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. 1994 Jan;71(1):41–44. doi: 10.1136/hrt.71.1.41

Insulin resistance syndrome as a feature of cardiological syndrome X in non-obese men.

J W Swan 1, C Walton 1, I F Godsland 1, D Crook 1, M F Oliver 1, J C Stevenson 1
PMCID: PMC483609  PMID: 8297693

Abstract

OBJECTIVE--To assess the features of the insulin resistance syndrome in patients presenting with cardiological syndrome X, who experience angina despite angiographically normal coronary arteries. PATIENTS AND METHODS--14 Non-obese male patients with syndrome X and 38 symptom free, apparently healthy, male volunteers were studied. Insulin sensitivity (inversely related to insulin resistance) was measured by minimal modelling analysis of glucose and insulin concentrations during an intravenous glucose tolerance test. Serum lipids, lipoproteins, and apolipoproteins were also measured. RESULTS--Insulin sensitivity was 31% lower in the men with syndrome X (p < 0.05) and fasting insulin concentration was 30% higher (p < 0.05). The patient group also had 64% higher mean triglycerides (p < 0.001) and 20% lower mean high density lipoprotein cholesterol concentration (p < 0.01). Systolic blood pressure was also 10% higher in the syndrome X group (p < 0.01). There were no differences in total cholesterol, low density lipoprotein cholesterol or lipoprotein (a). CONCLUSION--These findings show that non-obese male patients with anginal chest pain but normal coronary arteries (syndrome X) are insulin resistant, hyperinsulinaemic, and have higher concentrations of triglycerides and lower high density lipoprotein cholesterol than healthy men. The insulin resistance syndrome may predispose to a spectrum of arterial disease capable of causing myocardial ischaemia.

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Selected References

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  1. Bergman R. N., Ider Y. Z., Bowden C. R., Cobelli C. Quantitative estimation of insulin sensitivity. Am J Physiol. 1979 Jun;236(6):E667–E677. doi: 10.1152/ajpendo.1979.236.6.E667. [DOI] [PubMed] [Google Scholar]
  2. Boudoulas H., Cobb T. C., Leighton R. F., Wilt S. M. Myocardial lactate production in patients with angina-like chest pain and angiographically normal coronary arteries and left ventricle. Am J Cardiol. 1974 Oct 3;34(5):501–505. doi: 10.1016/0002-9149(74)90118-0. [DOI] [PubMed] [Google Scholar]
  3. Bøtker H. E., Møller N., Ovesen P., Mengel A., Schmitz O., Orskov H., Bagger J. P. Insulin resistance in microvascular angina (syndrome X) Lancet. 1993 Jul 17;342(8864):136–140. doi: 10.1016/0140-6736(93)91344-l. [DOI] [PubMed] [Google Scholar]
  4. Cannon R. O., 3rd, Bonow R. O., Bacharach S. L., Green M. V., Rosing D. R., Leon M. B., Watson R. M., Epstein S. E. Left ventricular dysfunction in patients with angina pectoris, normal epicardial coronary arteries, and abnormal vasodilator reserve. Circulation. 1985 Feb;71(2):218–226. doi: 10.1161/01.cir.71.2.218. [DOI] [PubMed] [Google Scholar]
  5. Dean J. D., Jones C. J., Hutchison S. J., Peters J. R., Henderson A. H. Hyperinsulinaemia and microvascular angina ("syndrome X") Lancet. 1991 Feb 23;337(8739):456–457. [PubMed] [Google Scholar]
  6. Facchini F. S., Hollenbeck C. B., Jeppesen J., Chen Y. D., Reaven G. M. Insulin resistance and cigarette smoking. Lancet. 1992 May 9;339(8802):1128–1130. doi: 10.1016/0140-6736(92)90730-q. [DOI] [PubMed] [Google Scholar]
  7. Fink R. I., Kolterman O. G., Griffin J., Olefsky J. M. Mechanisms of insulin resistance in aging. J Clin Invest. 1983 Jun;71(6):1523–1535. doi: 10.1172/JCI110908. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Friedewald W. T., Levy R. I., Fredrickson D. S. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972 Jun;18(6):499–502. [PubMed] [Google Scholar]
  9. Gidez L. I., Miller G. J., Burstein M., Slagle S., Eder H. A. Separation and quantitation of subclasses of human plasma high density lipoproteins by a simple precipitation procedure. J Lipid Res. 1982 Nov;23(8):1206–1223. [PubMed] [Google Scholar]
  10. Godsland I. F., Crook D., Walton C., Wynn V., Oliver M. F. Influence of insulin resistance, secretion, and clearance on serum cholesterol, triglycerides, lipoprotein cholesterol, and blood pressure in healthy men. Arterioscler Thromb. 1992 Sep;12(9):1030–1035. doi: 10.1161/01.atv.12.9.1030. [DOI] [PubMed] [Google Scholar]
  11. Kaul S., Newell J. B., Chesler D. A., Pohost G. M., Okada R. D., Boucher C. A. Quantitative thallium imaging findings in patients with normal coronary angiographic findings and in clinically normal subjects. Am J Cardiol. 1986 Mar 1;57(8):509–512. doi: 10.1016/0002-9149(86)90825-8. [DOI] [PubMed] [Google Scholar]
  12. Kemp H. G., Jr Left ventricular function in patients with the anginal syndrome and normal coronary arteriograms. Am J Cardiol. 1973 Sep 7;32(3):375–376. doi: 10.1016/s0002-9149(73)80150-x. [DOI] [PubMed] [Google Scholar]
  13. Kolterman O. G., Insel J., Saekow M., Olefsky J. M. Mechanisms of insulin resistance in human obesity: evidence for receptor and postreceptor defects. J Clin Invest. 1980 Jun;65(6):1272–1284. doi: 10.1172/JCI109790. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Korhola O., Valle M., Frick M. H., Wiljasalo M., Riihimäki E. Regional myocardial perfusion abnormalities on xenon-133 imaging in patients with angina pectoris and normal coronary arteries. Am J Cardiol. 1977 Mar;39(3):355–359. doi: 10.1016/s0002-9149(77)80088-x. [DOI] [PubMed] [Google Scholar]
  15. Mammohansingh P., Parker J. O. Angina pectoris with normal coronary arteriograms: hemodynamic and metabolic response to atrial pacing. Am Heart J. 1975 Nov;90(5):555–561. doi: 10.1016/0002-8703(75)90217-3. [DOI] [PubMed] [Google Scholar]
  16. Modan M., Halkin H., Lusky A., Segal P., Fuchs Z., Chetrit A. Hyperinsulinemia is characterized by jointly disturbed plasma VLDL, LDL, and HDL levels. A population-based study. Arteriosclerosis. 1988 May-Jun;8(3):227–236. doi: 10.1161/01.atv.8.3.227. [DOI] [PubMed] [Google Scholar]
  17. Mount J. N., Kearney E. M., Rosseneu M., Slavin B. M. Immunoturbidimetric assays for serum apolipoproteins A1 and B using Cobas Bio centrifugal analyser. J Clin Pathol. 1988 Apr;41(4):471–474. doi: 10.1136/jcp.41.4.471. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Opherk D., Zebe H., Weihe E., Mall G., Dürr C., Gravert B., Mehmel H. C., Schwarz F., Kübler W. Reduced coronary dilatory capacity and ultrastructural changes of the myocardium in patients with angina pectoris but normal coronary arteriograms. Circulation. 1981 Apr;63(4):817–825. doi: 10.1161/01.cir.63.4.817. [DOI] [PubMed] [Google Scholar]
  19. Panza J. A., Quyyumi A. A., Brush J. E., Jr, Epstein S. E. Abnormal endothelium-dependent vascular relaxation in patients with essential hypertension. N Engl J Med. 1990 Jul 5;323(1):22–27. doi: 10.1056/NEJM199007053230105. [DOI] [PubMed] [Google Scholar]
  20. Pfeifle B., Ditschuneit H. Effect of insulin on growth of cultured human arterial smooth muscle cells. Diabetologia. 1981 Feb;20(2):155–158. doi: 10.1007/BF00262020. [DOI] [PubMed] [Google Scholar]
  21. Reaven G. M. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes. 1988 Dec;37(12):1595–1607. doi: 10.2337/diab.37.12.1595. [DOI] [PubMed] [Google Scholar]
  22. Richardson P. J., Livesley B., Oram S., Olsen E. G., Armstrong P. Angina pectoris with normal coronary arteries. Transvenous myocardial biopsy in diagnosis. Lancet. 1974 Sep 21;2(7882):677–680. doi: 10.1016/s0140-6736(74)93260-7. [DOI] [PubMed] [Google Scholar]
  23. Saenz de Tejada I., Goldstein I., Azadzoi K., Krane R. J., Cohen R. A. Impaired neurogenic and endothelium-mediated relaxation of penile smooth muscle from diabetic men with impotence. N Engl J Med. 1989 Apr 20;320(16):1025–1030. doi: 10.1056/NEJM198904203201601. [DOI] [PubMed] [Google Scholar]
  24. Sax F. L., Cannon R. O., 3rd, Hanson C., Epstein S. E. Impaired forearm vasodilator reserve in patients with microvascular angina. Evidence of a generalized disorder of vascular function? N Engl J Med. 1987 Nov 26;317(22):1366–1370. doi: 10.1056/NEJM198711263172202. [DOI] [PubMed] [Google Scholar]
  25. Swislocki A. L., Hoffman B. B., Reaven G. M. Insulin resistance, glucose intolerance and hyperinsulinemia in patients with hypertension. Am J Hypertens. 1989 Jun;2(6 Pt 1):419–423. doi: 10.1093/ajh/2.6.419. [DOI] [PubMed] [Google Scholar]
  26. Walton C., Godsland I. F., Proudler A. J., Felton C. V., Wynn V. Effect of body mass index and fat distribution on insulin sensitivity, secretion, and clearance in nonobese healthy men. J Clin Endocrinol Metab. 1992 Jul;75(1):170–175. doi: 10.1210/jcem.75.1.1619007. [DOI] [PubMed] [Google Scholar]
  27. Walton C., Godsland I. F., Proudler A. J., Felton C., Wynn V. Evaluation of four mathematical models of glucose and insulin dynamics with analysis of effects of age and obesity. Am J Physiol. 1992 May;262(5 Pt 1):E755–E762. doi: 10.1152/ajpendo.1992.262.5.E755. [DOI] [PubMed] [Google Scholar]
  28. Warnick G. R., Albers J. J. A comprehensive evaluation of the heparin-manganese precipitation procedure for estimating high density lipoprotein cholesterol. J Lipid Res. 1978 Jan;19(1):65–76. [PubMed] [Google Scholar]

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