Compared with Q1 and after adjusting for age, gender, race, hemoglobin, SBP, smoking, cholesterol, and insulin use, patients in Q4 had higher risk of MI (OR 3.17 [2.17–4.64], P < 0.001), stroke (OR 1.12 [1.03–1.22], P = 0.006), and CKD (OR 1.13 [1.05–1.21], P = 0.002). This evidence concerns the gene INS and chronic kidney disease.