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Endothelial Function Varies According to Insulin Resistance Disease Type

From the ¹Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts; the ²Division of Cellular and Molecular Physiology, Joslin Diabetes Center, Boston, Massachusetts; and the ³Division of Endocrinology, Northwestern University, Chicago, Illinois

Address correspondence and reprint requests to Joshua A. Beckman, MD, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115. E-mail: jbeckman{at}partners.org

OBJECTIVE—We examined the relationship between insulin resistance and vascular function in three insulin-resistant states (type 2 diabetes, non-HIV lipodystrophic diabetes, and nondiabetic polycystic ovary syndrome [PCOS]) and in healthy control subjects.

RESEARCH DESIGN AND METHODS—The population included 12 women with type 2 diabetes, 6 with lipodystrophic diabetes, 10 with PCOS, and 19 healthy female subjects. Metabolic measures included insulin sensitivity by the homeostasis model assessment, lipids, free fatty acids, and adiponectin. High-resolution B-mode ultrasound was used to determine endothelium-dependent and -independent vasodilation.

RESULTS—Type 2 diabetic, liposdystrophic, and PCOS subjects were insulin resistant compared with control subjects (P = 0.001). Flow-mediated vasodilation was reduced in diabetic (3.4 ± 1.3%) compared with control (7.3 ± 1.1%) subjects but not in lipodystrophic (7.7 ± 1.2%) or PCOS (9.9 ± 0.7%) subjects (P = 0.005). Nitroglycerin-mediated vasodilation was attenuated in both diabetic (15.2 ± 2.0%) and lipodystrophic (16.7 ± 3.6%) subjects compared with healthy control (24.6 ± 2.4%) and PCOS (23.2 ± 1.8%) subjects (P = 0.019). Insulin resistance, free fatty acids, adiponectin, or C-reactive protein did not associate with vascular dysfunction.

CONCLUSIONS—Among these different types of patients with insulin resistance, we found abnormal endothelium-dependent vasodilation only in the patients with type 2 diabetes. We postulate that variations in the mechanism of insulin resistance may affect endothelial function differently than glucose homeostasis.

Abbreviations: CoA, coenzyme A • CRP, reactive protein • HOMA-IR, homeostasis model assessment of insulin resistance • PCOS, polycystic ovary syndrome

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