[Hyperinsulinism and the coronary syndrome].

Area of Science:

• Endocrinology
• Cardiology
• Metabolic Syndrome

Context:

• Ischemic heart disease (IHD) frequently co-occurs with Non-Insulin-Dependent Diabetes Mellitus (NIDDM) and arterial hypertension in approximately one-third of patients.
• Hyperinsulinism, characterized by elevated insulin and C-peptide levels, is prevalent in the majority of IHD patients, irrespective of glucose tolerance levels.

Purpose:

• To investigate the role of hyperinsulinism as a risk factor in ischemic heart disease (IHD).
• To explore the association between hyperinsulinism and other cardiovascular risk factors, including hypertension, hyperglycemia, and obesity.
• To elucidate the direct and indirect mechanisms by which hyperinsulinism contributes to coronary syndrome pathogenesis.

Summary:

• Hyperinsulinism, stemming from hypersecretion and reduced insulin utilization, is a consistent finding in IHD patients.
• It acts as an independent risk factor for IHD, synergizing with arterial hypertension, hyperglycemia (NIDDM), hyperlipidemia (HPLP), and hirsutism (often associated with polycystic ovary syndrome).
• Hyperinsulinism contributes to coronary syndrome indirectly through the '5H syndrome' (hyperinsulinism, hypertension, HPLP, hyperglycemia, hirsutism) and directly impacts coronary circulation via endothelial dysfunction, favoring vasoconstriction.

Impact:

• Identifies hyperinsulinism as a key component of the '5H syndrome,' a cluster of risk factors for cardiovascular disease.
• Highlights the direct impact of hyperinsulinism on coronary artery endothelial function, potentially leading to vasospasms and coronary X syndrome.
• Suggests that managing hyperinsulinism may be crucial for preventing and treating ischemic heart disease and related conditions.