Insulin Response to Oral Glucose in Patients with a Previous Myocardial Infarction and in Patients with Peripheral Vascular Disease: Hyperinsulinism and Its Relationships to Hypertriglyceridemia and Overweight

Sorge, F; Schwartzkopff, W; Neuhaus, G

doi:10.2337/diab.25.7.586

Cited by 29 publications

(14 citation statements)

References 2 publications

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“…Although an abnormality in glucose tolerance may occur in the majority of patients who have had a myocardial infarction (3,6,16,17), an increased insulin response to glucose administration has been reported to have an even higher incidence in such patients (14,18,19). But the present study suggests that if the delay in the glucose peak in the G.T.T.…”

Section: Discussioncontrasting

confidence: 56%

See 1 more Smart Citation

Relationship between serum sex hormones and glucose, insulin and lipid abnormalities in men with myocardial infarction.

Phillips¹

1977

Proc. Natl. Acad. Sci. U.S.A.

106

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Fifteen patients who had had a myocardial infarction before the age of 43 were compared with thirteen age-matched normal subjects. Twelve of the patients and three of the controls had a delayed glucose and insulin peak in the glucose tolerance test. Curves with delayed peaks defin larger mean glucose and insulin areas than normal curves. When the measurements of the four patients with the largest areas under the glucose tolerance curve were separated, significant correlations were observed in the remaining patients and controls.The ratio in serum of the concentrations of estradiol-17j# to testosterone (E/) correlated with serum glucose area (r = +0.69, P < 0.001), insulin area (r = +0.80, P < 0.001), and the ratio of insulin area to glucose area (I/G) (r = +0.64, P < 0.005) in the glucose tolerance test. Serum cholesterol concentration correlated with E/T, insulin area, and I/G, and serum triglyceride concentration correlated with glucose area, I/G, and serum cholesterol concentration. The hypothesis is presented (i) that in men who have had a myocardial infarction, an abnormality in glucose tolerance and insulin response and elevation in serum cholesterol and triglyceride concentrations are all part of the same defect (glucose-insulin-lipid defect), (ii) that this glucose-insulin-lipid defect when glucose intolerance is present is the "mild diabetes" commonly associated with myocardial infarction but is based on a mechanism different from that of classical diabetes, (iii) that this glucose-insulin-lipid defect is secondary to an elevation in E/T, and (iv) that an alteration in the sex hormone milieu is the major predisposing factor for myocardial infarction.An abnormality in glucose tolerance, insulin response, serum lipid or lipoprotein concentrations, or some combination of these has been reported to occur in 80-96% of patients with coronary heart disease (1-7). In a previous study (8), a high incidence of hyperestrogenemia was observed in men under 44 years of age with myocardial infarction. The present report describes further investigations carried out on the patients and normal subjects of that study in order to determine whether the hyperestrogenemia was related to the glucose, insulin, and lipid abnormalities. The results of these investigations show a high level of correlation between the degrees of the glucose and insulin defects and the ratio of the weight concentrations in serum of estradiol-17fl to testosterone (E/T). The degree of the glucose-insulin defect was also found to correlate with the serum cholesterol and triglyceride concentrations, suggesting that an elevation in the concentrations of these lipids is part of the same defect (glucose-insulin-lipid defect). These observations raise the possibility that this glucose-insulin-lipid defect is secondary to an elevation in E/T and that a disturbance in the relationships of serum sex hormones is the major predisposing factor for myocardial infarction in men.

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Section: Discussioncontrasting

confidence: 56%

“…To obtain the mean correlation coefficient, the correlation coefficients (r) for the patient and control samples were compared and combined using the Fisher z transformation (13 (14), the one obese patient was considered separately, leaving 10 patients in Group II. The G.T.T.…”

mentioning

confidence: 99%

Relationship between serum sex hormones and glucose, insulin and lipid abnormalities in men with myocardial infarction.

Phillips¹

1977

Proc. Natl. Acad. Sci. U.S.A.

106

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“…Individuals who suffered a myocardial infarction had a higher I/G ratio than controls [21]. Santen et al observed a higher fasting I/G ratio in diabetic patients with atherosclerosis compared with those without atherosclerosis [22].…”

Section: Then: Insulin-a Link Between Metabolism and Cardiovascular Cmentioning

confidence: 98%

Insulin and cardiovascular disease: biomarker or association?

Jandeleit‐Dahm

Gray

2012

Diabetologia

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In the 1980s prospective studies using whole populations suggested a relationship between insulin and cardiovascular disease, and these studies proposed that both metabolic and haemodynamic factors were associated with cardiovascular events. The initial analysis of the Paris Prospective Study , published in 1980, showed a positive correlation between insulin and cardiovascular events in healthy middle-aged policemen after a 5 year follow-up. In the Bedford Survey (Diabetologia 22: 79-84), also performed in the 1980s, a higher cardiovascular risk was demonstrated in diabetic patients and in those with borderline diabetes; however, in contrast to the Paris Prospective Study, insulin was negatively correlated to cardiovascular endpoints in the Bedford Survey. The initial enthusiasm for insulin as a cardiovascular risk marker was dampened when the 15 year follow-up data of the Paris Prospective Study showed that the correlation between insulin and cardiovascular risk subsided with increased duration of follow-up. Despite the fact that hyperinsulinaemia was always strongly associated with other classical cardiovascular risk factors, univariate analyses usually failed to show a strong correlation between insulin and cardiovascular risk. The San Antonio Heart Study (Diabetologia 34: 416-422) performed in a bi-ethnic population that included a large proportion of Mexican-American participants again emphasised that insulin resistance may be the underlying factor associated with a cluster of metabolic and haemodynamic abnormalities. However, recently performed meta-analyses that included larger studies have not been able to confirm a critical role for insulin levels in cardiovascular risk. Indeed, it has been suggested that proinsulin or other factors may be better markers than insulin per se.

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“…Interference from previous antihypertensive treatment also seems unlikely because, firstly, all patients were off-treatment from at least 2 weeks at the moment of sampling, and, secondly, all had previously been treated with angiotensin-converting enzyme inhibitors and calcium-channel blockers; both classes of drugs did not change insulin sensitivity nor circulating insulin in previous reports. [26][27][28] A second noteworthy finding is confirmation that PVD patients exhibit hyperinsulinaemia and marginally elevated plasma glucose in response to oral glucose, 12,13 as well as a high prevalence of triglyceride abnormalities, 29 both suggestive of reduced insulin sensitivity. 24 A new finding is that hyperinsulinaemia cannot be ascribed to hypertension, since the same metabolic abnormality was shared by strictly normotensive and hypertensive subjects; possibly, physical deconditioning due to disease status may be a relevant factor.…”

Section: Lack Of a Relationship Between Urine Albumin And Post-load Pmentioning

confidence: 95%

“…For this reason, those same parameters were also evaluated in normotensive patients with atherosclerotic peripheral vascular disease (PVD) in whom hyperinsulinaemia could be anticipated on the basis of previous reports. 11,12 …”

Section: Introductionmentioning

confidence: 99%

Dissociation between albuminuria and insulinaemia in hypertensive and atherosclerotic men

et al. 1999

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To better understand the links between circulating insulin and albuminuria in essential hypertension, the plasma insulin response to a 75 gram glucose load and albuminuria were evaluated in 53 glucose-tolerant essential hypertensives and 12 controls. To allow any direct pressure-independent albuminuric effect of insulin to emerge more clearly, those same parameters were also evaluated in 20 glucose-tolerant normotensive patients with stable atherosclerotic peripheral vascular disease, a condition in which hyperinsulinaemia could be anticipated on the basis of previous reports. In response to glucose ingestion, hyperinsulinaemia was evident in both hypertensive and normotensive atherosclerotic patients, while, on average, urine albumin was elevated only in the former. When plasma insulin, systolic and diastolic blood pressure (BP) (by 24-h ambulatory BP monitoring), plasma glucose, triglycerides and

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Insulin Response to Oral Glucose in Patients with a Previous Myocardial Infarction and in Patients with Peripheral Vascular Disease: Hyperinsulinism and Its Relationships to Hypertriglyceridemia and Overweight

Cited by 29 publications

References 2 publications

Relationship between serum sex hormones and glucose, insulin and lipid abnormalities in men with myocardial infarction.

Relationship between serum sex hormones and glucose, insulin and lipid abnormalities in men with myocardial infarction.

Insulin and cardiovascular disease: biomarker or association?

Dissociation between albuminuria and insulinaemia in hypertensive and atherosclerotic men

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