INS and chronic obstructive pulmonary disease: Nearly half of the study cohort had established CVD, defined as ≥1 prior MI, ≥1 prior cerebrovascular event, or established peripheral vascular disease (PVD), and these patients were older and had significantly higher rates of insulin-treated DM, chronic obstructive pulmonary disease (COPD), congestive cardiac failure, and unstable angina, compared with those without.