Abstract
Both postprandial hyperlipidemia and hyperinsulinemia have been thought to play an important role in the development of atherosclerosis, and to be a potent risk factor for cardiovascular event. To examine effects of glycemic state on postprandial hyperlipidemia and hyperinsulinemia in patients with coronary artery disease (CAD), a total of 112 consecutive male pati ents with angiographically confirmed CAD were loaded with a high-fat and high-glucose test meal. CAD patients were divided into three groups as “non-diabetic”, “prediabetic”, and “diabetic” CAD groups. The serum triglyceride (TG) and remnant-like particle cholesterol (RLP-C) levels at the 6th hour in diabetic CAD group showed significantly higher than non-diabetic CAD group, and the incremental area under the curves (iAUCs) of these levels in diabetic CAD group were significantly greater than non-diabetic CAD group (TG, P = 0.0194; RLP-C, P = 0.0219). There were no significant differences in the iAUCs of TG or RLP-C between prediabetic and non-diabetic CAD group. The AUCs of plasma insulin levels or insulin resistance index (IRI): (AUCs of insulin) × (AUCs of glucose) as the insulin resistance marker were greater in diabetic CAD group than non-diabetic CAD group (insulin, P = 0.0373; IRI, P = 0.0228). The AUCs of serum TG or RLP-C levels showed a correlation with the AUCs of plasma insulin (AUC-TG, r = 0.5437, P < 0.0001; AUC-RLP-C, r = 0.6847, P < 0.0001), and they correlated well with the insulin resistance index (AUC-TG, r = 0.7724, P < 0.0001; AUC-RLP-C, r = 0.7645, P < 0.0001). We found that the insulin resistance showed a close relationship with postprandial hyperlipidemia in CAD patients. Diabetic, but not prediabetic state, may be a risk for postprandial impaired lipid metabolism in CAD patients.
Highlights
The importance of hyperlipidemia, especially elevated serum levels of low-density lipoprotein cholesterol (LDLC), has been established as a risk factor for cardiovascular disease [1]
Patients with coronary artery disease (CAD) were classified into three groups according to glycated hemoglobin A1c (HbA1c) levels and fasting plasma glucose (FPG) levels in accordance with 2010 American Diabetes Association (ADA) Guidelines [8, 9]
BMI body mass index, HbA1c hemoglobin A1c, LDL low-density lipoprotein, HDL high-density lipoprotein, RLP remnant lipoprotein, MDA malondialdehyde-modified # Difference among three groups analyzed by one-way analysis of variance (ANOVA) for continuous variables, chi-square test for categoric variables in non-diabetic CAD group; 47 patients (42 %) in prediabetic CAD group; 33 patients (29 %) in diabetic CAD group
Summary
The importance of hyperlipidemia, especially elevated serum levels of low-density lipoprotein cholesterol (LDLC), has been established as a risk factor for cardiovascular disease [1]. The direct effect of serum triglyceride (TG) on atherosclerotic lesion formation has been still unclear, recent meta-analysis and epidemiologic studies have revealed that elevated serum levels of TG are associated with the development of coronary artery disease (CAD) independent of other coronary risk factors [2, 3]. Postprandial hyperlipidemia characterized by pronounced and prolonged serum levels of TG, has been shown to play an important role in progression or vulnerability of coronary arterial plaque [4]. We examined whether a significant correlation existed between the severity of glycemic state and the degree of postprandial lipidemic responses for studying
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