Abstract 14007: Insulin Resistance Expressed by Homa2 Predicts Risk for Recurrent Coronary Events in Post Infarction Patients

Abstract

We investigated risk for recurrent coronary events associated with insulin resistance in post infarction patients from the Thrombogenic Factors and Recurrent Coronary Events (THROMBO) study. The association between insulin resistance expressed by Homeostatic Model Assessment 2 for Insulin Resistance (HOMA2-IR) and risk for recurrent coronary events was investigated in a cohort of 1,035 patients evaluated 2 months after myocardial infarction with an average follow-up of 26 months. The end point for the study was recurrent coronary event defined as death, nonfatal myocardial infarction and unstable angina whichever occurred first. We used time dependent survival analysis and Cox proportional hazards regression method to determine the association between HOMA2 categorized as high >75th percentile and endpoints after adjustment for relevant clinical covariates. High HOMA2-IR defined as in fourth quartile(> 2.4) was associated with increased risk for recurrent coronary events (hazard ratio [HR] 1.54; 95% confidence interval [CI] 1.10-2.14; P <0.01) after adjustment for: age, gender, diabetes, prior myocardial infarction, pulmonary congestion on chest roentgenogram, ejection fraction< 0.3, PTCA and CABG. The interaction between HOMA2-IR and diabetes status regarding recurrent coronary events was not statistically significant. The highest risk of cardiac events was observed in non-obese patients (BMI<=30kg/m2) with high HOMA2-IR (hazard ratio [HR] 1.55; 95% confidence interval [CI] 1.05-2.23; P <0.05). Patients with High HOMA2-IR had higher plasma level of fibrinogen, PAI-1, von Willebrand factor, triglyceride and apolipoprotein B. Insulin resistance predicts recurrence of coronary events in post-infarction population. HOMA2-IR and BMI are useful parameters in clinical practice to stratify risk. Multilevel intervention to increase insulin sensitivity in people after myocardial infarction may modify clinical outcome.