Insuline resistance, lipoproteins, body fat and hemostasis in nonobese men with angina and a normal or abnormal coronary angiogram

Ley, Christopher J.; Swan, Jonathan W.; Godsland, Ian F.; Walton, Christopher; Crook, David; Stevenson, John C.

doi:10.1016/0735-1097(94)90423-5

Cited by 40 publications

(18 citation statements)

References 41 publications

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“…This ®nding is in keeping with some coronary angiographic studies in which fasting insulin was measured. 11,12 The comparable degree of coronary damage we found in smokers and non-smokers, as well as in drinkers and non-drinkers, independently of the amount of # Selected as being signi®cantly correlated with coronary score in the group-related Pearson analysis. NI not included in the model because their P-value was b 0.1 in the group-related Pearson analysis.…”

Section: Discussionmentioning

confidence: 71%

“…3,4 In recent years, the correlation of CAD with body fat was also studied directly using coronary angiography. 5 ± 15 In the majority of these studies CAD was found to be signi®cantly correlated with abdominal fat distribution, which was evaluated by waist-to-hip ratio (WHR) or waist-to-thigh ratio (WTR), dual energy X-ray absorptiometry (DEXA) 12 and by computer tomography (CT) scanning at L4 level. 10 To a variable extent this correlation was also found with age, sex, serum cholesterol, triglyceride, LDL-cholesterol, or systolic blood pressure, exceptionally with body mass index (BMI).…”

Section: Introductionmentioning

confidence: 99%

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The role of central fat distribution in coronary artery disease in obesity: comparison of nondiabetic obese, diabetic obese, and normal weight subjects

et al. 1999

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OBJECTIVE: To investigate the degree of coronary artery disease (CAD) in relation to obesity and fat distribution in obese patients with normal glucose tolerance, in comparison with CAD of diabetic obese patients and of normal weight subjects with CAD. DESIGN: Patients listed for coronary angiography with different body mass index (BMI) with or without diabetes: study of the correlation between severity of coronary damage and fat distribution. SUBJECTS: 92 patients subdivided into: 30 normal glucose tolerant obese (BMI 31.7 AE 0.5, aged 53 AE 1.7 y), 28 type 2 diabetic obese (BMI 30.7 AE 0.3, aged 57 AE 1.2 y), and 34 normal weight patients (BMI 23.1 AE 0.3, aged 54 AE 1.7 y). MEASUREMENTS: CAD assessed by angiography and evaluated according to the method of Gensini. Fat mass and fat distribution assessed by bioelectrical impedance and anthropometry. Clinical, biochemical and hormonal variables, as well as smoking habits and alcohol intake. RESULTS: The angiographic coronary scores were similar in nondiabetic obese and in diabetic obese patients, and were signi®cantly higher than those of normal weight subjects. In the entire population coronary score correlated with indices of abdominal fat distribution. In the stepwise analysis of each group separately, waist hip ratio (WHR) correlated with coronary score only in normal weight nondiabetic patients. CAD was inversely associated with BMI only in nondiabetic obese patients. CONCLUSION: CAD of obese patients: 1) is similar to that of diabetic obese patients; 2) is more severe than that of normal weight individuals; and 3) is inversely correlated with BMI. CAD appears to be associated with WHR, not with BMI, only in nondiabetic patients with normal body weight. On the contrary, CAD of diabetic obese patients is unrelated to BMI and parameters of fat distribution, but is associated with smoking habits.

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Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

The role of central fat distribution in coronary artery disease in obesity: comparison of nondiabetic obese, diabetic obese, and normal weight subjects

et al. 1999

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“…Male non-diabetic CHD patients were assigned to 3 CHD groups according to their GS (tertile values were used as cutoff points) and according to the number of diseased coronary arteries. Ley et al showed that even patients with angina pectoris with normal coronary arteriograms had a 28% lower insulin sensitivity than normal controls, 33 and Chauhan et al showed that patients with syndrome X with normal coronary arteriograms exhibited hyperinsulinemia. 34 In our study, hyperinsulinemia, as reflected by increased fasting levels of insulin and insulin response during the OGTT, and IR, as measured by the HOMA model, were significantly and linearly associated with the severity of coronary atherosclerosis as measured by GS and by the number of diseased coronary arteries (Tables 5,6).…”

Section: Discussionmentioning

confidence: 99%

Insulin Resistance and Angiographical Characteristics of Coronary Atherosclerosis

et al. 1999

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“…A síndrome de resistência à insulina, mesmo excluindo-se hipertensos, parece, também, ter correlação com a síndrome X. Vários estudos têm demonstrado que pacientes com síndrome X e hiper-resistência coronariana (angina microvascular) apresentam elevada incidência de resistên-cia à insulina [28][29][30] , o que talvez faça parte de um distúrbio vascular generalizado envolvendo, até mesmo, as artérias coronarianas.…”

Section: Dor Torácica Não-cardiogênicaunclassified

“…Não apenas diabetes melito, mas, também, seu estado precursor, a resistência à insulina, têm estreita correlação com síndrome X, pois podem desenvolver disfunção microvascular relacionada ao endotélio e à musculatura lisa [28][29][30] . Pacientes com síndrome X, especialmente aqueles com angina microvascular (hiper-resistência coronariana comprovada), apresentam hiperinsulinemias de jejum e durante teste oral de tolerância à glicose.…”

Section: Resistência à Insulinaunclassified

Dor torácica em pacientes com cinecoronariografia normal (síndrome X): novos conceitos

Ramires¹,

Vianna²

1998

Rev. Assoc. Med. Bras.

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UNITERMOS: Síndrome X. Angina microvascular.KEY WORDS: Syndrome X. Microvascular angina. INTRODUÇÃONesta revisão, abordamos uma síndrome polê-mica e intrigante da Cardiologia, a síndrome X, condição de dor torácica do tipo anginosa acometendo pacientes com artérias coronárias normais à cinecoronariografia. Essa possibilidade foi levantada pela primeira vez por Likoff 1 et al., em 1967. A condição não é rara, haja vista que, na última década, 10% a 20% dos pacientes submetidos a cinecoronariografias para avaliação de dor toráci-ca tinham artérias coronárias normais.O termo síndrome X foi pela primeira vez utilizado por Kemp 2 , em 1973, em editorial comentando o trabalho de Arbogast e Bornassa 3 , publicado no mesmo periódico, o qual estudou os efeitos de isquemia miocárdica pacing induzida sobre a função do ventrículo esquerdo de pacientes com doença arterial coronariana (grupo C) e pacientes com cinecoronariografia normal (grupo X). Os autores destacaram, entre suas conclusões, que os pacientes do grupo X tinham performance ventricular normal, apesar de evidência eletrocardiográfica e metabólica de isquemia miocárdica. Kemp identificou, de maneira notável, aspectos importantes da síndrome, que persistem até hoje, até mesmo sua natureza heterogênea, de mecanismos patogê-nicos múltiplos.A HETEROGENEIDADE DA SÍNDROME Apesar de Kemp não ter definido objetivamente quais casos deveriam receber a denominação de síndrome X, foi a partir de seu editorial que a síndrome passou a ser genericamente definida como "presença de dor torácica e cinecoronariografia normal". Essa definição, apesar de imprecisa, foi a única utilizada por muitos anos e ainda é usual. Nos dias atuais, é conhecida como "definição lato sensu" da síndrome X. Em relação à dor, a definição dá origem a interpretações dúbias, pois não fica especificado se devem ser incluídos apenas casos com angina pectoris típica ou qualquer tipo de dor torácica. Ao longo dos anos, novos estudos foram adotando um ou outro critério em relação ao tipo de dor. Da mesma forma, o termo cinecoronariografia normal gerou alguma confusão. Enquanto alguns estudos relacionavam apenas casos com artérias coronárias absolutamente lisas à cinecoronariografia, outros incluíam, também, coronárias com irregularidades.A maior parte dos estudos inclui pacientes com dor torácica independente da demonstração de isquemia à ergometria ou outros métodos clínicos diagnósticos de isquemia. Nos últimos anos, na tentativa de procurar formar casuísticas mais uniformes, especialmente em centros europeus, passou-se a estudar mais pacientes com "dor torácica, cinecoronariografia normal e teste ergométrico positivo". Essa definição passou a ser conhecida como "definição stricto sensu" da síndrome X. Essa definição, contudo, mantém as mesmas interpretações dúbias a respeito da dor e do aspecto cinecoronariográfico.Opherk et al., em 1981, observaram pela primeira vez que a maioria dos pacientes com síndrome X tem reduzida reserva de fluxo coronariano 4 . O termo "angina microvascular" foi proposto por Canon...

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Insuline resistance, lipoproteins, body fat and hemostasis in nonobese men with angina and a normal or abnormal coronary angiogram

Abstract: These findings provide new evidence of the central role of insulin resistance and hyperinsulinemia in the development of risk factors associated with coronary heart disease.

Cited by 40 publications

References 41 publications

The role of central fat distribution in coronary artery disease in obesity: comparison of nondiabetic obese, diabetic obese, and normal weight subjects

The role of central fat distribution in coronary artery disease in obesity: comparison of nondiabetic obese, diabetic obese, and normal weight subjects

Insulin Resistance and Angiographical Characteristics of Coronary Atherosclerosis

Dor torácica em pacientes com cinecoronariografia normal (síndrome X): novos conceitos

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