A high carbohydrate meal yields a lower ischemic threshold than a high fat meal in patients with stable coronary disease

Gabriele Fragasso, Chiara Montano, Guido Lattuada, Anna Salerno, Altin Palloshi, Giliola Calori, Livio Luzi, Gianluca Perseghin, Alberto Margonato

Research output: Contribution to journalArticle


Objective: To assess the ischemic threshold and stress-induced left ventricular dysfunction after high fat (HFM) and high carbohydrate (HCM) meals in patients with stable coronary disease. Methods: Twelve patients (68 ± 7 years) underwent stress (treadmill exercise testing) echocardiography after fasting (8 h), after HFM and HCM (2 h). Time to 1 mm ST-segment depression (time to 1 mm) and stress wall motion score index (WMSI) were evaluated. Before eating and just before exercise testing glucose, insulin, triglycerides, total cholesterol and FFA levels were measured. Results: Results are expressed as medians (Q1-Q3). HFM did not affect exercise variables compared to fasting, whereas HCM reduced the ischemic threshold [time to 1 mm from 376 (343-493) to 297 (180-420) s, p = 0.003]. Compared to fasting [1.47 (1.31-1.66)], stress WMSI was higher after HCM [1.56 (1.44-1.69)] (p = 0.04) but not after HFM [1.56 (1.30-1.63)]. Glycemia and insulinemia were significantly higher after HCM, compared to fasting and HFM. Conclusions: In patients with coronary disease, exercise testing after a high carbohydrate meal results in a lower ischemic threshold and greater ischemia magnitude. Conversely, compared to fasting, a high fat meal does not induce additional detrimental effects. Hyperglycemia and hyperinsulinemia were the only metabolic determinants identified as potential metabolic mechanisms of this phenomenon.

Original languageEnglish
Pages (from-to)209-213
Number of pages5
JournalInternational Journal of Cardiology
Issue number2
Publication statusPublished - Mar 3 2011



  • Coronary disease
  • Glucose
  • High carbohydrate meal
  • High fat meal
  • Ischemic threshold
  • Myocardial ischemia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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