Insulin resistance, hyperinsulinemia, and hypertriglyceridemia in patients with coronary artery disease independent of obesity.

Insulin resistance and hyperinsulinemia both in normal persons and those with non-insulin dependent diabetes mellitus (NIDDM) (type 2 diabetes) appears to be related to obesity. It seems also that insulin plays a role in modulating the obesity-related factors (eg, hyperinsulinemia, hyperglycemia, hypertension, hypertriglyceridemia, hypercholesterolemia, low concentrations of high-density lipoprotein cholesterol) and takes its place among the many risk factors for coronary artery disease (CAD) associated with obesity. Insulin resistance and hyperinsulinemia could play the same role in pathogenesis of CAD independently of obesity. The authors determined blood glucose and immunoreactive insulin and plasma triglyceride concentrations in the fasting state at 60 and 120 minutes after a glucose load of 75 g in 68 patients (54 men, 14 women) with angiographic evidence of CAD and in 65 healthy volunteers matched to the patients for age, gender, and body mass index (43 men and 22 women). Patients with CAD and the healthy volunteers were categorized as obese (body mass index > or = 26 kg/m2) and nonobese (body mass index < 26 kg/m2). Four groups of subjects were analyzed: Group A included 40 healthy (28 men and 12 women) nonobese volunteers; group B, 25 healthy (15 men and 10 women) obese volunteers; group C, 39 (30 men and 9 women) nonobese patients with CAD; and group D, 29 (24 men and 5 women) obese patients with CAD. Fasting and postchallenged 60- and 120-minute glucose values were similar in groups A and C. However, significantly higher insulin values (mU/L) were observed in group C than in group A during fasting (12.2+/-6.2 vs 91+/-3, p<0.05), and postchallenged at 60 minutes (103.1+/-53.2 vs 71.9+/-64.3, p<0.01) and 120 minutes (57.9+/-41.2 vs 44.9 +/-41.3, p<0.01). Fasting glucose and insulin values were similar in groups B and D. However, significantly higher glucose (mg/dL) and insulin values were observed in group D than in group B postchallenged at 60 and 120 minutes: glucose at 60 minutes (188.7 +/-45.1 vs 154.2+/-37.5, p<0.05); insulin at 60 minutes (127.5+/-98.5 vs 112.1+/-81.1, p<0.05); glucose at 120 minutes (124.2+/-46.1 vs 99.5+/-28.9, p<0.05); insulin at 120 minutes (86.1+/-57.6 vs 62.8+/-27.9, p<0.05). The glucose and insulin values during 60- and 120-minute fasting as well as postchallenged were similar in groups B and C. Significantly higher plasma triglyceride concentrations were observed in group C than in group A (149.0+/-64.1 vs 114.6+/-46.6, p<0.01) and in group D compared with group B (229.4+/-104.7 vs 144.9+/-65.1, p<0.001). Plasma triglyceride concentrations were similar in groups B and C. The authors conclude that patients with documented CAD are insulin resistant independently of obesity.