Abstract
Selective coronary angiography and 75-gram oral glucose tolerance test were carried out in 123 subjects to clarify the pathogenesis of the increased incidence of coronary heart disease (CHD) in diabetics.
The coronary score was defined on the basis of angiographic results. The subjects were divided into four groups according to the coronary score: N group, coronary score 0; L group, coronary score 1-7; M group, coronary score 8-12; H group, coronary score 13-. No obstruction was detected in subject in the N group. Subjects in the H group had severe coronary arterial lesions. Age, obesity index, plasma total cholesterol level and plasma triglyceride level were matched among the four groups.
1) The percentage of diabetics in each group was as follows: 5% for the N group, 14% for the L group, 30% for the M group, and 29% for the H group.
2) The plasma glucose and insulin levels before glucose ingestion and 30, 60 and 120 minutes after glucose ingestion were compared among the four groups. The severer were the coronary arterial lesions, the higher were the plasma glucose levels before and after glucose loading. The plasma insulinlevels before and after glucose loading were higher in the H group than those in the M group. The results suggest that hyperinsulinemia plays an important role in the development of CHD.
3) The coronary scores of the DM group and the non-DM group (N group) in men were compared. The coronary score in the DM group was significantly higher than that in the N group (p<0.05). Age, obesity index, blood pressure, daily consumption of tobacco, plasma total cholesterol level and plasma triglyceride level were matched in the DM group and the N group. These results suggest taat the diabetic state is an independent risk factor for CHD, and that the increased incidence of CHD in diabetics is not attributable of age, obesity, hypertension, tobacco, or hyperlipidemia.
