Differential effects of selective beta-adrenergic blockade on insulin sensitivity and release in control subjects and in patients with angina and normal coronary arteries (syndrome X)

Gabriele Fragasso, Nicoletta Cattaneo, Massimo Locatelli, Andrea Caumo, Paolo Pagnotta, Piermarco Piatti, Pierangelo Bonini, Sergio L. Chierchia

Research output: Contribution to journalArticlepeer-review

Abstract

AIMS. Betablockers are very effective in patients with angina and angiographically smooth coronary arteries (syndrome X), but may exacerbate the state of insulin resistance that is known to be present in such patients. The aim of the study was to evaluate the effects of short-term treatment with etenolol on carbohydrate metabolism in syndrome X patients, as compared to normal subjects. METHODS AND RESULTS. Seventeen patients (15 females, 55 ± 8 years, BMI 23.4 ± 2.7 kg/m2) and 11 controls (5 females, 50 ± 7 years, BMI 23.1 ± 2.0 kg/m2) were studied twice by an intravenous glucose tolerance test (IVGTT, 0.5 g/kg) after ten days of both placebo and atenolol (100 mg o.d.), given in random order. Metabolic indices measuring glucose effectiveness and insulin sensitivity were derived from minimal model analysis of the glucose and insulin profiles measured during the IVGTT. Indices of first- and second-phase insulin release were also calculated from the IVGTT insulin response. Atenolol had different metabolic effects on normal subjects and syndrome X patients. Despite the fact that the drug was found to be effective in relieving symptoms of chest pain, it induced e significant (p <0.05) worsening of insulin resistance in syndrome X patients. No such effect was observed in control subjects. On the other hand, atenolol produced a marked reduction (40%, p <0.05) of first-phase insulin release in control subjects, but no significant change of the same index in syndrome X patients. CONCLUSION. These results show that betablockers are very effective for controlling symptoms and improving quality of life in syndrome X patients. However, they appear to further impair the ability to dispose glucose. Long-term studies on the net effects of betablockade administration for the treatment of such patients are warranted.

Original languageEnglish
Pages (from-to)623-629
Number of pages7
JournalGiornale Italiano di Cardiologia
Volume28
Issue number6
Publication statusPublished - Jun 1998

Keywords

  • Angina pectoris
  • Syndrome X

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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