HYPERINSULINEMIA IN PATIENTS WITH CORONARY HEART-DISEASE IN ABSENCE OF OVERT RISK-FACTORS

The objective of the study was to determine if male subjects with coro nary atherosclerotic heart disease (CHD) without major CHD risk factor s have hyperinsulinemia and related metabolic changes. Previous studie s suggested that hyperinsulinemia is a CHD risk factor, but they did n ot entirely exclude concurrent metabolic abnormalities. A prospective, comparative, cross-sectional study in a tertiary care teaching hospit al in Mexico City was conducted in 15 men who had suffered myocardial infarction 6 to 24 months before and had significant coronary occlusio n on angiography. Control group was formed by 15 age-matched healthy m en. None had hypertension, obesity, diabetes, gout, glucose intoleranc e or hyperlipidemia. Body mass index (BMI), waist/hip ratio (WHR), blo od pressure (BP); oral glucose tolerance test (OGTT) with measurement of serum glucose, insulin and C-peptide every 30 min for 2 h, fasting serum cholesterol, triglycerides and uric acid, areas under curve (AUG ) of glucose and insulin, insulin/glucose ratio and insulin sensitivit y index were calculated. BMI, WHR and BP were similar in both groups. Pasting and post-load serum glucose and insulin concentrations were si gnificantly higher in CHD than in control group (p <0.01); fasting glu cose 5.9 +/- 0.6 vs. 4.8 +/- 0.7 nmol/l, 2-h glucose 8.3 +/- 0.6 vs. 7 .3 +/- 0.9 mmol/l, fasting insulin 17.5 +/- 1.2 vs. 15.3 +/- 1.7 pmol/ l, 2 h insulin 448 +/- 108 vs. 282 +/- 87 pmol/l in CHD and control gr oup, respectively. AUC of glucose, AUC of insulin, insulin/glucose rat io, post load C-peptide, serum cholesterol, triglycerides and uric aci d levels were also significantly higher in CHD than in healthy control s. Insulin sensitivity index was significantly lower in patients with CHD (27.7 +/- 8.3) than in healthy control subjects (73.9 +/- 18) (p < 0.001). Patients with CHD have hyperinsulinemia and subtle metabolic a bnormalities related with insulin resistance even in absence of overt risk factors.