Open AccessPossible Relationship between Insulin Resistance and Remnant‐Like Lipoprotein Particles in Coronary Endothelial Dysfunction
Author(s) -
Inoue Teruo,
Uchida Toshihiko,
Kamishirado Hirotoshi,
Sakuma Masashi,
Sakai Yoshihiko,
Takayanagi Kan,
Hayashi Terumi,
Morooka Shigenori
Publication year - 2002
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960251110
Subject(s) - medicine , insulin resistance , hyperinsulinemia , endocrinology , endothelial dysfunction , insulin , coronary artery disease , lipoprotein particle , homeostasis , lipoprotein , coronary atherosclerosis , diabetes mellitus , cholesterol , very low density lipoprotein
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 HOME 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.