PubMed · 6807820
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1982. LV function held key CAD prognosticator.. https://pubmed.ncbi.nlm.nih.gov/6807820/
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BACKGROUND: It is generally believed that coronary artery spasm plays an important role in the progression of obstructive coronary artery disease. Since insulin resistance together with hyperinsulinemia plays an important role in the pathogenesis of coronary atherosclerosis, we investigated the association of hyperinsulinemia and insulin resistance with vasospastic angina (VAP). METHODS AND RESULTS: The study population consisted of 60 patients with VAP and 42 control subjects (62 subjects with normal glucose tolerance and 40 with impaired glucose tolerance). Insulin sensitivity was determined by the steady-state plasma glucose (SSPG) method for nondiabetic, normotensive, nonobese subjects (16 control subjects, 16 obstructive coronary artery disease patients, and 16 VAP patients). Compared with the control group, the 2-hour insulin area (area under the plasma insulin concentration-time curve) during a 75-g oral glucose tolerance test was significantly higher in both VAP groups with normal and impaired glucose tolerance. A high frequency of vasospastic angina was observed in subjects with clustered risk factors for insulin resistance syndrome, suggesting a close association of VAP with this syndrome. In stepwise discriminant analysis, the 2-hour insulin area was significantly associated with VAP independent of other risk factors. SSPG level in VAP was about twofold over control, indicating the presence of insulin resistance in patients with VAP. However, no differences were found between patients with VAP and obstructive coronary artery disease with respect to mean SSPG level. CONCLUSIONS: SSPG level was significantly elevated in patients with VAP and obstructive coronary artery disease compared with control subjects. This indicates that hyperinsulinemia is secondary to insulin resistance, both of which are thought to play important roles as risk factors for VAP in the early atheromatous lesion and in the future development of occlusive lesions when chronically present.
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The expression unstable angina pectoris covers a wide range of clinical symptoms with different pathogenetic mechanisms and clinical outcome. Several forms of unstable angina pectoris, in particular progressive angina pectoris (crescendo angina) with chest pain at rest in a previously asymptomatic patient, progressive angina pectoris with chest pain at rest in a previously symptomatic patient, and chest pain at rest of at least 15 min duration without obvious trigger mechanisms have been distinguished. In simpler terms: one may also distinguish angina pectoris of recent onset, crescendo angina, and acute coronary insufficiency. Four risk factors appear to determine the prognosis in these patients: exercise-induced angina pectoris, multiple episodes of chest pain before hospitalization, electrocardiographic changes, and recurrent angina pectoris during hospitalization. Acute coronary insufficiency and nontransmural infarction have initially better prognosis than transmural infarction; however, recurrent cardiac events are more frequent in patients with nontransmural infarction, particularly in the elderly with persistent ECG changes, cardiac decompensation, and infarct extension. Unstable angina pectoris and myocardial ischemia after myocardial infarction are generally associated with a poorer prognosis. In contrast, recurrence of angina pectoris after PTCA (within the first six months) is most commonly due to restenosis and hence prognostically not of great importance. Unstable angina pectoris after coronary bypass surgery, however, is a prognostically unfavourable sign. Prognosis in patients with Prinzmetal angina is determined by the extent of coronary disease. In summary, long-term prognosis in patients with unstable angina pectoris depends heavily on the clinical presentation and the previous clinical history of the patient.