Abstract
In a cross-sectional study of 240 patients with angiographically documented coronary artery disease (CAD), we investigated whether obese and non-obese subjects differed as to the influence of insulin deficiency and insulin resistance on glucose intolerance and cardiovascular risk. Patients were classified according to a 75-g oral glucose tolerance test as having normal glucose tolerance (NGT), impaired glucose tolerance (IGT), or diabetes mellitus (DM). We defined obesity as a body mass index (BMI) exceeding 25 kg/m 2. Early phase insulin secretion (insulinogenic index) declined with worsening glucose intolerance in non-obese ([tau ] = [minus ].216, P [lt ] .001; Kendall's correlation coefficient) and obese subjects ([tau ] = [minus ].392, P [lt ] .001). Total insulin secretion was higher in obese subjects with NGT or IGT than in controls and decreased in association with worsening glucose intolerance in obese subjects ([tau ] = [minus ].239, P [lt ] .001). Insulin sensitivity was calculated by 3 proposed indices. The first of these decreased in association with worsening in glucose tolerance in non-obese subjects ([tau ] = [minus ].137, P [lt ] .01). The second showed such a pattern in both groups (non-obese, [tau ] = [minus ].407, P [lt ] .001; obese, [tau ] = [minus ].311, P [lt ] .001), as did the third (non-obese, [tau ] = [minus ].512, P [lt ] .001; obese, [tau ] = [minus ].488, P [lt ] 0.001). Because even prediabetic Japanese subjects with CAD showed a latent insulin secretion defect in response to a glucose load, as well as impaired insulin sensitivity, compensatory hyperinsulinemia is not a sensitive indicator of coronary risk.
Published Version
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