Interrelationships of Hyperinsulinism and Hypertriglyceridemia in Young Patients with Coronary Heart Disease

Abstract

Fasting serum lipid levels, glucose tolerance, and immunoreactive insulin concentrations of 50 young patients with coronary heart disease (CHD) and 30 control subjects were evaluated to study the interrelationships of these metabolic factors. Abnormalities in one or more of these factors could be shown in 90% of the patients and 20% of the control subjects. Thirty-four of the 50 patients had elevated cholesterol or triglyceride levels, or both, 30 had abnormally elevated or delayed insulin responses after glucose, and 17 had abnormal glucose tolerance. A significant correlation existed between serum triglyceride and insulin concentrations. When insulin levels were reduced by phenformin, triglyceride concentrations fell toward normal.These findings indicate that carbohydrate, insulin, and lipid abnormalities are rather prevalent in patients with CHD. Excessive insulin secretion secondary to mild glucose intolerance probably induces hepatic synthesis of triglycerides and hypertriglyceridemia. Dietary alterations or pharmacological agents may help to control some of the metabolic abnormalities associated with premature CHD.

Diurnal fluctuations in triglyceride, free fatty acids, and insulin during sucrose consumption and insulin infusion in man

“…Bagdade, Porte, and Bierman (18) In studies of prolonged carbohydrate intake, the triglyceride concentration as measured in the fasting state in the morning, has frequently been found to correlate positively with the insulin concentration, and it has therefore been suggested that the increased secretion of insulin might stimulate the production of triglyceride (2). Furthermore, a significant positive correlation has been found between serum triglyceride and serum insulin levels in a group of young patients with coronary heart disease; reduction in the insulin levels with phenformin was associated with a decrease in the triglyceride concentration (21). There is, however, little evidence that insulin stimulates the formation of plasma triglyceride, although insulin given in vivo does restore the capacity of the perfused liver to secrete triglyceride (22) and in rat liver slices insulin has been reported to stimulate the incorporation of '4C-U-glucose into triglyceride fatty acids (23,24).…”

Type 2 (non-insulin-dependent) diabetes mellitus and coronary heart disease ? chicken, egg or neither?

“…One pre-existing factor which may sway the balance in the direction of diabetes is obesity, which has a much stronger relationship in prospective studies to the incidence of diabetes than to that of CHD [31]. The common antecedents date back to adolescence or before, for association between levels of blood pressure, blood glucose and plasma lipids have been demonstrated in the young as well as in adults [32][33][34]. For both serum cholesterol and blood pressure, there is evidence of tracking of level with increasing age [35,36].…”

Influence of obesity on plasma lipoproteins, glycaemia and insulinaemia in patients with familial combined hyperlipidaemia

“…Hyperinsulinaemia in the basal state has been described as being moderately correlated with concentrations of plasma of apo B and triglycerides. 42,43 Data regarding insulin resistance are, to-date, limited possibly because of the relationship with abdominal obesity which, per se, produces a certain degree of insulin resistance 44 that would modulate the basal state measurements.…”