(Circulation. 1995;92:1749-1757.)
© 1995 American Heart Association, Inc.
Articles |
Insulin Resistance Associated With Compensatory Hyperinsulinemia as an Independent Risk Factor for Vasospastic Angina
From the Division of Atherosclerosis, Metabolism, and Clinical Nutrition (K.S., M.S., M.I., Y. Hara, M.T., Y. Harano) and the Division of Cardiology (H.T.), Department of Medicine, National Cardiovascular Center, Osaka, Japan.
Correspondence to Kazuya Shinozaki, MD, Division of Atherosclerosis, Metabolism, and Clinical Nutrition, Department of Medicine, National Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka 565, Japan.
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.
Key Words: insulin • apolipoproteins • glucose • vasospasm
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