Gender Differences in the Relationships Between Plasma Plasminogen Activator Inhibitor-1 Activity and Factors Linked to the Insulin Resistance Syndrome in Essential Hypertension

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Abstract
Abstract Impaired fibrinolysis due to elevated levels of plasma plasminogen activator inhibitor type 1 (PAI-1) is a risk factor for thromboembolic disease. Hypertension, obesity, derangements in lipid and glucose homeostasis, and elevated levels of PAI-1 are features of the insulin resistance syndrome. The interrelationships between PAI-1 and the metabolic disturbances seen in this condition are unsettled. We investigated the associations between PAI-1 activity and components of the insulin resistance syndrome in 53 men and 31 women with untreated hypertension. In men, PAI-1 activity correlated significantly with plasma glucose ( r =.41, P =.002), insulin sensitivity ( r =−.35, P =.01), and insulin-induced suppression of nonesterified fatty acid (NEFA) ( r =−.43, P =.007). Plasma glucose and NEFA suppression were independently associated with PAI-1 activity in a multivariate analysis. In women, PAI-1 activity correlated with body mass index ( r =.62, P =.0005), waist-to-hip ratio ( r =.75, P =.0001), plasma glucose ( r =.50, P =.007), insulin ( r =.49, P =.009), proinsulin ( r =.57, P =.002), C-peptide ( r =.60, P =.0009), insulin sensitivity ( r =−.74, P =.0001), NEFA suppression ( r =−.64, P =.003), and triglycerides ( r =.58, P =.001). In multivariate analyses, insulin sensitivity and NEFA suppression were independently associated with PAI-1 if waist-to-hip ratio was not included in the model. After introduction of waist-to-hip ratio into the model, waist-to-hip ratio was the only independent predictor of PAI-1 activity. We conclude that in women, waist-to-hip ratio, body mass index, and insulin-induced NEFA suppression are determinants for PAI-1 activity. In men, insulin-induced NEFA suppression and plasma glucose are independently associated with PAI-1 activity.

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