Glucose tolerance and insulin response to glucose in nondiabetic young male survivors of myocardial infarction

Cardiac Metabolic and Hemodynamic Effects of Insulin in Patients With Coronary Artery Disease

“…Fasting is known to be associated with low circulating insulin concentrations (25) as found in control and CAD patients, which was consistent with several other studies (13,14) but contrasted with a single report of fasting hyperinsulinism in CAD (15). Despite 10-fold increases of arterial levels after insulin, even peak values remained inside the normal physiological range seen in the fed state (26) or after glucose challenges (13,14).…”

“…Although myocardial metabolic changes during glucose, insulin, and potassium therapy have been well described (8,12), metabolic changes after insulin administered without concomitant glucose infusion are not known. Relative insulin resistance in patients with ischemic heart disease has been suggested because of increased circulating insulin responses to glucose challenge (13,14) and fasting hyperinsulinemia (15). Abnormal insulin secretory patterns have been regarded as risk factors for the development of coronary sclerosis (16) but might also be a metabolic response to the increased carbohydrate demands of the ischemic heart.…”

Involvement of the hemostatic system in the insulin resistance syndrome. A study of 1500 patients with angina pectoris. The ECAT Angina Pectoris Study Group.

“…tProbability value for cholesterol from multiple regression adjusting also for logarithmically transformed triglycerides and vice versa. 29 did not find a relation between hyperinsulinemia and coronary atheromatous score. However, in a prospective study, the same group 30 showed that among survivors of MI with glucose intolerance, PAI-1 levels and insulin release correlated with the progression of coronary atherosclerosis as evaluated by a comparison of the angiograms performed 3 to 6 months and 5 years after MI; in contrast, they found that low-density lipoprotein cholesterol was the best predictor in patients with normal glucose tolerance.…”

Myocardial infarction at a young age: mechanisms and management

“…Studies in our unit, which also included lipoprotein fractionations and aspects of haemostatic function, have identified a set of major risk factor profile components including heavy smoking, dyslipoproteinaemias involving both very low-density lipoprotein (VLDL), low-density lipoprotein (LDL) and high-density lipoprotein (HDL), a family history of premature CHD, hyperinsulinaemia and defective fibrinolytic capacity, [10][11][12][13] Minor factors which also characterized the patients were foreign extraction, a history of hypertension and manifest diabetes mellitus.8 Dyslipoproteinaemias were found in 75% of the male patients, with disorders of the metabolism of trigyceride-rich lipoproteins dominating over hypercholesterolaemias. Manifest diabetes mellitus or decreased oral glucose tolerance were present in around one-third of male and female patients.…”

“…However, there are few major studies of representative groups of patients which have also included adequate control groups; instead, case reports and uncontrolled studies illustrating diverse aspects of early-onset coronary heart disease (CHD) are abundant. Taken together, the most extensive studies of young men with myocardial infarction have unequivocally singled out a common risk factor profile comprising heavy smoking, hypercholesterolaemia, a family history of premature CHD and hypertension.2-6 In Sweden, the high proportion of immigrants has also been a striking features and comparison between countries has indicated that the risk factor pattern in young men might differ as 46 a consequence of varying cultural and genetic influences.2 The total risk factor burden appears to be heavier in younger than in older patients,6 and some established risk factors such as smoking, hypercholesterolaemia and a family history of premature CHD also seem to be more common in the young patient,6,9 compared to others such as hypertension and diabetes mellitus which are more prevalent in older age groups.Studies in our unit, which also included lipoprotein fractionations and aspects of haemostatic function, have identified a set of major risk factor profile components including heavy smoking, dyslipoproteinaemias involving both very low-density lipoprotein (VLDL), low-density lipoprotein (LDL) and high-density lipoprotein (HDL), a family history of premature CHD, hyperinsulinaemia and defective fibrinolytic capacity, [10][11][12][13] Minor factors which also characterized the patients were foreign extraction, a history of hypertension and manifest diabetes mellitus.8 Dyslipoproteinaemias were found in 75% of the male patients, with disorders of the metabolism of trigyceride-rich lipoproteins dominating over hypercholesterolaemias. Manifest diabetes mellitus or decreased oral glucose tolerance were present in around one-third of male and female patients.…”