INSULIN-RESISTANCE, LIPOPROTEINS, BODY-FAT AND HEMOSTASIS IN NONOBESEMEN WITH ANGINA AND A NORMAL OR ABNORMAL CORONARY ANGIOGRAM

Objectives. The aim of this study was to compare metabolic risk factor s in men with anginal chest pain and a normal or abnormal coronary ang iogram with those in healthy men. Background. Risk factors for coronar y heart disease, including lipoprotein abnormalities, hypertension and adiposity, may be metabolically interlinked, with insulin resistance and hyperinsulinemia being pivotal to these disturbances. Methods. Glu cose and insulin metabolism, lipids and lipoproteins, hemostasis, bloo d pressure and body fat distribution were measured in 77 nonobese midd le-aged men who had anginal chest pain (39 with an abnormal coronary a ngiogram and 38 with no detectable angiographic abnormality) and were compared with those of 40 healthy men of similar age and body mass ind ex. Results. Patients with chest pain had higher insulin responses to an intravenous glucose challenge, lower insulin sensitivity, lower hig h density lipoprotein (HDL) and subfraction 2 cholesterol, lower apoli poprotein AI, higher triglycerides, greater android fat and higher sys tolic blood pressure at rest compared with levels in healthy control s ubjects (p < 0.05). Those with an abnormal coronary angiogram had lowe r tissue plasminogen activator levels, higher plasminogen activator in hibitor 1 levels and more android fat than did those with a normal ang iogram (p < 0.05). Insulin sensitivity correlated positively with HDL (p < 0.05) and subfraction 2 (p < 0.001) cholesterol and negatively wi th triglycerides (p < 0.01), android fat proportion (p < 0.01) and sys tolic blood pressure (p < 0.05), whereas insulin response showed conve rse correlations. Conclusions. These findings provide new evidence of the central role of insulin resistance and hyperinsulinemia in the dev elopment of risk factors associated with coronary heart disease.