Hiperinsulinemia in patients with coronary heart disease in absence of overt risk factors

ABSTRACT

The objetive of the study was to determine if male subjectes with coronary atherosclerotic heart disease (CHD) without major CHD risk factor have hyperinsulinemia and related metabolic changes. Previoys studies suggestested that hyperinsulinemia is a CHD risk factor, but they did not entirely exclude concurrent metabolic abnormalities. A prospective, comparative, cross-sectional study in a tertiary care teaching hospital in Mexico City was conducted in 15 men who had suffered myocardial infarction 6 to 24 months before and had significant coronary occlusion on angiography. Control group was formed by 15 age-matched healthy men. None had hypertension, obesity, diabetes, gout, glucose intolerance or hyperlipidemia. Body mass index (BMI), waist/hip ratio (WHR), blood pressure (BP); oral glucose tolerance test (OGTT) with measurement of serum glucose, insulin and C-peptide every 30 min for 2 h, fasting serum cholesterol, triglycerides and uric acid, areas under curve (AUC) of glucose and insulin, insuli/glucose ratio and insulin sensitivity indez were calculated. BMI, WHR and BP were similar in both groups. Fasting and post-load serum glucose and insulin concentrations were significantly higher in CHD than in control group (p<0.01); fasting glucose 5.9 ñ 0.6 vs. 4.8 ñ 0.7 nmol/l, 2-h glucose 8.3 ñ 0.6 vs. 7.3 ñ 0.9 mmol/l, fasting insulin 17.5 ñ 1.2 vs. 15.3 ñ 1.7 pmol/l, 2 h insulin 448 ñ 108 vs. 282 ñ 87 pmol/l in CHD and control group, respectively. AUC of glucose, AUC of insulin, insulin/glucose ratio, pos load C-peptide, serum cholesterol, triglycerides and uric acid levels were also significantly higher in CHD than in healthy controls. Insulin sensitivity index was significantly lower in patients with CHD (27.7 ñ 8.3) than in healthy control subjects (73.9 ñ 18) (p<0.001). Patients with CHD have hyperinsulinemia and subtle metabolic abnormalities realted with insulin resistance even in absence of overt risk factors