stroke, June 1, 2006; 37(6): 1583 - 1633. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Poirier, T. D. Giles, G. A. Bray, Y. Hong, J. S. Stern, F. X. Pi-Sunyer, and R. H. Eckel Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss. Arterioscler Thromb Vasc Biol, May 1, 2006; 26(5): 968 - 976. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Poirier, T. D. Giles, G. A. Bray, Y. Hong, J. S. Stern, F. X. Pi-Sunyer, and R. H. Eckel Obesity and Cardiovascular Disease: Pathophysiology, Evaluation, and Effect of Weight Loss: An Update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease From the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism Circulation, February 14, 2006; 113(6): 898 - 918. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. M. Najarian, L. M. Sullivan, W. B. Kannel, P. W. F. Wilson, R. B. D'Agostino, and P. A. Wolf Metabolic Syndrome Compared With Type 2 Diabetes Mellitus as a Risk Factor for Stroke: The Framingham Offspring Study Arch Intern Med, January 9, 2006; 166(1): 106 - 111. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H Satoh, H Terada, A Uehara, H Katoh, M Matsunaga, K Yamazaki, F Matoh, and H Hayashi Post-challenge hyperinsulinaemia rather than hyperglycaemia is associated with the severity of coronary artery disease in patients without a previous diagnosis of diabetes mellitus Heart, June 1, 2005; 91(6): 731 - 736. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Tanne, J. H. Medalie, and U. Goldbourt Body Fat Distribution and Long-Term Risk of Stroke Mortality Stroke, May 1, 2005; 36(5): 1021 - 1025. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. M. Stuveling, S. J. L. Bakker, H. L. Hillege, P. E. de Jong, R. O. B. Gans, and D. de Zeeuw Biochemical risk markers: a novel area for better prediction of renal risk? Nephrol. Dial. Transplant., March 1, 2005; 20(3): 497 - 508. [Full Text] [PDF]
|
|
|
|
|
|
K. Jood, C. Jern, L. Wilhelmsen, and A. Rosengren Body Mass Index in Mid-Life Is Associated With a First Stroke in Men: A Prospective Population Study Over 28 Years Stroke, December 1, 2004; 35(12): 2764 - 2769. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. N. Kernan, S. E. Inzucchi, C. M. Viscoli, L. M. Brass, D. M. Bravata, G. I. Shulman, J. C. McVeety, and R. I. Horwitz Impaired insulin sensitivity among nondiabetic patients with a recent TIA or ischemic stroke Neurology, May 13, 2003; 60(9): 1447 - 1451. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. N. Kernan, S. E. Inzucchi, C. M. Viscoli, L. M. Brass, D. M. Bravata, and R. I. Horwitz Insulin resistance and risk for stroke Neurology, September 24, 2002; 59(6): 809 - 815. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. J.G. Hanley, K. Williams, M. P. Stern, and S. M. Haffner Homeostasis Model Assessment of Insulin Resistance in Relation to the Incidence of Cardiovascular Disease: The San Antonio Heart Study Diabetes Care, July 1, 2002; 25(7): 1177 - 1184. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Shinohara, T. Shoji, M. Emoto, H. Tahara, H. Koyama, E. Ishimura, T. Miki, T. Tabata, and Y. Nishizawa Insulin Resistance as an Independent Predictor of Cardiovascular Mortality in Patients with End-Stage Renal Disease J. Am. Soc. Nephrol., July 1, 2002; 13(7): 1894 - 1900. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. D Mills and P. J Grant Insulin resistance, haemostatic factors and cardiovascular risk The British Journal of Diabetes & Vascular Disease, January 1, 2002; 2(1): 19 - 26. [Abstract] [PDF]
|
|
|
|
|
|
K. Kain, A. J. Catto, J. Young, J. Bamford, J. Bavington, and P. J. Grant Insulin Resistance and Elevated Levels of Tissue Plasminogen Activator in First-Degree Relatives of South Asian Patients With Ischemic Cerebrovascular Disease Stroke, May 1, 2001; 32(5): 1069 - 1073. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Vehkavaara, J. Westerbacka, T. Hakala-Ala-Pietilä, A. Virkamäki, O. Hovatta, and H. Yki-Järvinen Effect of Estrogen Replacement Therapy on Insulin Sensitivity of Glucose Metabolism and Preresistance and Resistance Vessel Function in Healthy Postmenopausal Women J. Clin. Endocrinol. Metab., December 1, 2000; 85(12): 4663 - 4670. [Abstract] [Full Text]
|
|
|
|
|
|
H.-M. Lakka, T. A. Lakka, J. Tuomilehto, J. Sivenius, and J. T. Salonen Hyperinsulinemia and the Risk of Cardiovascular Death and Acute Coronary and Cerebrovascular Events in Men: The Kuopio Ischaemic Heart Disease Risk Factor Study Arch Intern Med, April 24, 2000; 160(8): 1160 - 1168. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Pyorala, H. Miettinen, P. Halonen, M. Laakso, and K. Pyorala Insulin Resistance Syndrome Predicts the Risk of Coronary Heart Disease and Stroke in Healthy Middle-Aged Men : The 22-Year Follow-Up Results of the Helsinki Policemen Study Arterioscler Thromb Vasc Biol, February 1, 2000; 20(2): 538 - 544. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. G. Wannamethee, I. J. Perry, and A. G. Shaper Nonfasting Serum Glucose and Insulin Concentrations and the Risk of Stroke Stroke, September 1, 1999; 30(9): 1780 - 1786. [Abstract] [Full Text] [PDF]
|
|