CLINICAL STUDY: OBESITY, DIABETES, AND HEART DISEASE
Relationship between obesity, insulin resistance, and coronary heart disease risk
Fahim Abbasi, MD*,
Byron William Brown, Jr, PhD ,
Cindy Lamendola, MSN, ANP*,
Tracey McLaughlin, MD* and
Gerald M. Reaven, MD*,*
* Department of Medicine, Stanford, California, USA
Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA
Manuscript received August 27, 2001;
revised manuscript received March 19, 2002,
accepted June 4, 2002.
* Reprint requests and correspondence: Dr. Gerald M. Reaven, Falk CVRC Stanford University School of Medicine, 300 Pasteur Drive, Stanford, California 94305-5406, USA
greaven{at}cvmed.Stanford.edu
OBJECTIVES: The study goals were to: 1) define the relationship between body mass index (BMI) and insulin resistance in 314 nondiabetic, normotensive, healthy volunteers; and 2) determine the relationship between each of these two variables and coronary heart disease (CHD) risk factors.
BACKGROUND: The importance of obesity as a risk factor for type 2 diabetes and hypertension is well-recognized, but its role as a CHD risk factor in nondiabetic, normotensive individuals is less well established.
METHODS: Insulin resistance was quantified by determining the steady-state plasma glucose (SSPG) concentration during the last 30 min of a 180-min infusion of octreotide, glucose, and insulin. In addition, nine CHD risk factors: age, systolic blood pressure, diastolic blood pressure (DBP), total cholesterol, triglycerides (TG), high-density lipoprotein (HDL) cholesterol and low-density lipoprotein cholesterol concentrations, and glucose and insulin responses to a 75-g oral glucose load were measured in the volunteers.
RESULTS: The BMI and the SSPG concentration were significantly related (r = 0.465, p < 0.001). The BMI and SSPG were both independently associated with each of the nine risk factors. In multiple regression analysis, SSPG concentration added modest to substantial power to BMI with regard to the prediction of DBP, HDL cholesterol and TG concentrations, and the glucose and insulin responses.
CONCLUSIONS: Obesity and insulin resistance are both powerful predictors of CHD risk, and insulin resistance at any given degree of obesity accentuates the risk of CHD and type 2 diabetes.
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Abbreviations and Acronyms
| | BMI | | body mass index | | CHD | | coronary heart disease | | DBP | | diastolic blood pressure | | EGIR | | European Group for the Study of Insulin Resistance | | HDL | | high-density lipoprotein | | LDL | | low-density lipoprotein | | NHANES | | National Health and Nutrition Examination Survey | | SBP | | systolic blood pressure | | SSPG | | steady-state plasma glucose | | SSPI | | steady-state plasma insulin | | TG | | triglycerides |
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