Diabetes, fasting insulin, glucose, and risk of coronary heart disease

We assessed the association of diabetes, fasting blood glucose, and insulin with coronary heart disease incidence over 4 to 7 years in a cohort of 13,446 middle-aged adults. Coronary heart disease risk was elevated more than threefold among women and more than twofold among men with diabetes, after adjustment for demographic characteristics, smoking status, ethanol intake, sports participation, and hormone replacement therapy. The percentage of coronary heart disease cases that could be attributed to diabetes (population attributable risk) was 27% for black women, 15% for non-black women, 8% for black men, and 12% for non-black men. Among persons without diabetes, fasting blood glucose was not independently associated with an incidence of coronary heart disease. We found a positive association between fasting insulin levels and coronary heart disease for women who did not have diabetes.