© 1997 American Heart Association, Inc.
Articles |
Defects of Insulin Action on Fatty Acid and Carbohydrate Metabolism in Familial Combined Hyperlipidemia
From the Molecular Medicine Group, MRC Clinical Sciences Centre and Department of Medicine, Hammersmith Hospital (T.J.A., B.F., J.S.); the Wynn Division of Metabolic Medicine (National Heart and Lung Institute, Imperial College) (I.F.G., D.C.); and the Department of Chemical Pathology, Queen Mary's University Hospital (H.J.W.), London, England.
Correspondence to Dr T.J. Aitman, Molecular Medicine Group, MRC Clinical Sciences Centre and Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, DuCane Road, London W12 0NN, UK. E-mail taitman{at}rpms.ac.u
Abstract Familial combined hyperlipidemia (FCHL) is a common cause of premature myocardial infarction, but its metabolic basis is unknown. Insulin resistance has been suggested in some patients by the presence of fasting hyperinsulinemia. We studied insulin action on carbohydrate and fatty acid metabolism in FCHL patients and healthy control subjects by a two-step euglycemic, hyperinsulinemic clamp. During low-dose insulin infusion, steady-state nonesterified fatty acids (NEFAs) were higher in patients than in control subjects (0.36 mmol/L [95% confidence limits, 0.19, 0.53] versus 0.19 mmol/L [0.10, 0.28]; P=.05). The ratio of steady-state to basal NEFAs was increased by 88% in patients compared with control subjects (P=.005). During high-dose insulin infusion, insulin sensitivity for peripheral glucose disposal was reduced by 60% in FCHL patients compared with control subjects (P=.03). Hepatic glucose production at baseline and during the clamp was similar in the two groups. In multiple regression analysis, increased upper-body fat in the patient group accounted for the impairment of insulin-mediated glucose disposal but did not influence the defect in insulin-mediated NEFA suppression in the FCHL patients. This defect in fatty acid metabolism may be a primary defect in FCHL that contributes to abnormalities in the secretion and composition of lipoproteins in this disorder. Direct study of this defect may facilitate genetic analysis of this disorder.
Key Words: insulin resistance • nonesterified fatty acids • hyperlipoproteinemia • hormone-sensitive lipase • glucose clamp technique
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