Fasting plasma insulin concentrations were obtained in 82 patients (51 men and 31 women), mean age 60 +/- 11 years, with a body mass index >25 kg/m(2) who had coronary angiography because of suspected symptomatic coronary artery disease (CAD). Obstructive CAD was diagnosed if there was >50% obstruction of > or =1 vessel. Of 82 patients, 37 (45%) had left main or 3-vessel CAD, 22 (27%) had 2-vessel CAD, 9 (11%) had 1-vessel CAD, and 14 (17%) had no obstructive CAD. Among the 4 groups, there was no significant difference in gender, age, dyslipidemia, and smoking. Hypertension (p = 0.0003), diabetes mellitus (p = 0.035), and increased fasting plasma insulin concentration (p < 0.0001) were significantly associated with the severity of CAD. Stepwise ordinal logistic regression analysis identified increased fasting plasma insulin concentrations in these obese subjects as a significant independent risk factor for the severity of angiographic CAD (p < 0.0001).
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