IMPACT OF HYPERINSULINEMIA ON MORBIDITY AND MORTALITY FOLLOWING ACUTE MYOCARDIAL INFARCTION

Abstract

Objective: To study the association of hyperinsulinemia, insulin resistance andits impact on morbidity and mortality following acute myocardial infarction(AMI).

Methodology: This prospective observational study was carried out atcardiology department, Lady Reading Hospital, Peshawar from May toDecember 2008. A total of 110 patients with first acute myocardial infarctionwere assessed for fasting insulin and grouped on the basis of normal or highinsulin level. The patients were given standard therapy and evaluated formorbidity and in hospital mortality.

Results: More patients in high insulin group were obese (72% vs. 23%,p=0.001), hypertensive (70% vs. 23%, p=0.001), diabetic (70% vs. 16%,p=0.001) and had higher evidence of heart failure i,e Killip class II & III(60% vs.34%, p=0.04) and Killip class IV(20% vs. 7%, p=0.17). These patients also hadhigher fasting glucose (158% ± 25 vs. 103 ± 18 mg/dl, p=0.02) andtriglyceride (245 ± 40 vs. 165 ± 35 mg/dl, p=0.01). More patients among nonsurvivors had high insulin (80% vs. 38%, p=0.002) in survivor group.

Conclusion: Hyperinsulinemia is positively associated with obesity, diabetes,hypertension and higher morbidity and mortaliy following acute myocardialinfarction.