Coronary artery disease risk predicted by insulin resistance, plasma lipids, and hypertension in people without diabetes

Background: It has been shown that insulin resistance syndrome, including g lucose intolerance, dyslipidemia, and hypertension, is frequently associate d with coronary artery disease (CAD). However, their relative contributions and predictive power in the development of CAD are still unclear, particul arly in persons without diabetes. Method: We examined these risk factors be tween 96 patients without diabetes but with angiographically documented CAD and 96 age-, sex-, and body mass index-matched healthy control subjects. F asting plasma lipoprotein, glucose, and insulin concentrations in response to a 75-g oral glucose tolerance test were determined, and insulin sensitiv ity was measured by the insulin suppression test. Results: Patients with CA D had significantly higher values of fasting glucose, glucose and insulin r esponses to oral glucose tolerance test, total cholesterol, low-density lip oprotein (LDL) cholesterol, and triglyceride and decreased high-density lip oprotein (HDL) cholesterol concentrations compared with those of healthy pe ople (P < 0.02-0.001). Although the steady-state plasma insulin values were similar in both groups, the steady-state plasma glucose (SSPG) concentrati ons were significantly higher in patients with CAD (12.2 +/- 0.4 versus 8.1 +/- 0.4 mmol/L, P < 0.001) compared with healthy subjects. When HDL < 0.9 mmol/L, LDL cholesterol greater than or equal to 4.1 mmol/L, triglyceride g reater than or equal to 2.3 mmol/L, SSPG greater than or equal to 10.5 mmol /L, and presence of hypertension were defined as separate risk factors for CAD, significantly higher odds-ratio values were observed in patients with CAD compared with healthy people. From logistic multiple regression analysi s, SSPG was the strongest risk, Followed by lowered HDL cholesterol, elevat ed triglyceride and LDL cholesterol, and hypertension, to predict CAD. Thes e 5 factors accounted for 36% of total risk for development of CAD in perso ns without diabetes. Conclusions: Patients without diabetes with CAD have a bnormal glucose metabolism, hyperinsulinemia, and insulin resistance. Degre e of insulin resistance (SSPG values), plasma lipid values, and history of hypertension together accounted for one third of all risk for CAD, although degree of insulin resistance was the strongest risk factor.