IMPACT OF HYPERINSULINEMIA ON MORBIDITY AND MORTALITY FOLLOWING ACUTE MYOCARDIAL INFARCTION

Objective: To study the association of hyperinsulinemia, insulin resistance and its impact on morbidity and mortality following acute myocardial infarction (AMI). Methodology: This prospective observational study was carried out at cardiology department, Lady Reading Hospital, Peshawar from May to December 2008. A total of 110 patients with first acute myocardial infarction were assessed for fasting insulin and grouped on the basis of normal or high insulin level. The patients were given standard therapy and evaluated for morbidity 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 had higher fasting glucose (158% +/- 25 vs. 103 +/- 18 mg/dl, p=0.02) and triglyceride (245 +/- 40 vs. 165 +/- 35 mg/dl, p=0.01). More patients among non survivors 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 myocardial infarction.