Abstract
ObjectiveThis study aims to investigate whether pre-operative Homeostasis Model Assessment Insulin Resistance (HOMA-IR) value is a predictor in non-diabetic coronary artery bypass grafting patients in combination with hemoglobin A1c, fasting blood glucose and insulin levels.MethodsEighty one patients who were admitted to Cardiovascular Surgery Clinic at our hospital between August 2012 and January 2013 with a coronary artery bypass grafting indication were included. Patients were non-diabetic with <6.3% hemoglobin A1c and were divided into two groups including treatment and control groups according to normal insulin resistance (HOMA-IR<2.5, Group A; n=41) and high insulin resistance (HOMA-IR>2.5, Group B; n=40), respectively. Pre-operative fasting blood glucose and insulin were measured and serum chemistry tests were performed. The Homeostasis Model Assessment Insulin Resistance values were calculated. Statistical analysis was performed.ResultsThere was a statistically significant difference in fasting blood glucose and HOMA-IR values between the groups. Cross-clamping time, and cardiopulmonary bypass time were longer in Group B, compared to Group A (P=0.043 and P=0.031, respectively). Logistic regression analysis revealed that hemoglobin A1c was not a reliable determinant factor alone for pre-operative glucometabolic evaluation of non-diabetic patients. The risk factors of fasting blood glucose and cardiopulmonary bypass time were more associated with high Homeostasis Model Assessment Insulin Resistance levels.ConclusionOur study results suggest that preoperative screening of non-diabetic patients with Homeostasis Model Assessment Insulin Resistance may improve both follow-up visit schedule and short-term outcomes, and may be useful in risk stratification of the high-risk population for impending health problems.
Highlights
The cardiovascular risk is increased in individuals, who are non-diabetic, but have elevated insulin and glucose concentrations[1,2]
The risk factors of fasting blood glucose and cardiopulmonary bypass time were more associated with high Homeostasis Model Assessment Insulin Resistance levels
We aimed to investigate whether pre-operative Homeostasis Model Assessment Insulin Resistance (HOMA-IR) value is a predictor in non-diabetic coronary artery bypass grafting (CABG) patients when used in combination with hemoglobin A1c (HbA1c), fasting blood glucose (FBG) and fasting blood insulin (FBI) levels
Summary
The cardiovascular risk is increased in individuals, who are non-diabetic, but have elevated insulin and glucose concentrations[1,2]. Elevated insulin and glucose concentrations which are likely to be pro-atherogenic are directly associated with insulin resistance[3,4]. Molecular studies have shown that insulin resistance plays a major role in all stages of atherosclerosis[5]. It promotes atherosclerosis and coronary artery diseases, while metabolic factors such as dyslipidemia, hypertension, and obesity may contribute to the development of cardiac problems[3,6]. There is growing evidence that dysglycemia, irrespective of DM history, is associated with adverse outcomes including prolonged hospitalization and higher mortality in coronary artery bypass grafting (CABG) patients[8,9]
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