Plasminogen activator inhibitor 1 and insulin levels in various insulin resistance states

Among obese insulin resistant subjects plasminogen activator inhibitor 1 (PAI 1) levels are closely associated with fasting insulin levels in cross sectional as well as intervention studies. Insulin concentration by itself does not seem to modulate PAI 1 levels at least in acute conditions. PAI 1 levels could be more directly related to the insulin resistant state than to hyperinsulinaemia. To elucidate further this phenomenon we compared insulin, triglyceride and PAI 1 levels in twenty control subjects and in three groups of patients presenting insulin resistance 14 obese subjects, 6 patients with Cushing disease and 7 with acromegaly. None of the tested subjects was diabetic. Fasting insulin levels were elevated in obese (21.4 +/- 8.0) hypercortisolic (20.3 +/- 11.0) and acromegalic patients (16.1 +/- 5.0) compared to controls (9.2 +/- 3.0 microU/ml, m +/- SD). PAI activity and PAI 1 antigen levels were elevated in the obese group only (34.3 +/- 13.0 for PAI 1 activity) and not in the others: 10.2 +/- 10.0, 7.0 +/- 4.6 I U/l for hypercortisolic and acromegalic patients respectively (normal controls 9.7 +/- 5.4). Triglyceride levels were also elevated among obese subjects 2.2 +/- 1.3 vs 1.1 +/- 0.4 mM/l in the controls; they were slightly higher than normal but not significantly in the hypercortisolic (1.5 +/- 0.6) and acromegalic (1.43 +/- 0.6 mM/l) patients. The mechanism of insulin resistance is different in the three conditions studied here. This may explain why elevated PAI 1 concentration are restricted to the common form of insulin resistance as seen in obese subjects. Therefore insulin resistant state per se is not associated with elevated PAI 1 levels.