Tags

Type your tag names separated by a space and hit enter

The influence of obesity and consequent insulin resistance on coronary risk factors in medically treated patients with coronary disease.
Int J Obes (Lond). 2008 Jun; 32(6):967-74.IJ

Abstract

OBJECTIVE

Obesity promotes the development and progression of coronary heart disease (CHD), in part, through its association with hyperlipidemia, hypertension, clotting abnormalities and insulin resistance. We assessed whether these relationships persist in patients with established CHD treated with evidence-based preventive pharmacologic therapies.

DESIGN AND SUBJECTS

We performed a cross-sectional study of 74 adults with CHD and a body mass index (BMI) of >27 kg m(-2) (mean 32+/-4). The mean age of subjects was 64+/-9 years (range 44-84 years).

MEASUREMENTS

Obesity measures included weight, BMI, waist, fat mass, intra-abdominal fat and subcutaneous fat. Risk factor measures included insulin sensitivity, fasting insulin level, lipid profiles, blood pressure, C-reactive protein (hs-CRP), plasminogen activator inhibitor (PAI-1) and platelet reactivity. Medication use included aspirin (99%), statin (84%), beta-blocker (71%), ACE inhibitor or blocker (37%) and clopidogrel (28%).

RESULTS

There was no direct relationship between obesity parameters and risk factor measures of lipid concentrations, blood pressure, clotting abnormalities or platelet reactivity except for a modest relationship between visceral fat and hs-CRP (r=0.30, P=0.02). However, increased BMI, waist circumference, fat mass, total abdominal fat and abdominal subcutaneous fat all correlated with insulin sensitivity (r-values -0.30 to -0.45, P-values 0.01 to <0.001) and insulin concentrations. Insulin sensitivity, in turn, was the best predictor of PAI-1, triglycerides, high-density lipoprotein (HDL) levels, cholesterol/HDL levels (all P<0.01) and platelet reactivity (R=0.34, P=0.02).

CONCLUSIONS

Use of preventive pharmacologic therapies obviated the expected relationship between adiposity and CHD risk factors. However, a residual effect of insulin resistance is left untreated. Total adiposity and central adiposity were strong predictors of insulin sensitivity, which in turn predicted cardiac risk factors such as lipid concentrations, PAI-1 and platelet reactivity. Thus, while evidence-based pharmacologic treatments may diminish the statistical relationship between obesity and many cardiac risk factors, adiposity negatively impacts CHD risk by reducing tissue insulin sensitivity.

Authors+Show Affiliations

Division of Cardiology, University of Vermont College of Medicine, Burlington, VT 05403, USA. Philip.Ades@vtmednet.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18268512

Citation

Ades, P A., et al. "The Influence of Obesity and Consequent Insulin Resistance On Coronary Risk Factors in Medically Treated Patients With Coronary Disease." International Journal of Obesity (2005), vol. 32, no. 6, 2008, pp. 967-74.
Ades PA, Savage PD, Toth MJ, et al. The influence of obesity and consequent insulin resistance on coronary risk factors in medically treated patients with coronary disease. Int J Obes (Lond). 2008;32(6):967-74.
Ades, P. A., Savage, P. D., Toth, M. J., Schneider, D. J., Audelin, M. C., Bunn, J. Y., & Ludlow, M. (2008). The influence of obesity and consequent insulin resistance on coronary risk factors in medically treated patients with coronary disease. International Journal of Obesity (2005), 32(6), 967-74. https://doi.org/10.1038/ijo.2008.6
Ades PA, et al. The Influence of Obesity and Consequent Insulin Resistance On Coronary Risk Factors in Medically Treated Patients With Coronary Disease. Int J Obes (Lond). 2008;32(6):967-74. PubMed PMID: 18268512.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The influence of obesity and consequent insulin resistance on coronary risk factors in medically treated patients with coronary disease. AU - Ades,P A, AU - Savage,P D, AU - Toth,M J, AU - Schneider,D J, AU - Audelin,M C, AU - Bunn,J Y, AU - Ludlow,M, Y1 - 2008/02/12/ PY - 2008/2/13/pubmed PY - 2009/1/1/medline PY - 2008/2/13/entrez SP - 967 EP - 74 JF - International journal of obesity (2005) JO - Int J Obes (Lond) VL - 32 IS - 6 N2 - OBJECTIVE: Obesity promotes the development and progression of coronary heart disease (CHD), in part, through its association with hyperlipidemia, hypertension, clotting abnormalities and insulin resistance. We assessed whether these relationships persist in patients with established CHD treated with evidence-based preventive pharmacologic therapies. DESIGN AND SUBJECTS: We performed a cross-sectional study of 74 adults with CHD and a body mass index (BMI) of >27 kg m(-2) (mean 32+/-4). The mean age of subjects was 64+/-9 years (range 44-84 years). MEASUREMENTS: Obesity measures included weight, BMI, waist, fat mass, intra-abdominal fat and subcutaneous fat. Risk factor measures included insulin sensitivity, fasting insulin level, lipid profiles, blood pressure, C-reactive protein (hs-CRP), plasminogen activator inhibitor (PAI-1) and platelet reactivity. Medication use included aspirin (99%), statin (84%), beta-blocker (71%), ACE inhibitor or blocker (37%) and clopidogrel (28%). RESULTS: There was no direct relationship between obesity parameters and risk factor measures of lipid concentrations, blood pressure, clotting abnormalities or platelet reactivity except for a modest relationship between visceral fat and hs-CRP (r=0.30, P=0.02). However, increased BMI, waist circumference, fat mass, total abdominal fat and abdominal subcutaneous fat all correlated with insulin sensitivity (r-values -0.30 to -0.45, P-values 0.01 to <0.001) and insulin concentrations. Insulin sensitivity, in turn, was the best predictor of PAI-1, triglycerides, high-density lipoprotein (HDL) levels, cholesterol/HDL levels (all P<0.01) and platelet reactivity (R=0.34, P=0.02). CONCLUSIONS: Use of preventive pharmacologic therapies obviated the expected relationship between adiposity and CHD risk factors. However, a residual effect of insulin resistance is left untreated. Total adiposity and central adiposity were strong predictors of insulin sensitivity, which in turn predicted cardiac risk factors such as lipid concentrations, PAI-1 and platelet reactivity. Thus, while evidence-based pharmacologic treatments may diminish the statistical relationship between obesity and many cardiac risk factors, adiposity negatively impacts CHD risk by reducing tissue insulin sensitivity. SN - 1476-5497 UR - https://www.unboundmedicine.com/medline/citation/18268512/The_influence_of_obesity_and_consequent_insulin_resistance_on_coronary_risk_factors_in_medically_treated_patients_with_coronary_disease_ L2 - https://doi.org/10.1038/ijo.2008.6 DB - PRIME DP - Unbound Medicine ER -