From the Lipid Research Group (D.G., P.P., G.T., C.G., D.L.), Chicoutimi
Hospital, Chicoutimi, Québec and the Lipid Research Center (D.G.,
M.-C.V., C.G., J.B., S.M., J.-P.D.), Laval University Hospital, Sainte-Foy,
Québec, Canada.
Correspondence to Daniel Gaudet, MD, Director, Lipid Research Group, Chicoutimi Hospital, 305 St-Vallier St, Chicoutimi, Québec, Canada G7H 5H6. E-mail dgaudet{at}saglac.qc.ca
Background—Patients with a mutation
in the LDL receptor gene (familial
hypercholesterolemia, or FH) are characterized
by substantial elevations in plasma LDL cholesterol and are
at higher risk of developing coronary artery disease (CAD).
Correlates of abdominal obesity may also contribute to the risk of
ischemic cardiac events. Whether the
hyperinsulinemic–insulin-resistant state of
abdominal obesity affects coronary
atherosclerosis among FH patients has not been
determined.
Methods and Results—The relation of abdominal adiposity and
hyperinsulinemia to angiographically assessed CAD
was evaluated in a sample of 120 French Canadian men aged <60 years
who were heterozygotes for FH and in a group of 280 men without FH. In
the present study, the risk of CAD associated with abdominal
obesity, as estimated by the waist circumference, was largely dependent
on the concomitant variation in plasma lipoprotein and insulin
concentrations. In contrast, the association between fasting insulin
and CAD was independent of variations in waist girth,
triglyceride, HDL, and apolipoprotein B concentrations
(odds ratio, 1.86; P=.0005). However, the most
substantial increase in the risk of CAD was observed among abdominally
obese (waist circumference >95 cm) and
hyperinsulinemic FH patients (odds ratio, 12.9;
P=.0009). This increase in risk remained significant
even after adjustment for LDL cholesterol or apolipoprotein
B concentrations.
Conclusions—Results of the present study provide support for
the notion that the
hyperinsulinemic–insulin-resistant state of
abdominal obesity is a powerful predictor of CAD in men, even in a
group of patients with raised LDL cholesterol
concentrations due to FH.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Relationships of Abdominal Obesity and Hyperinsulinemia to Angiographically Assessed Coronary Artery Disease in Men With Known Mutations in the LDL Receptor Gene
Key Words: hyperinsulinemia • obesity • hypercholesterolemia • coronary disease
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