Relationship between serum sex hormones and glucose, insulin and lipid abnormalities in men with myocardial infarction.

Abstract

Patients (15) who had a myocardial infarction before the age of 43 were compared with 13 age-matched normal subjects. Twelve of the patients and 3 of the controls had a delayed glucose and insulin peak in the glucose tolerance test. Curves with delayed peaks defined larger mean glucose and insulin areas than normal curves. When the measurements of the 4 patients with the largest areas under the glucose tolerance curve were separated, significant correlations were observed in the remaining patients and controls. The ratio in serum of the concentrations of estradiol-17.beta. to testosterone (E/T) correlated with serum glucose area (r = +0.69, P < 0.001), insulin area (r = +0.80, P < 0.001) and the ratio of insulin area to glucose area (I/G) (r = +0.64, P < 0.005) in the glucose tolerance test. Serum cholesterol concentration correlated with E/T, insulin area and I/G, and serum triglyceride concentration correlated with glucose area, I/G, and serum cholesterol concentration. In men who have had a myocardial infarction, an abnormality in glucose tolerance and insulin response and elevation in serum cholesterol and triglyceride concentrations are all apparently part of the same defect (glucose-insulin-lipid defect). This glucose-insulin-lipid defect, when glucose intolerance is present, is possibly the mild diabetes commonly associated with myocardial infarction but is based on a mechanism different from that of classical diabetes. This glucose-insulin-lipid defect seems to be secondary to an elevation in E/T. An alteration in the sex hormone milieu is possibly the major predisposing factor for myocardial infarction.