CARDIOVASCULAR MEDICINE

Post-challenge hyperinsulinaemia rather than hyperglycaemia is associated with the severity of coronary artery disease in patients without a previous diagnosis of diabetes mellitus

H Satoh, H Terada, A Uehara, H Katoh, M Matsunaga, K Yamazaki, F Matoh, H Hayashi

Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan

Correspondence to:
Correspondence to:
Dr Hiroshi Satoh
Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan; satoh36{at}hama-med.ac.jp

Objective: To ascertain the prevalence of abnormal glucose metabolism in patients with coronary artery disease (CAD) but no previous diagnosis of diabetes mellitus (DM) and to examine the relation between the severity of CAD and responses of glucose and insulin to the glucose tolerance test.

Methods and results: Abnormalities of glucose metabolism and insulin response were analysed in 144 patients with CAD without a previous diagnosis of DM who underwent both coronary arteriography and 75 g oral glucose tolerance test. The proportions of impaired and diabetic glucose tolerance were very high (39% for impaired and 21% for diabetic glucose tolerance); only 40% had normal glucose tolerance. The parameters of glucose metabolism were not associated with the number of diseased coronary arteries or the presence of previous myocardial infarction (MI). However, the insulin concentration at 60 minutes or 120 minutes after glucose challenge, insulin area, and the ratio of insulin to glucose area were significantly higher in patients with significant coronary stenosis and with previous MI. Fasting glucose concentration and most conventional risk factors did not predict post-challenge hyperinsulinaemia.

Conclusion: Patients with CAD without a previous diagnosis of DM had a high prevalence of abnormal glucose tolerance. Post-challenge hyperinsulinaemia was associated with the number of diseased coronary arteries and the presence of previous MI. The insulin response to the glucose challenge test requires further investigation as a potential risk factor for CAD and a potential target for intervention.

Abbreviations: 75g-oGTT, 75 g oral glucose tolerance test; AUCglu, area under the glucose curve; AUCins, area under the insulin curve; BMI, body mass index; CAD, coronary artery disease; DECODE, diabetes epidemiology: collaborative analysis of diagnostic criteria in Europe; DM, diabetes mellitus; HOMA-IR, insulin resistance estimated by homeostasis model assessment; IRI, plasma insulin; MI, myocardial infarction; PG, plasma glucose; VD, vessel disease

Keywords: coronary artery disease; glucose; insulin resistance; myocardial infarction

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Blood Glucose and Its Link to Coronary Artery Disease

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