Disturbances of glucose metabolism in men referred for coronary arteriography. Postload glycemia as predictor for coronary atherosclerosis.

OBJECTIVE

In some studies, fasting and postload glycemia are a strong predictor of coronary events and cardiac death. Therefore, we investigated the relationship between fasting and postload glucose concentrations and coronary status in 363 men referred for coronary arteriography without a previous history of diabetes.

RESEARCH DESIGN AND METHODS

A total of 363 men (mean age 53.0 +/- 9.1 years, mean BMI 27.9 +/- 3.7 kg/m2) with positive results of exercise testing were included in the study. A standard oral glucose tolerance test (OGTT) with glucose and insulin estimations was performed on all subjects. The concentrations of total cholesterol, HDL cholesterol, triglycerides, and HbA1c were also measured. All patients were divided into four groups, according to coronary status: no changes in coronary arteries (group 0, n = 61), one-vessel disease (group 1, n = 113), two-vessel disease (group II, n = 116), and three-vessel disease (group III, n = 73).

RESULTS

The highest postload glucose concentrations were observed in group III. Also, insulin concentrations and HbA1c increased with the progression of atherosclerotic lesions in the coronary arteries. Based on results of the OGTT, 16% of the patients (n = 59) fulfilled the World Health Organization criteria for type 2 diabetes and 36% of the patients (n = 131) met criteria for impaired glucose tolerance. Significant correlations were observed between the number of involved vessels and postload glycemia, HbA1c, fasting insulin, and postload insulin. The multiple stepwise regression analysis showed that age, total cholesterol, and HDL cholesterol independently correlated with the number of involved vessels.

CONCLUSIONS

We conclude that patients with advanced changes in the coronary arteries experience more pronounced metabolic disturbances. Postload glycemia could be an important predictor of nondiagnosed disturbances of glucose metabolism.