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Hyperinsulinemic hypoalphalipoproteinemia as a new indicator for coronary heart disease

Keijiro Saku, MD, PhD, FACC^a* , Bo Zhang, MS, PhD^a* , Kazuyuki Shirai, MD, PhD^a* , Shiro Jimi, PhD^*, Kazuhiko Yoshinaga, BS^a* and Kikuo Arakawa, MD, PhD, FACC^a*

^a Department of Internal Medicine, Fukuoka University School of Medicine, Fukuoka, Japan
^* Department of Pathology, Fukuoka University School of Medicine, Fukuoka, Japan
Department of Social Medicine, Fukuoka University School of Medicine, Fukuoka, Japan

View larger version (27K): [in a new window]   Figure 1 Frequency distributions of (A) insulin resistance as assessed by the HOMA model and (B) serum levels of HDL-C in 54 pairs of cases with coronary heart disease (solid bars) and controls (open bars). The frequency distributions of HOMA insulin resistance and HDL-C were each significantly different between the two groups (chi-square = 19.2 and 23.8, df = 7, p < 0.01). The proportion of cases in each tertile of HOMA insulin resistance (Fig. 1A) and HDL-C (Fig. 1B) is also shown, along with their corresponding mean values ± SD. Arrows on the X axis identify the tertile values (solid arrows on the left and right, 0.96 and 1.43 for HOMA insulin resistance and 45 and 56 mg/dl for HDL-C) and the median value (open arrows in the middle, 1.21 for HOMA insulin resistance and 53 mg/dl for HDL-C) of control subjects.

View larger version (29K): [in a new window]   Figure 2 (A) ROC curves of the true-positive rate (sensitivity) versus the false-positive rate (1–specificity) for HOMA insulin resistance. The smooth curves are model-fitted curves by the method of Swets (26). (B) Two-graph ROC plots of the sensitivity (solid lines) and specificity (dotted lines) curves from the ROC curve analysis versus HOMA insulin resistance. Cutoff values were defined to give 70% specificity.

View larger version (25K): [in a new window]   Figure 3 (A) Correlation between serum levels of HDL-C and HOMA insulin resistance in 54 pairs of cases (solid circles) and control subjects (open circles). Regression lines for cases and controls are shown by solid and dotted lines, respectively. (B) Differences in HOMA insulin resistance between cases and gender- and age-matched controls plotted against HDL-C in the case patient and fitted by linear regression.

View larger version (29K): [in a new window]   Figure 4 Odds ratios for CHD (95% confidence interval in parenthesis) and probability levels (top of bar) according to insulin resistance as assessed by the HOMA model (15) and high density lipoprotein cholesterol (HDL-C). Cutoff values at a specificity of 0.7 (70%) were used to make dummy variables. Odds ratios were obtained by a conditional logistic regression analysis and are adjusted for covariates (body mass index, hypertension and smoking status). CHD = coronary heart disease.