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(Arteriosclerosis, Thrombosis, and Vascular Biology. 1999;19:2818.)
© 1999 American Heart Association, Inc.

Thrombosis

Comparison of Plasminogen Activator Inhibitor-1 Concentration in Insulin-Resistant Versus Insulin-Sensitive Healthy Women

Fahim Abbasi; Tracey McLaughlin; Cindy Lamendola; Izabella Lipinska; Geoffrey Tofler; Gerald M. Reaven

From the Departments of Medicine, Stanford University School of Medicine, Calif (F.A., T.M., C.L., G.M.R.); Beth Israel Deaconess Hospital, Boston, Mass (I.L., G.T.); and Royal North Shore Hospital, Sydney, Australia (G.T.).

Correspondence to G.M. Reaven, MD, Shaman Pharmaceuticals, Inc, 213 East Grand Avenue, South San Francisco, CA 94080-4812. E-mail greaven{at}shaman.com

Abstract—The primary goal of this investigation was to see whether plasminogen activator inhibitor-1 (PAI-1) concentrations varied as a function of differences in insulin-mediated glucose disposal in 2 groups of healthy women matched for every other variable that might play a role in regulation of PAI-1. For this purpose, we recruited 32 healthy women, divided on the basis of their steady-state plasma glucose (SSPG) concentrations during the insulin suppression test into an insulin-resistant (SSPG=216±12 mg/dL, n=16) and an insulin-sensitive (94±6 mg/dL, n=16) group. PAI-1 antigen concentrations were significantly higher (26±4 versus 14±3 ng/mL, P<0.02) in the insulin-resistant group. In addition, fasting plasma insulin (18±3 versus 11±2 µU/mL, P<0.02) and triglyceride (160±19 versus 93±10 mg/dL, P<0.001) concentrations were higher in the insulin-resistant individuals, whereas HDL concentrations were lower (44±3 versus 58±3 mg/dL, P<0.005). However, the 2 groups were essentially identical in terms of age, menopausal status, hormone replacement therapy, body mass index (BMI), ratio of waist-to-hip girth, and blood pressure. When the experimental population was considered as 1 group, there were statistically significant correlations between PAI-1 antigen and the following variables: adjusting for differences in age and BMI, SSPG (r=0.56, P<0.001); triglyceride (r=0.39, P<0.05); and HDL cholesterol (r=-0.65, P<0.001) concentrations. Finally, multiple regression analysis revealed the major determinants of PAI-1 to be insulin resistance, or insulin concentration, and HDL cholesterol. These results: 1) demonstrate that PAI-1 concentrations are higher in healthy, insulin-resistant women as compared with insulin-sensitive individuals, independent of differences in BMI or ratio of waist-to-hip girth; and 2) provide another mechanism by which insulin-resistant individuals are at increased thrombotic cardiovascular risk.

Key Words: PAI-1 • insulin resistance • HDL cholesterol • hyperinsulinemia • triglycerides

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