Artículo de revista
Hyperinsulinemia is a predictor of new cardiovascular events in colombian patients with a first myocardial infarction
Fecha
2011-04-01Autor
García, Ronald G.
Rincón, Melvin Y.
Arenas, William D.
Silva, Sandra Y.
Reyes, Laura M.
Ruiz, Silvia L.
Ramírez, Fabián
Camacho López, Paul Anthony
Luengas, Carlos
Saaibi, José F.
Balestrini, Sebastián
Morillo, Carlos
Lopez-Jaramillo, Patricio
Institución
Resumen
Background: Acute Myocardial Infarction (AMI) is one of the main causes of mortality and disability in
Colombia. The factors associated to a new event in surviving subjects to a first AMI in our population have
not yet been fully identified.
Methods: Two hundred and ninety five surviving subjects to a first AMI (58.8±12.6 years) were included in a
prospective cohort study between 2000 and 2006. Lipid profile, glycemia and plasma insulin levels were
measured. Deaths of cardiovascular origin, a new AMI, unstable angina, heart failure, stroke, new myocardial
revascularization or angioplasty were considered new cardiovascular events.
Results: The study included 61 (20.6%) women and 234 (79.4%) men. The mean follow up time was 50±
30 months with a 38.9% incidence of new events. Fifty five patients (18.6%) were diabetic. Bi-varied analysis
identified as risk factors for a new cardiovascular event the presence of: hypertension, anterior descending
coronary artery stenosis, intrahospital cardiac failure, age over 55, low income, lack of education, Killip III–IV,
heart rate over 76 bpm, pulse pressure over 80 mm Hg, total cholesterol over 200 mg/dl and insulin over
10 IU/ml. After logistic regression analysis, the log values of insulin remained as the only significant predictor
for new cardiovascular events.
Conclusions: Hyperinsulinism was the most important factor associated to the occurrence of new
cardiovascular events in Colombian patients with AMI, which emphasizes the pivotal role of insulin
resistance in the physiopathologic mechanisms of atherosclerosis, especially in undeveloped countries.