title: Insulin resistance phenotypes and coronary artery disease in a native Pakistani cohort.
abstract: OBJECTIVE
  To determine the relationship between insulin resistance (IR) and atheroma burden in Pakistanis.
  
  
  METHODS
  A prospective case-control study of 400 patients selected for the presence/absence of angiographic disease. Coronary atheroma burden was quantified and IR and cardiovascular risk factors were measured.
  
  
  RESULTS
  The patients were divided into two groups by QuickI score. Waist circumference (90 +/- 10 vs. 90 +/- 9 cm; p = 0.7) was similar but the groups differed in body mass index (26.5 +/- 3.7 vs. 24.2 +/- 3.5 kg/m(2); p < 0.001) and waist:hip ratio (0.94 +/- 0.09 vs. 0.90 +/- 0.06; p < 0.001). Lipid parameters showed similar high-density lipoprotein cholesterol (HDL-C) (0.77 +/- 0.23 vs. 0.82 +/- 0.22 mmol/l; p = 0.1) differences in triglycerides [1.32 (0.08-3.98) vs. 1.12 (0.37-3.61) mmol/l; p = 0.01], but no difference in low-density lipoprotein cholesterol (LDL-C) (2.75 +/- 1.00 vs. 2.90 +/- 0.94 mmol/l; p = 0.14). In insulin-resistant patients C-reactive protein (CRP) [6.8 (0.3-175.1) vs. 3.9 (0.2-57.9) mg/l: p < 0.001], sialic acid (82 +/- 14 vs. 77 +/- 15 mg/l; p < 0.001) aspartate transaminase [24 (7-171) vs. 21 (7-83) IU/l; p < 0.001] and gamma-glutamyl transferase [27 (8-482) vs. 21 (7-168) IU/l; p = 0.005] levels were increased. In insulin-resistant patients (n = 187), coronary artery disease (CAD) burden correlated (r = 0.55) with age (beta = 1.62; p < 0.001), HDL-C (beta = -53.2; p < 0.001), lipoprotein (a) (beta = 11.4; p = 0.007), smoking (beta = 7.98; p = 0.004), CRP (beta = 6.06; p = 0.03) and QuickI index (beta = -146; p = 0.04). In contrast in insulin-sensitive patients (n = 178) CAD burden (r = 0.46) correlated with LDL-C (beta = 10.0; p = 0.02), CRP (beta = 7.13; p = 0.03), HDL-C (beta = -38.1; p = 0.03), and weakly with age (beta = 0.73; p = 0.07) and smoking (beta = 5.52; p = 0.09).
  
  
  CONCLUSIONS
  Indian Asians show a dichotomous insulin-resistance phenotype. Atheroma is associated with low HDL-C and inflammation associated in all but LDL-C is a factor in the insulin sensitive in contrast to age and extent of IR in the insulin resistant.
authors.affiliation: Department of Chemical Pathology, St. Thomas' Hospital, London, UK. anthony.wierzbicki@kcl.ac.uk
authors.forename: A S
authors.initials: AS
authors.lastname: Wierzbicki
authors.forename: S
authors.initials: S
authors.lastname: Nishtar
authors.forename: P J
authors.initials: PJ
authors.lastname: Lumb
authors.forename: M
authors.initials: M
authors.lastname: Lambert-Hammill
authors.forename: M A
authors.initials: MA
authors.lastname: Crook
authors.forename: M S
authors.initials: MS
authors.lastname: Marber
authors.forename: J
authors.initials: J
authors.lastname: Gill
mesh_terms: D000328:Adult; D050197:Atherosclerosis / Q000503:physiopathology; D001824:Body Constitution; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D024821:Metabolic Syndrome / Q000209:etiology; D008875:Middle Aged; D010641:Phenotype; D011446:Prospective Studies; D012307:Risk Factors