Hyperinsulinemic hypoalphalipoproteinemi as new indicator for coronary heart disease

OBJECTIVES The purpose of this study was to investigate the association among insulin resistance, high density lipoprotein cholesterol (HDL-C) and coronary heart disease (CHD), and to test the hypothesis that HDL-C may ameliorate the adverse effects of insulin. BACKGROUND Serum low HDL-C (hypoalphalipoproteinemia) and hyperinsulinemi are independent predictors for CHD, but strong negative correlation exists between them, as in patients with syndrome X. METHODS Fifty-four pairs of cases (M/F: 49/5), defined as patients with angiographically proved CHD, and control subjects (M/F: 49/5) matched with cases with regard to gender and age were included. Insulin resistance was assessed by the homeostasis model assessment (HOMA). RESULTS Cases had increased HOM insulin resistance and lower serum levels of HDL-C than controls. receiver operating characteristic (ROC) curve analysis indicated that HDL-C and insulin resistance were significant discriminators of CHD (are under ROC curve: 0.72 and 0.69, respectively). The interaction between HDL-C and the association of insulin resistance with CHD was significant: subjects with hyperinsulinemi and high HDL-C had no increased risk of CHD. Multivariate conditional logistic regression analysis showed that hyperinsulinemic hypoalphalipoproteinemi was stronger indicator for CHD than either HDL-C or insulin resistance alone (−2 log likelihood: 19.0 vs. 12.6 or 15.7). CONCLUSIONS Hyperinsulinemic hypoalphalipoproteinemi was more potent indicator for CHD than either insulin resistance or low serum HDL-C levels alone, and the adverse effects of hyperinsulinemi seem to be ameliorated by high HDL-C levels.