冠危険因子の性差に関して

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To clarify the differnces between the sexes in terms of ischemic heart disease, we examined the differential effects of visceral fat accumulation on lipid and glucose parameters, as well as the severity of coronary heart disease in 315 patients (172 males and 143 females) who had undergone coronary angiography. Total cholesterol, HDL-cholesterol, total amount of glucose during oral glucose tolerance tests, age, and smoking were independent coronary risk factors among males. For females, the independent coronary risk factor were the toal amount of glucose during oral glucose tolerance tests, the inverse of total amount of insulin during oral glucose tests, and total cholesterol. The amount of visceral fat was independently associated with the total amount of glucose, the insulin concentration at 120 minutes during glucose tolerance tests, and triglyceride levels among males. Among females, the total amount of visceral fat was associated with the insulin concentration at 120 minutes during glucose tolerance tests, and the inverse of the HDL-cholesterol and apolipoprotein B levels. The amount of visceral fat was an independent factor for apolipoprotein B concentration among females, but not among males. The effect of the amount of visceral fat on the metabolic variables was greater than the ratio of visceral fat to subcutaneous fat, particularly in the non-obese group. The joint effect of visceral fat accumulation and hyperternsion on coronary artery stenosis was greater among females than among males. Regarding metabolic profiles in the hypertensive visceral fat accumulation group, plasma insulin, the total amount of insulin during oral glucose tests and triglyceride concentrations were elevated among males. On the other hand, among females, the fasting plasma concentration of glucose and the total amounts of glucose during oral glucose tolerance tests, triglycerides, and apolipoprotein B were elevated, while the HDL-cholesterol concentration decreased. However, the basal insulin concentration and the total amounts of insulin during oral glucose tolerance tests were unchanged.We concluded that visceral fat accumulation affected lipid and glucose metabolism among males and females, differently, and that it was a significant determinant of differences between the sexes for coronary heart disease.