Author + information
- Received May 20, 1993
- Revision received August 25, 1993
- Accepted September 8, 1993
- Published online February 1, 1994.
- Christopher J. Ley, FRACP,
- Jonathan Swan, MRCP,
- Ian F. Godsland, PhD,
- Christopher Walton, PhD,
- David Crook, PhD and
- John C. Stevenson, FRCP∗
- ↵∗Address for correspondence:Dr. John C. Stevenson, Wynn Institute for Metabolic Research, 21 Wellington Road, London NW8 9SQ, United Kingdom.
Objectives. The aim of this study was to compare metabolic risk factors in men with anginal chest and a normal or abnormal coronary angiogram with those in healthy men.
Background. Risk factors for coronary heart disease, including lipoprotein abnormalities, hypertension and adiposity, may be metabolically interlinked, with insulin resistance and hyperinsulinemia being pivotal to these disturbances,
Methods. Glucose and insulin metabolism, lipids and lipoproteins, hemostasis, blood pressure and body fat distribution were measured in 77 nonobese middle-aged men who had anginal chest pain (39 with an abnormal coronary angiogram and 38 with no detectable angiographic abnormality) and were compared with those of 40 healthy men of similar age and body mass index.
Results. Patients with chest pain had higher insulin responses to an intravenous glucose challenge, Bower insulin sensitivity, lower high density lipoprotein (HDL) und subfraction 2 cholesterol, lower apolipoprotein AI, higher triglycerides, greater android fat and higher systolic blood pressure at rest compared with levels in healthy control subjects (p < 0.05). Those with an abnormal coronary angiogram had lower tissue plasminogen activator levels, higher plasminogen activator inhibitor 1 levels and more android fat than did those with a normal angiograin (p < 0.05). Insulin sensitivity correlated positively with HDL (p < 0.05) and sebfraction 2 (p< 0.001) cholesterol and negatively with triglycerides (p < 0.01), android fat proportion (p < 0.01) and systolic blood pressure (p < 0.05), whereas insulin response showed converse correlations.
Conclusions. These findings provide new evidence of the central role of insulin resistance and hyperinsulinemia in the development of risk factors associated with coronary heart disease.
☆ This study was supported in part by a grant from CORDA (Dr. Stevenson) and by the Heart Disease and Diabetes Research Trust, London.
- Received May 20, 1993.
- Revision received August 25, 1993.
- Accepted September 8, 1993.