influence of obesity and consequent insulin resistance on coronary risk factors in medically treated patients with coronary disease

• Published in: International Journal of Obesity 2008-06, Vol.32 (6), p.967-974
• Main Authors: Ades, P.A, Savage, P.D, Toth, M.J, Schneider, J, Audelin, M.C, Bunn, J.Y, Ludlow, M
• Format: Article
• Language: English
• Subjects: Abdomen; abdominal fat; Adiposity - physiology; Adrenergic beta-Antagonists - therapeutic use; Adult; adults; Aged; Aged, 80 and over; Angina pectoris; Biological and medical sciences; blood chemistry; blood coagulation disorders; Blood Glucose - metabolism; Blood platelets; Blood pressure; body fat; Body Mass Index; Cardiology. Vascular system; Cardiovascular disease; Cardiovascular diseases; Care and treatment; chemoprevention; Cholesterol; Complications and side effects; Coronary Disease - etiology; Coronary Disease - prevention & control; Coronary heart disease; Cross-Sectional Studies; Diagnosis; disease course; Disease prevention; Enzyme Inhibitors - therapeutic use; Epidemiology; Evidence-Based Medicine; Female; General aspects; Glucose; Glucose Clamp Technique; Health Promotion and Disease Prevention; Heart; Heart attacks; High density lipoprotein; Hormone replacement therapy; Humans; Hyperlipidemia; Hypertension; insulin; Insulin - blood; Insulin Resistance; Internal Medicine; Lipids; Male; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Metabolic syndrome; Middle Aged; Obesity; Obesity - complications; original-article; Overweight; patients; plasminogen activator inhibitor-1; Platelet Aggregation Inhibitors - therapeutic use; Public Health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; Statins; subcutaneous fat; waist circumference
• ISSN: 0307-0565; 1476-5497
• DOI: 10.1038/ijo.2008.6

Objective: Obesity promotes the development and progression of coronary heart disease (CHD), in part, through its association with hyperlipidemia, hypertension, clotting abnormalities and insulin resistance. We assessed whether these relationships persist in patients with established CHD treated with evidence-based preventive pharmacologic therapies. Design and subjects: We performed a cross-sectional study of 74 adults with CHD and a body mass index (BMI) of >27 kg m-2 (mean 324). The mean age of subjects was 649 years (range 44-84 years). Measurements: Obesity measures included weight, BMI, waist, fat mass, intra-abdominal fat and subcutaneous fat. Risk factor measures included insulin sensitivity, fasting insulin level, lipid profiles, blood pressure, C-reactive protein (hs-CRP), plasminogen activator inhibitor (PAI-1) and platelet reactivity. Medication use included aspirin (99% ), statin (84% ), -blocker (71% ), ACE inhibitor or blocker (37% ) and clopidogrel (28% ). Results: There was no direct relationship between obesity parameters and risk factor measures of lipid concentrations, blood pressure, clotting abnormalities or platelet reactivity except for a modest relationship between visceral fat and hs-CRP (r=0.30, P=0.02). However, increased BMI, waist circumference, fat mass, total abdominal fat and abdominal subcutaneous fat all correlated with insulin sensitivity (r-values - 0.30 to - 0.45, P-values 0.01 to