Insulin Resistance and Significance of Postprandial Lipid Profile in Normoglycemic Coronary Artery Disease Patients

Mookambika, R V (2012) Insulin Resistance and Significance of Postprandial Lipid Profile in Normoglycemic Coronary Artery Disease Patients. Masters thesis, PSG Institute of Medical Sciences and Research, Coimbatore.

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Abstract

We studied 100 patients o All are non-diabetic patients. o 50 cases with coronary artery disease. o 50 controls (age, gender matched) without coronary artery disease.  To detect the association of insulin resistance/ hyperinsulinemia in CAD.  To assess the significance of post prandial lipid profile (dyslipidemia) in patients with CAD.  To find out the relationship of apolipoproteins (a and b) in CAD. 92% of patients with CAD had Insulin resistance / hyperinsulinemia. o There was strong association between insulin resistance and obesity in both cases and the controls. o No significance when correlated with addictions both in cases and controls. There was a significant elevation of Apolipoprotein b levels (84%)in CAD patients than the control and when compared to apolipoprotein a which was only 16%. Postprandial lipid profile: o Serum triglycerides were significantly high in cases than controls in both fasting and postprandial states. o Percentage of postprandial hypertriglyceridemia was much higher in cases when compared to controls. o No significant change was observed in HDL, Total cholesterol and LDL in fasting and postprandial state. Patients with IR showed increased levels of Apolipoprotein B(84%) when compared to patients with out IR. Patients with IR showed TGL/HDLc value >4 in 82% of the cases with IR ; where as it was only 18% in patients without IR. TC/HDLc ratio was found to be >3.5:1 in 72% of the patients with IR and 28% of the cases with normal HOMA score. It still may need follow up. The controls with insulin resistance, obesity and dyslipidemia were given advice regarding the lifestyle modification( diet and physical exercise) and appropriate pharmacological intervention (statin/fenofibrates) were given. Limitations: 1. Number of study population was less. 2. Following up of teh controls with abnormal results were difficult. Suggestions: 1. Patients belonging to control group need to be followed up. 2. HOMA score can be routinely included as a part of diagnostic profile for assessing the risk factor of CAD in normoglycemic patients. CONCLUSIONS: There is insulin resistance in coronary artery disease / obesity in non diabetic patients. When insulin resistance in patients with addictions was calculated they had almost similar incidence when taken individually. There may have been some significance if we had included more study population. Apolipoprotein B levels were significantly raised in CAD patients. Serum triglycerides were significantly high in cases than controls in both fasting and postprandial states. Percentage of postprandial hypertriglyceridemia was much higher in cases when compared to controls. Fed state did not alter the total cholesterol/ LDL/HDL Patients with IR had high TGL/HDLc, TC/HDLc and Apo B values. Fasting Insulin and Insulin resistance(HOMA SCORE) can be included as one of the panel of investigations to assess the risk factor of CAD among nondiabetic population. Earlier identification of these patients would help to intervene and improve the quality of life. Improving insulin sensitivity would offer substantial benefits by decreasing the morbidity, mortality, and economic burden associated with CAD, respecially in the country like India.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Insulin Resistance, Significance, Postprandial Lipid Profile, Normoglycemic Coronary Artery Disease Patients.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 14 Sep 2020 03:07
Last Modified: 14 Sep 2020 03:07
URI: http://repository-tnmgrmu.ac.in/id/eprint/13123

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