Copyright © 2000 by the European Society of Cardiology.
Non-invasive assessment of vascular function. Paradoxical vascular response to intravenous glucose in coronary heart disease
a Department of Cardiac Medicine, Imperial College School of Medicine at the National Heart and Lung Institute, London, U.K.
b Rosen Laboratories of the Wynn Institute, Endocrinology and Metabolism, Imperial College School of Medicine, St Mary's Campus, London, U.K.
c Hypertension and Lipids Unit, Hospital Vírgen del Rocio, Sevilla, Spain
revised May 4, 1999; accepted May 5, 1999
Abstract
Background In healthy individuals, insulin administration causes an increase in forearm blood flow which is dependent on the effects of insulin on the vascular endothelium. Glucose, administered as an intravenous bolus, produces a transient hyperinsulinaemic response. We hypothesized that the insulin response to an intravenous glucose challenge during the intravenous glucose tolerance test might lead to increases in forearm blood flow in healthy individuals, and that such a response might be altered in patients with coronary heart disease.
Methods and Results Healthy individuals (n=10, aged 41·6±3·0 years, mean±SEM) and patients with angiographically proven coronary heart disease (n=13, aged 65·5±2·4 years) underwent an intravenous glucose tolerance test with simultaneous measurement of right forearm blood flow at 28 time points, using mercury-in-silastic venous occlusion plethysmography. In controls, forearm blood flow increased to a mean of 31·7% above baseline values at 7min and remained above baseline up to 180min after intravenous glucose. In contrast, patients with coronary heart disease exhibited an opposite response, with forearm blood flow decreasing to a mean of –16·2% below baseline values at 7min and –25·8% at 180min. Marked group differences emerged in net changes from baseline in forearm blood flow throughout the intravenous glucose tolerance test, expressed as incremental areas under the forearm blood flow profiles (controls: +351·3±121·7; coronary heart disease patients: –244·3±72·4minml–1.100ml–1,P =0·001).
Conclusions We have demonstrated for the first time that in healthy individuals forearm blood flow increases after an intravenous bolus of glucose, and that paradoxically, this response is reduced below baseline forearm blood flow in patients with coronary heart disease. Further studies are needed to determine whether plethysmographic measurement of forearm blood flow after an intravenous bolus of glucose could provide a clinically useful non-invasive test for the diagnosis of occult coronary heart disease.
Key Words: Endothelium, insulin, atherosclerosis
f1 Correspondence: Dr Francisco Leyva, Department of Cardiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, U.K. e-mail:leyvaleon@hotmail.com
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