Coronary endothelial dysfunction (ACh-positive response) was associated with significantly higher insulin resistance (HOMA IR 3.65 vs 0.75, p<0.05) and remnant lipoprotein levels.
Observational (n=49)
Is there a correlation between insulin resistance, remnant lipoproteins, and coronary endothelial dysfunction in patients without significant coronary artery disease?
High insulin resistance and elevated remnant lipoprotein levels are correlated and associated with impaired coronary vascular endothelial function in patients without significant coronary artery disease.
Absolute Event Rate: 3.65% vs 0.75%
p-value: p=< 0.05
BACKGROUND: High insulin resistance and elevated remnant lipoprotein levels both correlate with impaired coronary vascular endothelial function. Hyperinsulinemia induces abnormalities of lipid metabolism. However, the correlation among insulin resistance, remnant lipoproteins, and endothelial function has not been clinically elucidated. HYPOTHESIS: This study was designed to elucidate the correlation among insulin resistance, remnant lipoproteins, and acetylcholine (ACh)-induced coronary artery response. METHODS: Forty-nine patients suspected of having ischemic heart disease, but without angiographically significant atherosclerotic coronary artery disease, underwent an ACh provocation test. Fasting venous blood was taken early in the morning on the day coronary angiography was performed. The insulin resistance index (IR) was determined from fasting plasma glucose and insulin concentrations, using the homeostasis model assessment (HOMA). Serum levels of remnant-like lipoprotein particle cholesterol (RLP-C) were measured. RESULTS: Homeostasis model assessment IR was significantly higher (3.65 +/- 1.38 vs. 0.75 +/- 0.14, p < 0.05) and log-transformed HOMA (Log HOMA) was even more significantly higher (0.20 +/- 0.12 vs. -0.29 +/- 0.08, p < 0.001) in the ACh-positive group (n = 23) than in the ACh-negative group (n = 26). The serum RLP-C level was also higher in the ACh-positive group than in the ACh-negative group (4.37 +/- 0.63 vs. 2.52 +/- 0.18 mg/dl, p < 0.01). Log HOMA and RLP-C levels correlated with each other (R = 0.54, p < 0.001). Multiple regression analysis indicated that only the RLP-C level was a dependent predictor of Log HOMA in various lipid profiles. CONCLUSIONS: Both high insulin resistance and elevated remnant lipoprotein levels correlated and might have a crucial role in the impairment of coronary vascular endothelial function, even in patients without angiographically significant coronary artery disease.
Inoue et al. (Fri,) conducted a observational in Suspected ischemic heart disease without angiographically significant atherosclerotic coronary artery disease (n=49). Coronary endothelial dysfunction (ACh-positive response) vs. Normal endothelial function (ACh-negative response) was evaluated on Homeostasis model assessment insulin resistance index (HOMA IR) (p=< 0.05). Coronary endothelial dysfunction (ACh-positive response) was associated with significantly higher insulin resistance (HOMA IR 3.65 vs 0.75, p<0.05) and remnant lipoprotein levels.