Glucose intolerance, insulin resistance and metabolic syndrome in patients with stable angina pectoris. Obesity predicts coronary atherosclerosis and dysglycemia

Abstract

Introduction: Disturbances of glucose regulation and other metabolic disorders, as part of metabolic syndrome, are important risk factors for atherosclerosis. Abnormal glucose metabolism is commonly observed in patients with acute coronary syndrome. However, there is no consistent evidence for subjects with stable angina.

Objectives: To investigate the prevalence of glucose metabolism in patients with stable coronary artery disease (CAD) documented angiographically and to assess correlations of metabolic profile and extent of atherosclerotic lesions.

Patients and methods: 100 consecutive non-diabetic patients with stable CAD referred to coronary angiography were studied. Total cholesterol and its fractions, triglycerides, uric acid and fasting insulin levels were determined. Oral glucose tolerance test (OGTT) and then coronary angiography were performed. All patients were divided into groups according to glucometabolic and coronary status and insulin resistance. The sum of all lesions in coronary vessels was calculated for each patient (CAD score).

Results: After OGTT, 44% of patients presented disturbed glucose metabolism: 9% of patients had newly diagnosed diabetes and 35% patients were in the prediabetic state. There was no correlation between glycemic status and insulin resistance, and severity of coronary heart disease. Obesity, reflected by body mass index, waist circumference and waist-to-hip ratio, was a major metabolic disorder and independent predictor of the extent of coronary atherosclerosis and glucose intolerance.

Conclusions: Abnormal glucose regulation is very common in patients with stable CAD. Only obesity was the independent predictor of coronary atherosclerosis and dysglycemia. Other metabolic risk factors are target for prevention and treatment.