Insulin resistance/compensatory hyperinsulinemia predict carotid intimal medial thickness in patients with essential hypertension.
OBJECTIVE
Approximately 50% of subjects with essential hypertension (EH) are insulin resistant, and this defect in insulin action could contribute to increased cardiovascular disease (CVD) risk in these patients. To test this hypothesis, we attempted to see if there was a link between insulin resistance (IR) and carotid intimal medial thickness (IMT), an early index of CVD, in patients with essential hypertension.


RESULTS
Ultrasound quantification of carotid IMT was performed in 79 hypertensive patients, and 63 patients (31 m and 32 f), defined as being free of plaque (IMT < 1.3 mm), were further subdivided into normal (<1.0 mm) and thickened (1-1.3 mm) IMT groups. Subjects in the thickened IMT group were older and had significantly (p < 0.05) higher plasma concentrations of fasting insulin, nitric oxide (NO(x)) and intercellular adhesion molecule 1 (ICAM-1). However, the two groups were not significantly different in terms of blood pressure, overall or regional obesity, fasting lipid levels, uric acid, concentrations of other cellular adhesion molecules or levels of C-reactive protein. There were significant (p < 0.05) correlations in the whole population between IMT and age, fasting insulin and NO(x), and multiple regression analysis identified fasting insulin as an independent predictor of IMT.


CONCLUSIONS
The presence of increased IMT is significantly related to several metabolic and endothelial abnormalities associated with IR/hyperinsulinemia, and fasting insulin independently predicts the thickness of the intima-media layer. These results support the view that CVD risk is greatest in those patients with essential hypertension who are also IR/hyperinsulinemic.
Zavaroni
Ivana
I
Department of Internal Medicine and Biomedical Sciences, Parma University, via Gramsci 14, 43100 Parma, Italy. ivana.zavaroni@unipr.it
Ardigò
Diego
D
Zuccarelli
Alessandra
A
Pacetti
Edoarda
E
Piatti
Pier M
PM
Monti
Lucilla
L
Valtueña
Silvia
S
Massironi
Paola
P
Rossi
Pier C
PC
Reaven
Gerald M
GM
D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D002339:Carotid Arteries / Q000033:anatomy & histology / Q000473:pathology; D016893:Carotid Stenosis / Q000453:epidemiology / Q000209:etiology; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D006946:Hyperinsulinism / Q000097:blood / Q000150:complications*; D006973:Hypertension / Q000097:blood / Q000150:complications*; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000097:blood; D011237:Predictive Value of Tests; D012044:Regression Analysis; D017539:Tunica Intima / Q000033:anatomy & histology / Q000473:pathology*; D017540:Tunica Media / Q000033:anatomy & histology / Q000473:pathology*
D015415:Biomarkers; D007328:Insulin; D018799:Intercellular Adhesion Molecule-1; D009569:Nitric Oxide