Effect of insulin resistance on the endothelial vasomotor function of the coronary artery of nondiabetic patients.
Attention has been paid to the relationship between insulin resistance and coronary artery disease. The present study investigated the relationship between insulin resistance and the endothelial vasomotor function of the coronary artery of nondiabetic patients with chest pain and a positive exercise tolerance test. Twenty-five nondiabetic patients with chest pain were included. Patients with a steady state plasma glucose (SSPG) level of greater than or equal to 135 mg/dl were placed in the insulin resistant (IR) group, and those with a SSPG level less than 135 mg/dl were placed in the noninsulin resistant (NIR) group. The effect of acetylcholine, papaverine, and isosorbide dinitrate on the vasomotor response of the coronary endothelium was studied. The percent change in diameter of the coronary artery after injection of acetylcholine (20 microg ml(-1) min(-1)) was 84+/-17% in the IR group, and 109+/-18% in the NIR group. The difference in the degree of the vasodilative response is statistically significant (p<0.01). The percent change in coronary flow velocity after injection of acetylcholine (20 microg ml(-1) min(-1)) in the IR group was 120+/-67%, whereas that in the NIR group was 256+/-58%; the increase in coronary artery flow velocity of the IR group was significantly smaller than that of the NIR group (p<0.01). Nondiabetic patients with insulin resistance have endothelial vasomotor dysfunction, which raises an important question as to whether nondiabetic patients with insulin resistance should be treated to prevent the development of coronary heart disease.
Watanabe
I
I
Department of Cardiology, Surugadai Nihon University Hospital, Tokyo, Japan. ikuwata@med.nihon-u.ac.jp
Kawamura
I
I
Satoh
K
K
Nagao
K
K
Kushiro
T
T
Kanmatsuse
K
K
D000109:Acetylcholine / Q000494:pharmacology; D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D001786:Blood Glucose / Q000378:metabolism; D003327:Coronary Disease / Q000503:physiopathology; D003331:Coronary Vessels / Q000033:anatomy & histology / Q000502:physiology; D004730:Endothelium, Vascular / Q000502:physiology; D005260:Female; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D014664:Vasodilation / Q000187:drug effects; D014666:Vasomotor System / Q000503:physiopathology*
D001786:Blood Glucose; D000109:Acetylcholine