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Hyperinsulinemic hypoalphalipoproteinemia as a new indicator for coronary heart disease
1Department of Internal Medicine, Fukuoka University School of Medicine, Japan. hh035399@msat.fukuoka-u.ac.jp
Insights
High levels of high-density lipoprotein cholesterol (HDL-C) may protect against coronary heart disease (CHD) in individuals with insulin resistance. This suggests HDL-C can mitigate the negative impacts of high insulin, a key factor in CHD development.
Area of Science:
- Cardiovascular Medicine
- Metabolic Syndrome
- Lipidology
Background:
- Low high-density lipoprotein cholesterol (HDL-C) and hyperinsulinemia are independent risk factors for coronary heart disease (CHD).
- A significant inverse correlation exists between HDL-C and insulin levels, particularly noted in conditions like syndrome X.
Purpose of the Study:
- To examine the relationship between insulin resistance, HDL-C, and CHD.
- To determine if HDL-C can counteract the detrimental effects of insulin on cardiovascular health.
Main Methods:
- The study included 54 pairs of patients with angiographically confirmed CHD (cases) and matched controls.
- Insulin resistance was quantified using the Homeostasis Model Assessment (HOMA).
Main Results:
- Patients with CHD exhibited higher HOMA insulin resistance and lower HDL-C levels compared to controls.
- Receiver Operating Characteristic (ROC) curve analysis confirmed HDL-C and insulin resistance as significant CHD discriminators.
- A significant interaction was observed: individuals with hyperinsulinemia and high HDL-C did not show an increased CHD risk.
Conclusions:
- Hyperinsulinemic hypoalphalipoproteinemia is a stronger predictor of CHD than insulin resistance or low HDL-C alone.
- Elevated HDL-C levels appear to mitigate the adverse cardiovascular effects associated with hyperinsulinemia.
Objectives:
The purpose of this study was to investigate the association among insulin resistance, high density lipoprotein cholesterol (HDL-C) and coronary heart disease (CHD), and to test the hypothesis that HDL-C may ameliorate the adverse effects of insulin.
Background:
Serum low HDL-C (hypoalphalipoproteinemia) and hyperinsulinemia are independent predictors for CHD, but a strong negative correlation exists between them, as in patients with syndrome X.
Methods:
Fifty-four pairs of cases (M/F: 49/5), defined as patients with angiographically proved CHD, and control subjects (M/F: 49/5) matched with cases with regard to gender and age were included. Insulin resistance was assessed by the homeostasis model assessment (HOMA).
Results:
Cases had increased HOMA insulin resistance and lower serum levels of HDL-C than controls. A receiver operating characteristic (ROC) curve analysis indicated that HDL-C and insulin resistance were significant discriminators of CHD (area under ROC curve: 0.72 and 0.69, respectively). The interaction between HDL-C and the association of insulin resistance with CHD was significant: subjects with hyperinsulinemia and high HDL-C had no increased risk of CHD. Multivariate conditional logistic regression analysis showed that hyperinsulinemic hypoalphalipoproteinemia was a stronger indicator for CHD than either HDL-C or insulin resistance alone (-2 log likelihood: 19.0 vs. 12.6 or 15.7).
Conclusions:
Hyperinsulinemic hypoalphalipoproteinemia was a more potent indicator for CHD than either insulin resistance or low serum HDL-C levels alone, and the adverse effects of hyperinsulinemia seem to be ameliorated by high HDL-C levels.