Dietary quality indices in relation to cardiometabolic risk among Finnish children aged 6-8 years - The PANIC study.

BACKGROUND AND AIMS: There are no studies on the relationships of dietary quality indices to the clustering of cardiometabolic risk factors in children. We therefore investigated the associations of four dietary quality indices with cardiometabolic risk score and cardiometabolic risk factors in Finnish children. METHODS AND RESULTS: Subjects were a population sample of 204 boys and 198 girls aged 6-8 years. We assessed diet by 4-day food records and calculated Dietary Approaches to Stop Hypertension (DASH) Score, Baltic Sea Diet Score (BSDS), Mediterranean Diet Score (MDS), and Finnish Children Healthy Eating Index (FCHEI). We calculated the age- and sex-adjusted cardiometabolic risk score summing up Z-scores for waist circumference, mean of systolic and diastolic blood pressure and concentrations of fasting serum insulin and fasting plasma glucose, triglycerides and HDL cholesterol, the last multiplying by -1. Higher FCHEI was associated with lower cardiometabolic risk score among boys (standardised regression coefficient ß = -0.14, P = 0.044) adjusted for age, physical activity, electronic media time and household income. Higher DASH Score was related to a lower serum insulin in boys (ß = -0.15, P = 0.028). Higher DASH Score (ß = -0.16, P = 0.023) and FCHEI (ß = -0.17, P = 0.014) were related to lower triglyceride concentration in boys. Higher FCHEI was associated with lower triglyceride concentration in girls (ß = -0.16, P = 0.033). Higher DASH Score (ß = -0.19, P = 0.011) and BSDS (ß = -0.23, P = 0.001) were associated with lower plasma HDL cholesterol concentration in girls. CONCLUSION: Higher FCHEI was associated with lower cardiometabolic risk among boys, whereas DASH Score, BSDS or MDS were not associated with cardiometabolic risk in children.

Dietary factors associated with metabolic risk score in Finnish children aged 6-8 years: the PANIC study.

PURPOSE: Previous evidence for the associations of eating frequency and food consumption with clustering of metabolic risk factors among children is limited. We therefore investigated association of the daily number of main meals and snacks and food consumption with a metabolic risk score and individual metabolic risk factors in primary school children. METHODS: The subjects were a population sample of Finnish girls and boys 6-8 years of age. Dietary factors were measured by a four-day food record. Metabolic risk score was calculated summing up the Z-scores of waist circumference, systolic and diastolic blood pressure, and concentrations of fasting serum insulin and fasting plasma glucose, triglycerides and high-density lipoprotein cholesterol, the latest multiplying by -1. RESULTS: Skipping main meals (standardized regression coefficient ß = -0.18, P < 0.001), a higher consumption of non-root vegetables (ß = 0.18, P < 0.01), low-fat vegetable-oil-based margarine (ß = 0.13, P < 0.01) and sugar-sweetened beverages (ß = 0.11, P < 0.05) and a lower consumption of vegetable oils (ß = -0.10, P < 0.05) were associated with a higher metabolic risk score after adjustment for age, sex, total physical activity, electronic media time, energy intake and other dietary factors. The consumption of red meat was directly related to the metabolic risk score, but the association was not statistically significant after adjustment for energy intake. CONCLUSIONS: Eating main meals regularly, decreasing the consumption of sugar-sweetened beverages and low-fat margarine and increasing the consumption of vegetable oils should be emphasized to reduce metabolic risk among children.

Dietary factors associated with overweight and body adiposity in Finnish children aged 6-8 years: the PANIC Study.

OBJECTIVES: To investigate the associations of dietary factors with overweight, body fat percentage (BF%), waist circumference (WC) and hip circumference (HC) among children. DESIGN: Cross-sectional analysis of the Physical Activity and Nutrition in Children (PANIC) Study among 510 children (263 boys, 247 girls) aged 6-8 years from Kuopio, Finland. METHODS: The children's weight, height, WC and HC were measured. Overweight was defined by International Obesity Task Force body mass index cutoffs. The BF% was measured by dual-energy X-ray absorptiometry, nutrient intakes and meal frequency by 4-day food records and eating behaviour by Children's Eating Behaviour Questionnaire. RESULTS: Daily consumption of all the three main meals was inversely associated with overweight (odds ratio (OR) 0.37, 95% confidence interval (CI) 0.18-0.75), BF% (ß -0.12, P = 0.012), WC (ß -0.16, P = 0.002) and HC (ß -0.15, P = 0.002). Enjoyment of food, food responsiveness and emotional overeating were directly associated with overweight (OR 1.57, 95% CI 1.04-2.35; OR 4.68, 95% CI 2.90-7.54; OR 2.60, 95% CI 1.52-4.45, respectively), BF% (ß 0.13, P = 0.004; ß 0.30, P<0.001; ß 0.09, P = 0.035, respectively), WC (ß 0.14, P = 0.003; ß 0.40, P<0.001; ß 0.19, P<0.001, respectively) and HC (ß 0.15, P = 0.001; ß 0.38, P<0.001; ß 0.15, P = 0.001, respectively). Satiety responsiveness was inversely associated with overweight (OR 0.42, 95% CI 0.26-0.67), BF% (ß -0.20, P<0.001), WC (ß -0.26, P<0.001) and HC (ß -0.26, P<0.001). Slowness in eating was inversely associated with overweight (OR 0.61, 95% CI 0.41-0.92), WC (ß -0.16, P = 0.001) and HC (ß -0.17, P<0.001). Protein intake was directly associated with BF% (ß 0.11, P = 0.017), WC (ß 0.11, P = 0.020) and HC (ß 0.13, P = 0.008). CONCLUSIONS: Promoting regular consumption of main meals and healthy eating behaviours should be emphasized in the prevention of overweight among children. More research is needed on the association of protein-rich foods with body adiposity in children.

Dietary factors and their associations with socioeconomic background in Finnish girls and boys 6-8 years of age: the PANIC Study.

BACKGROUND/OBJECTIVES: To study nutrient intake, food consumption and meal pattern, and their associations with socioeconomic background in Finnish children. SUBJECTS/METHODS: The subjects were a population sample of 424 children (211 girls, 213 boys) 6-8 years of age. Nutrient intake and meal pattern were measured by food records, and food intake and socioeconomic characteristics were assessed by questionnaires. RESULTS: Intakes of saturated fat, sucrose and salt were higher, and intakes of vitamin D, iron and fibre and unsaturated-to-saturated fat ratio lower than recommended. Less than 5% of children consumed vegetables, fruit and berries as recommended. Children with highest parental education more likely ate fish (odds ratio (OR) 2.20, 95% confidence interval (CI) 1.06-4.54), fibre-rich bread (OR 5.06, 95% CI 1.80-14.29) and main meals (OR 2.54, 95% CI 1.34-4.83), but less likely used soft margarine (OR 0.43, 95% CI 0.20-0.94) as recommended than children with lowest parental education. Children with highest household income more likely consumed skimmed milk (OR 2.43, 95% CI 1.21-4.88) and fish (OR 2.21, 95% CI 1.12-4.36) as recommended than children with lowest household income. Only 34% of girls and 45% of boys ate all main meals daily. Snacks provided as much as 42% of total energy intake. CONCLUSIONS: Children do not meet recommendations in all important nutrients. Children from lowest socioeconomic position least likely consumed fish, skimmed milk and fibre-rich bread and ate main meals, but most likely used soft margarine as recommended. Less than half of children ate all main meals daily.

Association of diarrhoea, poor hygiene and poor social conditions in childhood with blood pressure in adulthood.

BACKGROUND: Previous research has suggested that dehydration in infancy may lead to high blood pressure in later life because of sodium retention. The purpose of this study was to examine the effect of poor hygiene of the child, poor social and poor housing conditions at home and diarrhoea in childhood as proxies for dehydration on high blood pressure in later life. METHODS: Data were from a subset of participants in the Kuopio Ischaemic Heart Disease Risk Factor Study, a population-based cohort study in eastern Finland. Information on childhood factors was collected from school health records (n=952), from the 1930s to the 1950s. Adult data were obtained from baseline examinations of the Kuopio Ischaemic Heart Disease Risk Factor Study cohort (n=2682) in 1984-1989. RESULTS: Men who had poor hygiene in childhood had on average 4.07 mm Hg (95% CI 0.53 to 7.61) higher systolic blood pressure than men who had good or satisfactory hygiene in childhood in the age-adjusted analysis. Reports of diarrhoea were not associated with adult blood pressure. CONCLUSIONS: The authors' findings suggest that poor hygiene and living in poor social conditions in childhood are associated with higher systolic blood pressure in adulthood. Reported childhood diarrhoea did not explain the link between hygiene and high blood pressure in adulthood.

Obesity and weight gain are associated with increased incidence of hyperinsulinemia in non-diabetic men.

We investigated the temporal relationships between obesity, weight change and hyperinsulinemia in a population-based 4-year follow-up study of 695 middle-aged, non-diabetic, and normoinsulinemic men. Thirty-eight men developed hyperinsulinemia during the follow-up (fasting serum insulin > or = 12.0 mU/l). In logistic regression analysis adjusting for other risk factors, men with body mass index of > or = 26.7 kg/m2 (highest third) had a 6.6-fold (p = 0.001) risk of developing hyperinsulinemia, compared with men with body mass index of < 24.4 kg/m2 (lowest third). Correspondingly, men with waist-to-hip ratio of > or = 0.95 (highest third) had a 3.5-fold (p = 0.028) incidence of hyperinsulinemia compared with men with waist-to-hip ratio of < 0.90 (lowest third). Weight gain in middle age and weight gain from the age of 20 years to middle age were also associated with increased risk of hyperinsulinemia. Hyperinsulinemia at baseline was not associated with weight gain during the follow-up. This prospective population-based study emphasizes the importance of avoiding obesity and weight gain during adulthood in preventing hyperinsulinemia.

Serum fatty acid composition predicts development of impaired fasting glycaemia and diabetes in middle-aged men.

AIMS: Dietary fatty acid intake is reflected in serum fatty acid composition. Studies prospectively investigating serum fatty acids and development of impaired fasting glycaemia (IFG) or diabetes mellitus (DM) are largely lacking. We assessed the association of serum fatty acid composition with development of IFG or DM. METHODS: Middle-aged normoglycaemic men (n = 895) participating in a prospective cohort study were followed up after 4 years. RESULTS: At baseline proportions of serum esterified and non-esterified saturated fatty acids were increased and polyunsaturated fatty acids decreased in men who after 4 years had developed IFG (n = 56) or DM (n = 34). No differences in dietary fatty acid composition as recorded in 4-day dietary records were noted. In logistic regression analyses adjusting for age; obesity; and fasting lipid, glucose and insulin concentrations, men with proportions of non-esterified and esterified linoleate in the upper third had nearly half the risk for IFG or DM compared with the lower third. In covariate analyses, baseline non-esterified linoleate proportions were associated with changes in fasting insulin and glucose concentrations over the 4-year follow-up. Baseline esterified fatty acid composition was also associated with changes in insulin. CONCLUSIONS: High serum linoleate proportions decreased the risk of developing IFG or DM in middle-aged men over a 4-year follow-up, possibly mediated in part by insulin resistance. These findings support recommendations to substitute vegetable fat for animal and dairy fat in the prevention of disturbances of glucose and lipid metabolism.

Abdominal obesity is associated with increased risk of acute coronary events in men.

AIMS: The purpose of the study was to investigate the associations of abdominal obesity and overall obesity with the risk of acute coronary events. METHODS AND RESULTS: Body mass index indicating overall obesity and waist-to-hip ratio and waist circumference indicating abdominal obesity were measured for 1346 Finnish men aged 42-60 years who had neither cardiovascular disease nor cancer at baseline. There were 123 acute coronary events during an average follow-up of 10.6 years. In Cox regression analyses adjusted for confounding factors, waist-to-hip ratio (P=0.009), waist circumference (P=0.010) and body mass index (P=0.013) as continuous variables were associated directly with the risk of coronary events. These associations were in part explained by blood pressure, diabetes, fasting serum insulin, serum lipids, plasma fibrinogen, and serum uric acid. Waist-to-hip ratio of > or =0.91 was associated with a nearly threefold risk of coronary events. Waist-to-hip ratio provided additional information beyond body mass index in predicting coronary heart disease, whereas body mass index did not add to the predictive value of waist-to-hip ratio. Abdominal obesity combined with smoking and poor cardiorespiratory fitness increased the risk of coronary events 5.5 and 5.1 times, respectively. CONCLUSIONS: Abdominal obesity is an independent risk factor for coronary heart disease in middle-aged men and even more important than overall obesity. Since the effect of abdominal obesity was strongest in smoking and unfit men, the strategy for lifestyle modification to prevent coronary heart disease should address these issues jointly.

Exhaustive exercise increases plasma/serum total oxidation resistance in moderately trained men and women, whereas their VLDL + LDL lipoprotein fraction is more susceptible to oxidation.

The purpose of this study was to evaluate the effects of exhaustive exercise (marathon run) on different lipid peroxidation measurements, including copper-induced serum lipids and VLDL + LDL oxidation susceptibility, and on plasma total antioxidative capacity (TRAP), muscular damage and plasma antioxidants in healthy moderately trained male (n = 21) and female (n = 25) volunteers. Blood samples were taken before and just after the 42-km run. In women, baseline levels of several antioxidative compounds (serum albumin and uric acid, plasma free thiols and blood glutathione) were lower, resulting in 21.5% lower plasma total antioxidative capacity and 70.3% higher serum oxidation susceptibility, compared to men. To compare effects in men and women, the exercise-induced variable changes were adjusted for their baseline levels. After this adjustment, there were no statistically significant differences between the genders in the extent of muscular damage (serum creatine kinase, (CK)), or in the change in serum lipids or VLDL + LDL oxidation susceptibility, or that of plasma antioxidative capacity. A possible beneficial effect of exercise was that serum HDL cholesterol levels increased significantly in both genders, but especially in women. In the group of pooled genders (n=46), the increases in serum CK and in plasma lactate were 190% (95% CI, 133% to 246%) and 109% (95% CI, 65% to 175%), respectively. On the basis of our lipid peroxidation and TRAP measurements, uric acid was observed to be the most important plasma antioxidant. The effect of exercise was to decrease the oxidation susceptibility of serum lipids by 24.8% (95% CI 13.4% to 36.2%) and to elevate plasma TRAP by 14.6% (95% CI, 11.4% to 17.7%). Nonetheless, the oxidation susceptibility of the VLDL + LDL fraction increased by 11.0% (95% CI, 1.9% to 20.2%). Our results suggest that there are no gender-based differences in exhaustive exercise-induced lipid peroxidation or muscular damage. Secondly, even though exhaustive exercise can increase plasma/serum total resistance towards oxidation, the oxidation resistance of the atherogenic lipoprotein fraction might be diminished. On the basis of these results, several in vitro measurements of lipid peroxidation assessing both water and lipid soluble plasma fractions are needed if a true perspective of the plasma redox status is to be obtained.

Leucine7 to proline7 polymorphism in the preproneuropeptide Y is associated with the progression of carotid atherosclerosis, blood pressure and serum lipids in Finnish men.

A rather common leucine7-to-proline7 (Leu7Pro) polymorphism in the preproneuropeptide Y (prepro-NPY) gene signal peptide may be important in blood pressure regulation, cholesterol metabolism and the pathogenesis of atherosclerosis in humans. We examined the associations of the Leu7Pro polymorphism with carotid atherosclerotic progression, blood pressure and serum lipids in a population-based sample of 966 men aged 42-60 years in Finland. The Pro7 substitution (carrier frequency 12.2%) was associated with accelerated four-year increase in the mean (P=0.01) and maximal (P=0.007) common carotid intima-media thickness (IMT) and with slightly increased systolic (P=0.03) and diastolic (P=0.02) blood pressures, adjusted for other major risk factors. Men with Pro7 substitution had 30.6% (95% CI 6.9-54.0%) greater increase in the mean IMT and 20.0% (95% CI 5.3-34.4%) greater increase in the maximal IMT than men with Leu7/Leu7 genotype. The Pro7 substitution was also related to increased serum total cholesterol (P=0.01) and LDL cholesterol (P=0.02) in obese (body mass index (BMI)>30 kg/m(2)) men. This study provides important evidence suggesting that the Pro7 substitution in the prepro-NPY is an important risk factor for accelerated atherosclerotic progression, increased blood pressure and increased serum cholesterol in humans.

Cardiorespiratory fitness and the progression of carotid atherosclerosis in middle-aged men.

BACKGROUND: Good cardiorespiratory fitness has been associated with reduced risk for clinical events of atherosclerotic vascular diseases, but whether it is related to slower progression of early atherosclerosis is unclear. OBJECTIVE: To study the association between cardiorespiratory fitness and the progression of early carotid atherosclerosis. DESIGN: 4-year follow-up study. SETTING: Eastem Finland. PARTICIPANTS: Population-based sample of 854 men 42 to 60 years of age. MEASUREMENTS: Maximal oxygen uptake (VO2max [mL/kg per minute]) was measured directly by using respiratory gas exchange in a cycle ergometer exercise test. Carotid atherosclerosis was assessed by using B-mode ultrasonography. RESULTS: After adjustments for age, technical covariates, and cigarette smoking, VO2max had strong, inverse, and graded associations with 4-year increases in maximal intima-media thickness (IMT) (standardized regression coefficient beta = -0.120; P = 0.002), plaque height (beta = -0.140; P < 0.001), surface roughness (beta = -0.147; P < 0.001), and mean IMT (beta = -0.080; P = 0.035). These associations weakened but remained statistically significant after additional adjustment for systolic blood pressure, serum levels of apolipoprotein B, diabetes, and plasma fibrinogen levels. The increases in maximal IMT, surface roughness, and mean IMT (23%, 31%, and 100%, respectively) were larger among men in the lowest quartile of VO2max (<26.1 mL/kg per minute) than among those in the highest quartile (>36.2 mL/kg per minute). CONCLUSIONS: Good cardiorespiratory fitness is associated with slower progression of early atherosclerosis in middle-aged men. These findings are important because they emphasize that middle-aged men can be evaluated for cardiorespiratory fitness to estimate their future risk for atherosclerotic vascular diseases. Additional research is warranted to investigate a possible causal relationship between cardiorespiratory fitness and atherosclerosis.

Abdominal obesity is associated with accelerated progression of carotid atherosclerosis in men.

Abdominal obesity increases the risk of clinical atherosclerotic diseases, but whether it accelerates the progression of preclinical atherosclerosis is unknown. We studied whether waist-to-hip ratio (WHR) and waist circumference are associated with 4-year increase in indicators of common carotid atherosclerosis, assessed by B-mode ultrasonography, in 774 Finnish men aged 42-60 years without atherosclerotic diseases. Men with WHR of <0.91, 0.91-0.96 and >0.96 (thirds) had increase in maximal intima-media thickness (IMT) of 0.230, 0.255 and 0.281 mm/4 years (P=0.007 for linear trend; P=0.025 for difference) and plaque height of 0.241, 0.254 and 0.291 mm/4 years (P=0.005, P=0.013) adjusting for age, body mass index and technical covariates. Men with waist circumference of <85, 85-93 and >93 cm (thirds) had increase in maximal IMT of 0.227, 0.251 and 0.290 mm/4 years (P=0.011, P=0.035) and plaque height of 0.229, 0.263 and 0.296 mm/4 years (P=0.003, P=0.013). These associations were stronger in men with high (> or =3.8 mmol/l) than lower serum LDL cholesterol (P<0.05 for interaction). This is the first documentation that abdominal obesity is associated with accelerated progression of atherosclerosis, and supports the view that it is an important cardiovascular risk factor. This study emphasizes the role of avoiding abdominal obesity to prevent atherosclerotic diseases.

Antioxidant Supplementation in Atherosclerosis Prevention (ASAP) study: a randomized trial of the effect of vitamins E and C on 3-year progression of carotid atherosclerosis.

OBJECTIVES: To study the efficacy of vitamin E and C supplementation on the progression of carotid atherosclerosis, hypothesizing an enhanced preventive effect in men and in smokers and synergism between vitamins. DESIGN AND SUBJECTS: Double-masked two-by-two factorial trial, randomization in four strata (by gender and smoking status) to receive twice daily either 91 mg (136 IU) of d-alpha-tocopherol, 250 mg of slow-release vitamin C, a combination of these or placebo for three years. A randomized sample of 520 smoking and nonsmoking men and postmenopausal women aged 45-69 years with serum cholesterol >/= 5.0 mmol L-1 were studied. SETTING: The population of the city of Kuopio in Eastern Finland. INTERVENTION: Twice daily either a special formulation of 91 mg of d-alpha-tocopherol, 250 mg of slow-release vitamin C, a combination of these (CellaVie(R)) or placebo for three years. MEASUREMENTS: Atherosclerotic progression, defined as the linear regression slope of ultrasonographically assessed common carotid artery mean intima-media thickness (IMT), was calculated over semi-annual assessments. RESULTS: The average increase of the mean IMT was 0.020 mm year-1 amongst men randomized to placebo and 0.018 mm year-1 in vitamin E, 0.017 mm year-1 in vitamin C and 0.011 mm year-1 in the vitamin combination group (P = 0.008 for E + C vs. placebo). The respective means in women were 0.016, 0.015, 0.017 and 0.016 mm year-1. The proportion of men with progression was reduced by 74% (95% CI 36-89%, P = 0.003) by supplementation with the formulation containing both vitamins, as compared with placebo. CONCLUSIONS: Our study shows that a combined supplementation with reasonable doses of both vitamin E and slow-release vitamin C can retard the progression of common carotid atherosclerosis in men. This may imply benefits with regard to other atherosclerosis-based events.

The common pentanucleotide polymorphism of the 3'-untranslated region of the leptin receptor gene is associated with serum insulin levels and the risk of type 2 diabetes in non-diabetic men: a prospective case-control study.

OBJECTIVES: The purpose of the study was to test whether the pentanucleotide insertion/deletion polymorphism in the 3'-untranslated region (3'-UTR) of the leptin receptor gene, which has previously been associated with serum insulin levels in obese subjects, is associated with insulin levels and the risk of type 2 diabetes in non-diabetic middle-aged men. SUBJECTS AND DESIGN: We studied these associations in a prospective population-based nested case-control study in 41 men who developed type 2 diabetes during 4-year follow-up and 81 controls who were matched for age, obesity, baseline glucose and insulin and other strongest risk factors. Both the cases and the controls came from a cohort of 985 men who had no diabetes at baseline. RESULTS: There was one homozygote and 22 heterozygotes for the 3'-UTR insertion allele amongst all 122 men. The carrier frequency of this allele was 9.8% amongst the cases and 23.5% amongst the controls. At baseline, the mean fasting serum insulin was 12.2 mU L-1 in the 23 men who were heterozygous or homozygous for the insertion allele and 17.1 mU L-1 in the 99 men who were homozygous for the deletion allele (P = 0.005). In a logistic regression model adjusting for four strongest non-matched predictors of type 2 diabetes, the carriers of the insertion allele had a 79% reduced risk of diabetes (OR = 0.21; 95% CI = 0.06-0.77, P = 0.019), compared with non-carriers. CONCLUSION: Our findings support the hypothesis that alterations in the leptin signalling system could contribute to serum insulin levels and the development of type 2 diabetes.

Hyperinsulinemia and the risk of cardiovascular death and acute coronary and cerebrovascular events in men: the Kuopio Ischaemic Heart Disease Risk Factor Study.

BACKGROUND: The role of hyperinsulinemia as a cardiovascular risk factor is controversial. We studied whether hyperinsulinemia is independently associated with increased cardiovascular morbidity and mortality. METHODS: Fasting serum insulin level and other cardiovascular risk factors were determined in 1521 men in eastern Finland aged 42 to 60 years with neither cardiovascular disease nor diabetes at baseline. Forty-five cardiovascular deaths, 110 acute coronary events, 48 strokes, and 163 any cardiovascular events occurred during an average follow-up of 9.5 years. A total of 163 cardiovascular events (45 cardiovascular deaths, 110 acute coronary events, and 48 strokes) occurred during an average follow-up of 9.5 years. RESULTS: In Cox regression analysis adjusting for age and examination years, fasting serum insulin level as a continuous variable was directly associated with the risk of cardiovascular death (P = .006), acute coronary events (P = .04), and stroke (P = .02). Men with insulin levels of 52 to 66 pmol/L, 67 to 89 pmol/L, and 90 pmol/L or more (3 highest quartiles) had 1.4-fold (95% confidence interval, 0.5-3.7), 1.4-fold (95% confidence interval, 0.5-3.7), and 2.5-fold (95% confidence interval, 1.0-5.9; P = .05) cardiovascular mortality, respectively, compared with men with insulin levels of less than 52 pmol/L (lowest quartile) (P = .04 for linear trend). Adjustment for serum lipid levels, blood pressure, and obesity reduced the excess cardiovascular mortality in the highest insulin quartile by 7%, 33%, and 67%, respectively. There were no statistically significant differences in the incidence of acute coronary events and stroke between the insulin quartiles. CONCLUSIONS: Hyperinsulinemia had a modest association with increased cardiovascular mortality in middle-aged men. This relationship was largely explained by obesity, hypertension, and dyslipidemia. Hyperinsulinemia had even weaker associations with the risk of acute coronary event and stroke.

Hyperinsulinemia is associated with the incidence of hypertension and dyslipidemia in middle-aged men.

Insulin resistance or compensatory hyperinsulinemia has been associated with hypertension and dyslipidemia in cross-sectional studies. In contrast, evidence from prospective population-based studies, which could establish the time order of the relationship, is sparse and inconsistent. Therefore, we investigated the associations of hyperinsulinemia with the incidence of hypertension and dyslipidemia in the Kuopio Ischemic Heart Disease Risk Factor Study, a population-based 4-year follow-up study of middle-aged men from eastern Finland. Out of 975 men who had no diabetes, 543 had resting systolic blood pressure (sBP) of < 165 mmHg and resting diastolic blood pressure (dBP) of < 95 mmHg at baseline and were not taking antihypertensive medication, and 764 had serum triglycerides of < 2.3 mmol/l and HDL cholesterol of > or =1.0 mmol/l at baseline. In logistic regression models adjusted for age, baseline resting blood pressure, baseline lipids, obesity, weight change, and other risk factors, men with hyperinsulinemia (fasting insulin in the highest quintile, > or =12.0 mU/l) at baseline had a 2.0-fold (95% CI 1.1-3.5, P = 0.025) incidence of hypertension (sBP of > or =165 or dBP of > or =95 mmHg), a 2.1-fold (95% CI 1.3-3.4, P = 0.002) incidence of dyslipidemia (serum HDL cholesterol of < 1.0 mmol/l or serum triglycerides of > or =2.3 mmol/l), and a 2.6-fold (95% CI 1.1-6.3, P = 0.028) incidence of the combination of these disorders in 4 years, compared with normoinsulinemic men. These findings demonstrate the role of hyperinsulinemia in incident hypertension and dyslipidemia and suggest that both hypertension and dyslipidemia are associated with insulin metabolism disturbance, independently of obesity and body weight.