Insulin Response to Oral Glucose Loading and Coronary Artery Disease in Nondiabetics

Abstract

SUMMARYHyperinsulinemia is related to coronary artery disease (CAD), as an indication of decreased insulin sensitivity. Although there are many studies showing the relation between fasting insulin levels and insulin resistance, there are fewer studies on postprandial insulin levels. The aim of the present study was to investigate the relationship between postprandial insulin levels and CAD and its extent in our patients. For this purpose, oral glucose tolerance testing was performed in 222 patients with no known diabetes and who were scheduled to undergo diagnostic coronary angiography. The patients were first separated into two groups, one group (group I) having an insulin response within reference values to oral glucose loading, and the other group (group II) with a higher than normal insulin response. The presence and extent of CAD in the two groups were compared. While 65% of the patients in group 1 had CAD, this rate increased to 79% in group 2 patients (P = 0.02). The mean vessel scores were 0.92 ± 0.78 in group 1 and 1.67 ± 0.99 (P < 0.0001) in group 2 patients. The stenosis scores were 2.192 ± 2.077 in group 1 and 5.588 ± 3.519 (P < 0.001) in group 2, while the extent scores were 1.230 ± 1.292 in group 1 and 2.729 ± 1.847 in group 2 (P < 0.0001). The differences between the two groups were significant. Postprandial insulin values were positively correlated with CAD (P = 0.001, r = 0.214), vessel scores (P < 0.0001, r = 0.326), stenosis scores (P < 0.0001, r = 0.261), and extent scores (P < 0.0001, r = 0.419). Logistic regression analysis revealed hyperinsulinemia increased CAD independent from the other risk factors (OR = 5.742, CI 95%: 1.809-18.227, P = 0.003). (Int Heart J 2005; 46: 761-770) Key words: Postprandial hyperinsulinemia, Severity of coronary artery disease HYPERINSULINEMIA, which is an indication of decreased insulin sensitivity, is recognized as an independent risk factor for CAD.1,2) High insulin levels are known to lead to CAD via many different mechanisms. Among these are an increase in low density lipoprotein (LDL) receptor activities in arterial smooth From the

Decreased Beta Cell Function and Insulin Sensitivity Contributed to Coronary Artery Disease in Patients with Normal Glucose Tolerance

“…R.A. DeFronzo et al demonstrated for the first time that individuals with angiographically documented CAD are characterized by insulin resistance 16) . It is well known that insulin resistance is directly related to the occurrence of atherosclerosis and the risk for cardiovascular diseases [17][18][19] ; however, few studies have focused on the relationship between insulin secretion and coronary atherosclerosis 3,4,20) . Moreover, these studies did not investigate beta cell function together with insulin secretion.…”

“…Moreover, most of the research has been concerned with the correlation between hyperinsulinemia and/or insulin resistance and atherosclerosis and/or cardiovascular events. It is well known that insulin resistance and hyperinsulinemia are major candidates contributing to the development of atherosclerosis in patients; however, few studies have focused on the role of insulin secretion during the development of atherosclerosis 3,4) . Beta cell dysfunction and/or insulin resistance are two important pathophysiological factors in type 2 diabe-one year).…”

Resveratrol Ameliorates Arterial Stiffness Assessed by Cardio-Ankle Vascular Index in Patients With Type 2 Diabetes Mellitus

“…[1][2][3] Although the current incidence of atherosclerotic diseases in Japan is relatively low compared to that in other countries, an increase is expected in the near future with the increase of diabetic patients. Therefore, treatment for atherosclerosis in diabetic patients is an important concern.…”

Postprandial Insulin and Triglycerides after Different Breakfast Meal Challenges: Use of Finger Stick Capillary Dried Blood Spots to Study Postprandial Dysmetabolism

“…For analyses of between-meal differences, the 2 h time point was chosen because published studies looking at postprandial hyperinsulinemia 5,7,8,13 have used this time point, at which glucose and insulin levels are expected to have returned to normal values in healthy subjects. Plasma glucose concentrations normally peak within 1 h after a meal and return to normal values within 2-3 h. 14 Population studies of postprandial hypertriglyceridemia have found it to be most predictive of cardiovascular events when measured 2 to 4 h after eating.…”

“…5,6 In subjects with no known diabetes, high postprandial insulin levels have been found to be an independent risk factor for CHD. 7,8 Triglyceride levels measured 2-4 h after a meal are also highly predictive of cardiovascular events, especially in women. 9,10 Cardiometabolic risk markers are routinely measured in fasting blood samples in order to provide meaningful levels of cholesterol, insulin, and triglycerides that are not affected by recent food consumption.…”