Hyperinsulinemic hypoalphalipoproteinemia as a new indicator for coronary heart disease.
OBJECTIVE
The purpose of this study was to investigate the association among insulin resistance, high density lipoprotein cholesterol (HDL-C) and coronary heart disease (CHD), and to test the hypothesis that HDL-C may ameliorate the adverse effects of insulin.


BACKGROUND
Serum low HDL-C (hypoalphalipoproteinemia) and hyperinsulinemia are independent predictors for CHD, but a strong negative correlation exists between them, as in patients with syndrome X.


METHODS
Fifty-four pairs of cases (M/F: 49/5), defined as patients with angiographically proved CHD, and control subjects (M/F: 49/5) matched with cases with regard to gender and age were included. Insulin resistance was assessed by the homeostasis model assessment (HOMA).


RESULTS
Cases had increased HOMA insulin resistance and lower serum levels of HDL-C than controls. A receiver operating characteristic (ROC) curve analysis indicated that HDL-C and insulin resistance were significant discriminators of CHD (area under ROC curve: 0.72 and 0.69, respectively). The interaction between HDL-C and the association of insulin resistance with CHD was significant: subjects with hyperinsulinemia and high HDL-C had no increased risk of CHD. Multivariate conditional logistic regression analysis showed that hyperinsulinemic hypoalphalipoproteinemia was a stronger indicator for CHD than either HDL-C or insulin resistance alone (-2 log likelihood: 19.0 vs. 12.6 or 15.7).


CONCLUSIONS
Hyperinsulinemic hypoalphalipoproteinemia was a more potent indicator for CHD than either insulin resistance or low serum HDL-C levels alone, and the adverse effects of hyperinsulinemia seem to be ameliorated by high HDL-C levels.
Saku
K
K
Department of Internal Medicine, Fukuoka University School of Medicine, Japan. hh035399@msat.fukuoka-u.ac.jp
Zhang
B
B
Shirai
K
K
Jimi
S
S
Yoshinaga
K
K
Arakawa
K
K
D000368:Aged; D016022:Case-Control Studies; D008076:Cholesterol, HDL / Q000097:blood; D003327:Coronary Disease / Q000097:blood* / Q000503:physiopathology; D005260:Female; D006801:Humans; D006946:Hyperinsulinism / Q000503:physiopathology*; D007009:Hypolipoproteinemias / Q000503:physiopathology*; D007333:Insulin Resistance; D008075:Lipoproteins, HDL / Q000097:blood* / Q000502:physiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014280:Triglycerides / Q000097:blood
D008076:Cholesterol, HDL; D008075:Lipoproteins, HDL; D014280:Triglycerides