Coronary artery calcification is associated with insulin resistance index in patients with type 1 diabetes

T.C Rodrigues,F.K Almeida,J.L Gross,K Biavatti

doi:10.1590/s0100-879x2010007500109

Abstract

The objective of the present study was to evaluate the risk factors associated with the presence of coronary artery calcification (CAC) in patients with type 1 diabetes (T1D). A cross-sectional study was conducted on 100 consecutive T1D patients without coronary artery disease, with at least 5 years of diabetes and absence of end-stage renal disease. Mean age was 38 ± 10 years and 57% were males. CAC score was measured by multidetector computed tomography (Siemens Sensation 64 Cardiac). The insulin resistance index was measured using the estimated glucose disposal rate (eGDR). The eGDR was lower among CAC-positive patients than among CAC-negative patients, suggesting an increased insulin resistance. In a logistic regression model adjusted for age (at 10-year intervals), eGDR, diabetic nephropathy and gender, CAC was associated with age [OR = 2.73 (95%CI = 1.53-4.86), P = 0.001] and with eGDR [OR = 0.08 (95%CI = 0.02-0.21), P = 0.004]. In T1D subjects, insulin resistance is one of the most important risk factors for subclinical atherosclerosis.

Highlights

Patients with type 1 diabetes (T1D) are at increased risk for coronary artery disease (CAD) [1]
The estimated glucose disposal rate (eGDR) was lower among CAC-positive patients compared to CAC-negative patients, suggesting an increased insulin resistance in subjects with CAC
We observed an interaction between insulin resistance and gender in female T1D subjects with CAC

Summary

Introduction

Patients with type 1 diabetes (T1D) are at increased risk for coronary artery disease (CAD) [1]. The detection of coronary artery calcification (CAC) has been used as a new tool to assess CAD and to predict coronary events beyond standard risk factors in the general population, independent of the presence of diabetes [2]. There is a good correlation between CAC and coronary atherosclerotic plaque burden [3] and CAC is a powerful predictor of clinical CAD in non-diabetic subjects [4]. Insulin resistance in T1D subjects increases progressively with disease duration and its prevalence in these patients is 12 to 42% [8,9,10,11]. Prospective data for the power of CAC to predict coronary heart disease events in

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