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Insulin Resistance Associated With Compensatory Hyperinsulinemia as an Independent Risk Factor for Vasospastic Angina
- Source :
- Circulation. 92:1749-1757
- Publication Year :
- 1995
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 1995.
-
Abstract
- Background It is generally believed that coronary artery spasm plays an important role in the progression of obstructive coronary artery disease. Since insulin resistance together with hyperinsulinemia plays an important role in the pathogenesis of coronary atherosclerosis, we investigated the association of hyperinsulinemia and insulin resistance with vasospastic angina (VAP). Methods and Results The study population consisted of 60 patients with VAP and 42 control subjects (62 subjects with normal glucose tolerance and 40 with impaired glucose tolerance). Insulin sensitivity was determined by the steady-state plasma glucose (SSPG) method for nondiabetic, normotensive, nonobese subjects (16 control subjects, 16 obstructive coronary artery disease patients, and 16 VAP patients). Compared with the control groups, the 2-hour insulin area (area under the plasma insulin concentration-time curve) during a 75-g oral glucose tolerance test was significantly higher in both VAP groups with normal and impaired glucose tolerance. A high frequency of vasospastic angina was observed in subjects with clustered risk factors for insulin resistance syndrome, suggesting a close association of VAP with this syndrome. In stepwise discriminant analysis, the 2-hour insulin area was significantly associated with VAP independent of other risk factors. SSPG level in VAP was about twofold over control, indicating the presence of insulin resistance in patients with VAP. However, no differences were found between patients with VAP and obstructive coronary artery disease with respect to mean SSPG level. Conclusions SSPG level was significantly elevated in patients with VAP and obstructive coronary artery disease compared with control subjects. This indicates that hyperinsulinemia is secondary to insulin resistance, both of which are thought to play important roles as risk factors for VAP in the early atheromatous lesion and in the future development of occlusive lesions when chronically present.
- Subjects :
- Angina Pectoris, Variant
Male
Chest Pain
medicine.medical_specialty
medicine.medical_treatment
Coronary Disease
Coronary Angiography
Impaired glucose tolerance
Coronary artery disease
Insulin resistance
Risk Factors
Hyperinsulinism
Physiology (medical)
Internal medicine
medicine
Hyperinsulinemia
Humans
Insulin
Coronary atherosclerosis
Glucose tolerance test
medicine.diagnostic_test
business.industry
Discriminant Analysis
Glucose Tolerance Test
Middle Aged
bacterial infections and mycoses
medicine.disease
Lipids
respiratory tract diseases
Endocrinology
Case-Control Studies
Cardiology
Female
Insulin Resistance
Cardiology and Cardiovascular Medicine
business
Compensatory Hyperinsulinemia
Subjects
Details
- ISSN :
- 15244539 and 00097322
- Volume :
- 92
- Database :
- OpenAIRE
- Journal :
- Circulation
- Accession number :
- edsair.doi.dedup.....1cbcdf0ae18a9b37cb10e9bc770024b6