Study on lipid and glucose metabolism in patients with vasospastic angina.
ABSTRACT The primary purpose of the present study was to evaluate the role of lipid and glucose metabolism in vasospastic angina. A group of 93 patients in whom the presence of ischemic heart disease was suggested, were classified into the control (C) group, consisting of 30 patients; the coronary artery disease (CAD) group, consisting of 47 patients; and the vasospastic angina (VSA) group, consisting of 16 patients. Among these three groups, age, total cholesterol (TC), triglyceride (TG), HDL-cholesterol (HDL-C), atherogenic index (AI), apolipoproteins and the prevalence of diabetes mellitus were compared. No age difference was seen among the three groups. The TC was the highest in the CAD group, followed by the VSA and C groups. A significant difference in TC was noted between the C and CAD groups and the C and VSA groups. TG levels were higher in the CAD group than in the C and VSA groups, without a significant difference among the three groups. The AI was significantly higher in the CAD group than in the C and VSA groups. No significant difference was noted in the prevalence of diabetes mellitus among the three groups. Apolipoprotein A-I (apo A-I) levels were higher in the VSA group than in the C and CAD groups, and the difference between the VSA and CAD groups was significant. Apolipoprotein A-II (apo A-II) levels were significantly higher in the VSA group than in the C and CAD groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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ABSTRACT: This study investigated whether insulin response to an oral glucose load correlates to acetylcholine-induced coronary vasoconstriction in subjects with vasospastic angina. It has been suggested that coronary vasospasm is caused by augmented vascular responsiveness possibly exerted by atherosclerosis. Recently, insulin resistance syndrome has been proposed as a major promotor of atherosclerotic disease, potentially enhancing vascular smooth muscular tone. Among subjects with angiographically smooth coronary arteries, we selected 14 subjects with vasospastic angina and 14 age- and gender-matched subjects with atypical chest pain. We compared coronary vasomotor response to acetylcholine infusion, glucose and insulin responses to an oral glucose load (75 g), serum lipid concentrations, obesity, heart rate, blood pressure and smoking habits in both groups. Fasting serum insulin concentrations and insulin response were higher in subjects with vasospastic angina than in those with atypical chest pain; however, glucose tolerance, obesity, heart rate, blood pressure and smoking habits did not differ between groups. In subjects with vasospastic angina, nearly all coronary segments, except distal segments of the left circumflex coronary artery, were constricted at peak acetylcholine infusion (20 to 100 micrograms), whereas all segments were dilated in subjects with atypical chest pain. Regression analysis for both groups demonstrated a correlation between coronary vasoconstriction and fasting serum insulin concentrations (r = 0.52, p < 0.01), insulin response (r = 0.71, p < 0.001), serum triglyceride concentrations (r = 0.51, p < 0.05) and atherogenic index (r = 0.44, p < 0.05). Results show that acetylcholine-induced coronary vasoconstriction in subjects with vasospastic angina correlates with hyperinsulinemia and enhanced insulin response, suggesting insulin resistance syndrome as a feature of vasospastic angina.Journal of the American College of Cardiology 02/1995; 25(2):356-61. · 14.09 Impact Factor