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Endothelial Function Varies According to Insulin Resistance Disease Type

¹Cardiovascular Division, Brigham and Women's Hospital, Boston, MA; Division of Cellular and Molecular Physiology, Joslin Diabetes Center, Boston, MA; and Division of Endocrinology, Northwestern University, Chicago, IL

jbeckman{at}partners.org

ABSTRACT

OBJECTIVE:: We examined the relationship between insulin resistance and vascular function in three insulin resistant states (type 2 diabetes mellitus, non-HIV lipodystrophic diabetes, and non-diabetic polycystic ovary syndrome (PCOS)) and in healthy controls.

RESEARCH DESIGN AND METHODS:: The population included 12 women with type 2 diabetes, 6 with lipodystrophic diabetes, 10 with polycystic ovary syndrome, 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 polycystic ovary syndrome subjects were insulin resistant compared with control subjects (p = 0.001). Flow mediated vasodilation (FMD) was reduced in diabetic subjects (3.4 ± 1.3%), compared with control (7.3 ± 1.1%) but not in lipodystrophic (7.7 ± 1.2%) or polycystic ovary syndrome subjects (9.9 ± .7%) (p = 0.005). Nitroglycerin-mediated vasodilation (NMD) was attenuated in both diabetic (15.2 ± 2.0%) and lipodystrophic subjects (16.7 ± 3.6%) compared to healthy control subjects (24.6 ± 2.4%) and polycystic ovary syndrome subjects (23.2 ± 1.8%)(p = 0.019). Neither insulin resistance, free fatty acids, adiponectin, nor C-reactive protein associated 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.

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