Insulin resistance and coronary artery disease

P. Bressler, S. R. Bailey, M. Matsuda, R. A. DeFronzo

Research output: Contribution to journalArticlepeer-review

174 Scopus citations

Abstract

The purpose of the present study was to quantitate insulin-mediated glucose disposal in normal glucose tolerant, patients with angiographically documented coronary artery disease (CAD) and to define the pathways responsible for the insulin resistance. We studied 13 healthy normal weight, normotensive subjects with angiographically documented CAD and 10 age-, weight-matched control subjects with an oral glucose tolerance test and a 2-h euglycaemic insulin (40 mU · m-2 · min-1) clamp with tritiated glucose and indirect: calorimetry. Lean body mass was measured with tritiated water. All CAD and control subjects had a normal oral glucose tolerance test. Fasting plasma insulin concentration (66 ± 6 vs 42 ± 6 pmol/l, p < 0.05) and area under the plasma insulin curve following glucose ingestion (498 ± 54 vs 348 ± 42 pmol · l-1 · min-1, p < 0.001) were increased in CAD vs control subjects. Insulin-mediated whole body glucose disposal (27.8 ± 3.9 vs 38.3 ± 4.4 μmol kg fat free mass (FFM)-1 · min-1, p < 0.01) was significantly decreased in CAD subjects and this was entirely due to diminished non-oxidative glucose disposal (8.9 ± 2.8 vs 20.0 ± 3.3 μmol · kg FFM-1 · min-1, p < 0.001). The magnitude of insulin resistance was positively correlated with the severity of CAD (r = 0.480, p < 0.05). In the CAD subjects basal and insulin-mediated rates of glucose and lipid oxidation were normal and insulin caused a normal suppression of hepatic glucose production. In conclusion, subjects with angiographically documented CAD are characterized by moderate-severe insulin resistance and hyperinsulinaemia and should be included in the metabolic and cardiovascular cluster of disorders that comprise the insulin resistance syndrome or 'syndrome X'.

Original languageEnglish (US)
Pages (from-to)1345-1350
Number of pages6
JournalDiabetologia
Volume39
Issue number11
DOIs
StatePublished - 1996

Keywords

  • Coronary artery disease
  • Glucose metabolism
  • Hyperinsulinaemia
  • Insulin resistance

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

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