Disturbances of glucose metabolism in men referred for coronary arteriography - Postload glycemia as a predictor for coronary atherosclerosis

OBJECTIVE - In some studies, fasting and postload glycemia are a strong pre dictor of coronary events and cardiac death. Therefore, we investigated the relationship between lasting and postload glucose concentrations and coron ary status in 363 men referred for coronary arteriography without a previou s history of diabetes. RESEARCH DESIGN AND METHODS - A total of 363 men (mean age 53.0 +/- 9.1 yea rs, mean BMI 27.9 +/- 3.7 kg/m(2)) with positive results of exercise testin g were included in the study. A standard oral glucose tolerance test (OGTT) with glucose and insulin estimations was performed on all subjects. The co ncentrations of total choleslerol, HDL cholesterol, triglycerides, and HbA( 1c) were also measured. All patients were divided into four groups, accordi ng to coronary status: no changes in coronary arteries (group 0, n = 61), o ne-vessel disease (group I, n = 113), two-vessel disease (group II, n = 116 ), and three-vessel disease (group III, n = 73). RESULTS - The highest postload glucose concentrations were observed in grou p III. Also. insulin concentrations and HbA(1c) increased with the progress ion of atherosclerotic lesions in the coronary arteries. Based on results o f the OGTT, 16% of the patients (n = 59) fulfilled the World Health Organiz ation criteria for type 2 diabetes and 36% of the patients (n = 131) met cr iteria for impaired glucose tolerance. Significant correlations were observ ed between the number of involved vessels and postload glycemia, HbA(1c), f asting insulin, and postload insulin. The multiple stepwise regression anal ysis showed that age, total cholesterol, and HDL cholesterol independently correlated with the number of involved vessels. CONCLUSIONS - We conclude that patients with advanced changes in the corona ry arteries experience more pronounced metabolic disturbances. Postload gly cemia could be an important predictor of nondiagnosed disturbances of gluco se metabolism.