Insulin response to oral glucose load is associated with coronary artery disease in subjects with normal glucose tolerance.
OBJECTIVE
The critical role of hyperinsulinemia, independent of hyperglycemia, in the pathogenesis of atherosclerosis has not been fully determined. We investigated the association between secretion patterns of insulin after oral glucose load and the severity of coronary artery disease (CAD) in patients with normal glucose tolerance (NGT).


METHODS
We enrolled 116 subjects with NGT from 243 patients who had undergone coronary angiography and a standard 75-g oral glucose tolerance test. The patients were divided into 0-vessel, single-vessel and multi-vessel disease groups on the basis of the severity of CAD.


RESULTS
The 2-h insulin levels in the multi-vessel disease group (p=0.005) and the single-vessel disease group (p<0.05) were significantly higher than those in the 0-vessel disease group. Multivariate analysis revealed that the levels of 2-h insulin were an independent variable for the presence of CAD (p=0.02) after adjustment for gender and the presence of each criterion of metabolic syndrome using the definition of the International Diabetes Federation.


CONCLUSIONS
A slight but significant increase in prolonged insulin secretion, which is associated with the early stage of insulin resistance, in subjects with NGT, may play an important role in the pathogenesis of atherosclerosis.
Miyazaki
Tetsuro
T
Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan. testuro@med.juntendo.ac.jp
Shimada
Kazunori
K
Iwama
Yoshitaka
Y
Kume
Atsumi
A
Sumiyoshi
Katsuhiko
K
Sato
Yayoi
Y
Ohmura
Hirotoshi
H
Watanabe
Yoshiro
Y
Mokuno
Hiroshi
H
Daida
Hiroyuki
H
D000328:Adult; D000368:Aged; D050197:Atherosclerosis / Q000209:etiology*; D003324:Coronary Artery Disease / Q000209:etiology*; D005260:Female; D005947:Glucose / Q000378:metabolism; D005951:Glucose Tolerance Test; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D006946:Hyperinsulinism / Q000150:complications*; D007328:Insulin / Q000378:metabolism*; D007333:Insulin Resistance; D000078790:Insulin Secretion; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index
D007328:Insulin; D005947:Glucose