The pathophysiological meanings of IHD risk factors in the occurrence of IHD have not yet been fully clarified. In order to clarify the significance of abnormalities in the carbohydrate-lipid metabolism as one of the IHD risk factors, we studied the correlation between the glucose tolerance as well as FFA patterns in blood to 50g-OGTT and Master exercise test in 66 cases of elderly subjects (74 yrs. in the mean age), to comparison with 20 young healthy subjects 20.5 yrs. in the mean age) and 20 cases of diabetes mellitus without IHD (40 yrs. in the mean age).
As a result, the following were found out:
1) The reduce of glucose tolerance was noted in 40% of 25 cases with Master-negativity and 36.5% of 41 cases with Master-positivity, showing no statistical significance in the higher rate of Master-positivity in the cases with the reduced glucose tolerance. Rather, the frequency of Master-positivity despite normal glucose tolerance (63.4%) was found significantly higher than the frequency (36.6%) of Master-positivity with the abnormal glucose tolerance.
2) A significant difference was noted in the FFA pattern in blood between the Master-negativity and the Master-positivity (P<0.001). The former indicated Type A which is normal in young and healthy subjects, which indicated the recovery of the once-dropped FFA level in blood into the prior level in 180 minutes after glucose-loading, whereas the latter indicated Type B similar to diabetes mellitus, which showed substantial delay in the revovery of the once-dropped FFA level to the prior level.
3) No significant correlation was noted between FFA
f and FFA
180 in the Master-positive subjects, where as significant positive correlation with a correlation coefficient of r=0.800 (p<0.001) was noted between the two in the Master-negative subjects.
4) The above results suggest the possibility that the reduced glucose tolerance is not always important factor to the occurrence of IHD and that the abnormality in the plasma FFA pattern to the loading of glucose plays a role as the accerelating factor.
5) There was no significant difference between the FFA pattern of Master-positive patients and that of those with diadetes mellitus, whereas significant difference was noted between the two groups in terms of the FFA value before the loading of glucose, i.e. the latter having been statistically higher than that of the former. In other words, it may be considered possible that factors other than disturbances in glucose tolerance may be correlated to the mechanism of the FFA pattern as seen in the Master-positive patients.
6) The effects of prostaqlandin E
1 (PGE
1) upon the Type B-patterns of FFA as seen in the patients with IHD may be elucidated by that the Type B was changed into Type A by the effect of intravenous PGE
1-administration, creating significant correlation between FFA
f and FFA
180 (r=0.877, p<0.001). This finding may suggest that the excess in the insulin secretion reaction against the loading of glucose may be related to the mechanism of Type B-FFA pattern in IHD and that delay in recovery of the decrease in FFA caused by the above-mentioned excess may have caused the change from Type A into Type B due to the insulin secretion inhibiting effect possessed by PGE
1.
Conclusion: The above result may suggest that the abnormality in FFA pattern in blood against ingestion of carbohydrates as the IHD risk factor plays an important role which can not be neglected. The fact that Type B changes into Type A by PGE
1 may eventually support the hypothesis that the excessive secretion of insulin against loading of sugars may be indirectly related to the accerelation of atherosclerosis.
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