Clinical study: obesity, diabetes, and heart disease
Relationship between obesity, insulin resistance, and coronary heart disease risk

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Abstract

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.

Abbreviations

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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Supported by Research Grants from the National Institutes of Health (RR-00070 and HL-08506).