Abstract
Metabolic syndrome X, a combination of hyper-insulinemia, hypertriglyceridemia, low HDL-cholesterol level, impaired glucose tolerance and hypertension, is associated with the risk of coronary heart disease. To investigate the relationship between visceral fat accumulation and metabolic syndrome X, we measured coronary artery stenosis, several metabolic variables, and the distribution of abdominal fat by CT scanner in 161 patients who underwent coronary angiography. Using a multiple regression analysis, visceral fat area was correlated with the sum of insulin during an oral glucose tolerance test (r=0.321, p=0.0004), HDL-cholesterol level (r=-0.319, p=0.0154), and the sum of glucose (r=0.181, p=0.0401). TG level, however, correlated not with regional fat distribution but with BMI (r=0.283, p=0.0126). Subcutaneous fat area and BMI were not significant predictors of any of the metabolic variables except insulin. Multivariate analysis indicated that the sum of glucose (r=0.364, p=0.0039) and plasma insulin concentration (r=0.233, p=0.048) were found to be independent of other risk factors for CAD in male Japanese. In normotensive patients, however, insulin concentration was not a significant predictor of CAD. In hypertensive patients, the combination of elevated plasma insulin level, visceral fat accumulation, triglyceride concentration and the exacerbation of glucose tolerance was important. We conclude that visceral fat accumulation is a generator of metabolic syndrome X, and that the combination of visceral fat accumulation and hypertension play an important role in CAD among male Japanese.
