The association between fasting serum insulin, apo-lipoproteins level, and severity of coronary artery involvement in non-diabetic patients

Authors

1 Department of Cardiovascular Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Epidemiology, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: In the previous studies, fasting insulin and apo-lipoproteins are considered as one of the risk-factor of coronary artery disease (CAD) but did not have the same results.
In this study, we attempted to define the association of high fasting insulin and apo-lipoproteins of serum in non-diabetic patients who were afflicted with coronary arteries disease with severity of coronary arteries involvement.
Materials and Methods: This study was conducted between September 2011 and February 2012 on three groups, each one consisting of 100 members while using angiographic scores of Gensini with three equal groups with low, medium, and high stenosis of coronary arteries.
The evaluation of non-diabetic patients afflicted with CADs, included the fasting glucose level less than 126 mg/dl or non-consumption of blood glucose reduction drugs or negativity history of diabetes.
Results: In this study, there were 300 non-diabetic patients afflicted with CAD in three groups of low, medium, and high extremity. Due to attained results, the patients afflicted with high CAD had a higher level of insulin (18.3 ± 0.8) in relation with low and medium groups (P < 0.001). As it was observed, the level of serum apo-lipoproteins of A1 (APO-A1) in low group of CAD (175 ± 36.4) is meaningfully higher than its quantity in high-CAD group (158 ± 42.4, P < 0.001). Furthermore, the quantity of serum apo-lipoproteins of B (APO-B) in mild CAD group (139 ± 30.4) is meaningfully less than severe CAD group (155.21 ± 29.7, P < 0.001).
Conclusion: Our findings show that insulin, APO-A1, APO-B, and total cholesterol measurement is a good case for defining the severity of coronary artery involvement, while high-density lipoprotein, low-density lipoprotein, and triglyceride are not important risk-factors.

Keywords

1. D'Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care: The Framingham Heart Study. Circulation 2008;117:743-53.  Back to cited text no. 1
    
2. Hubert HB, Feinleib M, McNamara PM, Castelli WP. Obesity as an independent risk factor for cardiovascular disease: A 26-year follow-up of participants in the Framingham Heart Study. Circulation 1983;67:968-77.  Back to cited text no. 2
    
3. Sharrett AR, Ballantyne CM, Coady SA, Heiss G, Sorlie PD, Catellier D, Patsch W; Atherosclerosis Risk in Communities Study Group. Coronary heart disease prediction from lipoprotein cholesterol levels, triglycerides, lipoprotein(a), apolipoproteins A-I and B, and HDL density subfractions: The Atherosclerosis Risk in Communities (ARIC) Study. Circulation 2001;104:1108-13.  Back to cited text no. 3
    
4. Ingelsson E, Schaefer EJ, Contois JH, McNamara JR, Sullivan L, Keyes MJ, et al. Clinical utility of different lipid measures for prediction of coronary heart disease in men and women. JAMA 2007;298:776-85.  Back to cited text no. 4
    
5. Dodani S. Excess coronary artery disease risk in South Asian immigrants: Can dysfunctional high-density lipoprotein explain increased risk? Vasc Health Risk Manag 2008;4:953-61.  Back to cited text no. 5
    
6. Williams RR, Hunt SC, Hopkins PN, Stults BM, Wu LL, Hasstedt SJ, et al. Familial dyslipidemic hypertension. Evidence from 58 Utah families for a syndrome present in approximately 12% of patients with essential hypertension. JAMA 1988;259:3579-86.  Back to cited text no. 6
    
7. Kamstrup PR, Tybjaerg-Hansen A, Steffensen R, Nordestgaard BG. Genetically elevated lipoprotein(a) and increased risk of myocardial infarction. JAMA 2009;301:2331-9.  Back to cited text no. 7
    
8. Sahi N, Pahlajani DB, Sainani GS. Apolipoproteins A-1 and B as predictors of angiographically assessed coronary artery disease. J Assoc Physicians India 1993;41:713-5.  Back to cited text no. 8
    
9. Orchard TJ, Becker DJ, Bates M, Kuller LH, Drash AL. Plasma insulin and lipoprotein concentrations: An atherogenic association? Am J Epidemiol 1983;118:326-37.  Back to cited text no. 9
    
10. Enbergs A, Dorszewski A, Luft M, Mönnig G, Kleemann A, Schulte H, et al. Failure to confirm ferritin and caeruloplasmin as risk factors for the angiographic extent of coronary arteriosclerosis. Coron Artery Dis 1998;9:119-24.  Back to cited text no. 10
    
11. Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol 1983;51:606.  Back to cited text no. 11
    
12. Smith GD, Ben-Shlomo Y, Beswick A, Yarnell J, Lightman S, Elwood P. Cortisol, testosterone, and coronary heart disease: Prospective evidence from the Caerphilly study. Circulation 2005;112:332-40.  Back to cited text no. 12
    
13. Aicher BO, Haser EK, Freeman LA, Carnie AV, Stonik JA, Wang X, et al. Diet-induced weight loss in overweight or obese women and changes in high-density lipoprotein levels and function. Obesity (Silver Spring) 2012;20:2057-62.  Back to cited text no. 13
    
14. Shand BI, Scott RS, Elder PA, George PM. Plasma adiponectin in overweight, nondiabetic individuals with or without insulin resistance. Diabetes Obes Metab 2003;5:349-53.  Back to cited text no. 14
    
15. Mojiminiyi OA, Abdella NA, Al Arouj M, Ben Nakhi A. Adiponectin, insulin resistance and clinical expression of the metabolic syndrome in patients with Type 2 diabetes. Int J Obes (Lond) 2007;31:213-20.  Back to cited text no. 15
    
16. Tobey TA, Greenfield M, Kraemer F, Reaven GM. Relationship between insulin resistance, insulin secretion, very low density lipoprotein kinetics, and plasma triglyceride levels in normotriglyceridemic man. Metabolism 1981;30:165-71.  Back to cited text no. 16
    
17. Taskinen MR. Diabetic dyslipidaemia: From basic research to clinical practice. Diabetologia 2003;46:733-49.  Back to cited text no. 17
    
18. Sayin MR, Cetiner MA, Karabag T, Akpinar I, Sayin E, Kurcer MA, et al. Framingham risk score and severity of coronary artery disease. Herz 2013.  Back to cited text no. 18
    
19. Morito N, Inoue Y, Urata M, Yahiro E, Kodama S, Fukuda N, et al. Increased carotid artery plaque score is an independent predictor of the presence and severity of coronary artery disease. J Cardiol 2008;51:25-32.  Back to cited text no. 19
    
20. Bush CA, VanFossen DB, Kolibash AJ Jr, Magorien RD, Bacon JP, Ansel GM, et al. Cardiac catheterization and coronary angiography using 5 French preformed (Judkins) catheters from the percutaneous right brachial approach: A comparative analysis with the femoral approach. Cathet Cardiovasc Diagn 1993;29:267-72.  Back to cited text no. 20
    
21. Hosszúfalusi N, Pánczél P, Jánoskuti L. Hyperinsulinemia predicts coronary heart disease risk in healthy middle-aged men. Circulation 1999;100:e118.  Back to cited text no. 21
    
22. Kaplan F, Al-Majali K, Betteridge DJ. PPARS, insulin resistance and type 2 diabetes. J Cardiovasc Risk 2001;8:211-7.  Back to cited text no. 22
    
23. Miller JL. Insulin resistance syndrome. Description, pathogenesis, and management. Postgrad Med 2003;Spec No:27-34.  Back to cited text no. 23
    
24. Challapalli S, Hendel RC, Bonow RO. Clinical profile of patients with congestive heart failure due to coronary artery disease: Stunned/hibernating myocardium, ischemia, scar. Coron Artery Dis 1998;9:629-44.   Back to cited text no. 24
    
25. Ramos M, DePasquale E, Coplan NL. Assessment of myocardial viability: Review of the clinical significance. Rev Cardiovasc Med 2008;9:225-31.   Back to cited text no. 25
    
26. Telkova IL, Tepliakov AT. Relationships between changes of coronary blood flow, energy metabolism of the myocardium, and hyperinsulinemia in patients with ischemic heart disease. Kardiologiia 2005;45:61-8.   Back to cited text no. 26
    
27. Kubota I, Hirono O, Takeishi Y. Progress in diagnosis of coronary disease: Blood markers, echocardiography and scintigraphy. Nihon Naika Gakkai Zasshi 2005;94:435-40. Review. Japanese.  Back to cited text no. 27
    
28. Banerjee D, Biggs ML, Mercer L, Mukamal K, Kaplan R, Barzilay J, et al. Insulin resistance and risk of incident heart failure: Cardiovascular Health Study. Circ Heart Fail 2013;6:364-70.  Back to cited text no. 28
    
29. Folsom AR, Rasmussen ML, Chambless LE, Howard G, Cooper LS, Schmidt MI, et al. Prospective associations of fasting insulin, body fat distribution, and diabetes with risk of ischemic stroke. The Atherosclerosis Risk in Communities (ARIC) Study Investigators. Diabetes Care 1999;22:1077-83.   Back to cited text no. 29
    
30. Smith GD, Ben-Shlomo Y, Beswick A, Yarnell J, Lightman S, Elwood P. Cortisol, testosterone, and coronary heart disease: Prospective evidence from the Caerphilly study. Circulation 2005;112:332-40.  Back to cited text no. 30
    
31. Hariawala MD, Deshmukh VV, Sellke FW. Insulin resistance: A common factor in the triad of dyslipidemia, hypertension, and coronary artery disease? Am J Med Sci 1997;313:104-6.  Back to cited text no. 31
    
32. Yazdandoust S, Parizadeh SM, Moohebati M, Yaghmaei P, Rahsepar AA, Tavallaie S, et al. Serum small dense low-density lipoprotein concentrations are elevated in patients with significant coronary artery stenosis and are related to features of the metabolic syndrome. Lipids 2012;47:963-72.  Back to cited text no. 32
    
33. Pigna G, Napoli A, Zaccagna F, Marincola BC, Monticolo R, Catalano C, et al. The relationship between metabolic syndrome, its components, and the whole-body atherosclerotic disease burden as measured by computed tomography angiography. Atherosclerosis 2011;215:417-20.   Back to cited text no. 33
    
34. Mitsutake R, Miura S, Kawamura A, Saku K. Are metabolic factors associated with coronary artery stenosis on MDCT? Circ J 2009;73:132-8.   Back to cited text no. 34
    
35. Koji Y, Tomiyama H, Yamada J, Yambe M, Motobe K, Shiina K, et al. Relationship between arterial stiffness and the risk of coronary artery disease in subjects with and without metabolic syndrome. Hypertens Res 2007;30:243-7.  Back to cited text no. 35
    
36. Martens FM, van der Graaf Y, Dijk JM, Olijhoek JK, Visseren FL. Carotid arterial stiffness is marginally higher in the metabolic syndrome and markedly higher in type 2 diabetes mellitus in patients with manifestations of arterial disease. Atherosclerosis 2008;197:646-53.   Back to cited text no. 36
    
37. Sadeghi M, Roohafza H, Afshar H, Rajabi F, Ramzani M, Shemirani H, et al. Relationship between depression and apolipoproteins A and B: A case-control study. Clinics (Sao Paulo) 2011;66:113-7.   Back to cited text no. 37
    
38. Khadem-Ansari MH, Rasmi Y, Rahimi-Pour A, Jafarzadeh M. The association between serum apolipoprotein A-I and apolipoprotein B and the severity of angiographical coronary artery disease. Singapore Med J 2009;50:610-3.  Back to cited text no. 38
    
39. Yamada N. Dyslipidemia. Nihon Rinsho 2004;62:1021-7.  Back to cited text no. 39
    
40. Osmancik PP, Bednar F, Móciková H. Glycemia, triglycerides and disease severity are best associated with higher platelet activity in patients with stable coronary artery disease. J Thromb Thrombolysis 2007;24:105-7.  Back to cited text no. 40
    
41. Telkova IL, Karpov RS. The diagnostic significance of insulinemia in the evaluation of myocardial torpor and hibernation in patients with coronary artery disease. Klin Med (Mosk) 2006;84:40-5.  Back to cited text no. 41
    
42. Goswami B, Rajappa M, Mallika V, Kumar S, Shukla DK. Apo-B/apo-AI ratio: A better discriminator of coronary artery disease risk than other conventional lipid ratios in Indian patients with acute myocardial infarction. Acta Cardiol 2008;63:749-55.  Back to cited text no. 42
    
43. Aslan I, Kucuksayan E, Aslan M. Effect of insulin analog initiation therapy on LDL/HDL subfraction profile and HDL associated enzymes in type 2 diabetic patients. Lipids Health Dis 2013;12:54.  Back to cited text no. 43
    
44. Rasouli M, Kiasari AM, Mokhberi V. The ratio of apoB/apoAI, apoB and lipoprotein(a) are the best predictors of stable coronary artery disease. Clin Chem Lab Med 2006;44:1015-21.  Back to cited text no. 44
    
45. Onat A, Sansoy V. Systolic and diastolic blood pressure related to six other risk parameters in Turkish adults: Strong correlation with relative weight. Int J Cardiol 1998;63:295-303.  Back to cited text no. 45