Effect of glycemic state on postprandial hyperlipidemia and hyperinsulinemia in patients with coronary artery disease

Heart Vessels. 2016 Sep;31(9):1446-55. doi: 10.1007/s00380-015-0757-y. Epub 2015 Oct 6.

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.

Keywords: Coronary artery disease; Diabetes; Hyperinsulinemia; Insulin resistance; Postprandial hyperlipidemia.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Area Under Curve
  • Biomarkers / blood
  • Blood Glucose / metabolism*
  • Coronary Angiography
  • Coronary Artery Disease / blood*
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / diagnostic imaging
  • Diabetes Mellitus, Type 2 / blood*
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / diagnosis
  • Dietary Carbohydrates / administration & dosage
  • Dietary Fats / administration & dosage
  • Glycated Hemoglobin / metabolism
  • Humans
  • Hyperinsulinism / blood*
  • Hyperinsulinism / diagnosis
  • Hyperinsulinism / etiology
  • Hyperlipidemias / blood*
  • Hyperlipidemias / diagnosis
  • Hyperlipidemias / etiology
  • Insulin / blood*
  • Insulin Resistance*
  • Lipids / blood*
  • Male
  • Middle Aged
  • Postprandial Period*
  • Prediabetic State / blood
  • Prediabetic State / diagnosis
  • ROC Curve
  • Risk Factors
  • Severity of Illness Index
  • Time Factors

Substances

  • Biomarkers
  • Blood Glucose
  • Dietary Carbohydrates
  • Dietary Fats
  • Glycated Hemoglobin A
  • Insulin
  • Lipids
  • hemoglobin A1c protein, human