Evolution of insulin resistance in coronary artery disease patients on four different pharmacological therapies
Gonzalo Piédrolaa, Enrique Novob, Joaquín Serrano-Gotarredonaa, Maria Luisa de Teresac, Rafael García-Roblesa
a Hospital
Ramón y Cajal, Carretera de Colmenar km 9,1, 28034 Madrid, Spain
Department of Endocrinology, b Department of Cardiology, c Department
of Critical Care
Correspondence to: Dr Gonzalo Piédrola, Plaza de los Campos 5, 18009 Granada, Spain
Accepted 8 July 1998
The objective of the study was to examine the evolution of
insulin sensitivity in a group of patients with stable coronary artery
disease receiving one of four different pharmacological therapies.
Insulin sensitivity was evaluated using an insulin suppression test in
40 newly diagnosed patients with coronary artery disease and no
previous history of metabolic disorders, who were not taking any
medication which might affect insulin sensitivity. The insulin
suppression test consisted of a constant infusion of glucose, insulin
and somatostatin for 150 min; insulin resistance was estimated by
determining the steady-state plasma glucose concentrations during the
last 60 minutes of the test. The insulin sensitivity index was
calculated by the formula: insulin sensitivity index = (glucose
infusion rate/steady state plasma glucose concentrations) × 103. A second insulin suppression test was performed after
6 months' therapy with either isosorbide mononitrate, atenolol,
diltiazem or captopril in 30 of the 40 patients.
There were no differences between any of the groups before
therapy was initiated. After 6 months, patients treated with captopril and, to a lesser extent, those treated with diltiazem showed
statistically significantly decreased steady state plasma glucose
concentrations and increased insulin sensitivity index compared to
basal values. No statistically significant differences were found in
the other two groups. We conclude that captopril and, to a lesser
extent, diltiazem improve insulin sensitivity in patients with stable coronary artery disease.
Keywords: insulin resistance; coronary artery disease; captopril; diltiazem
© 1999 by The Fellowship of Postgraduate Medicine
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