Abstract
BackgroundThe aim of our study was to explore and evaluate the relationship between insulin resistance and progression of coronary atherosclerotic plaques. With the great burden coronary heart disease is imposing on individuals, healthcare professionals have already embarked on determining its potential modifiable risk factors in the light of preventive medicine. Insulin resistance has been generally recognized as a novel risk factor based on epidemiological studies; however, few researches have focused on its effect on coronary atherosclerotic plaque progression.MethodsFrom June 7, 2007 to December 30, 2011, 366 patients received their index coronary angiogram and were subsequently found to have coronary atherosclerotic plaques or normal angiograms were consecutively enrolled in the study by the department of cardiology at the Ruijin Hospital, which is affiliated to the Shanghai Jiaotong University School of Medicine. All patients had follow-up angiograms after the 1-year period for evaluating the progression of the coronary lesions. The modified Gensini score was adopted for assessing coronary lesions while the HOMA-IR method was utilized for determining the state of their insulin resistance. Baseline characteristics and laboratory test results were described and the binomial regression analysis was conducted to investigate the relationship between insulin resistance and coronary atherosclerotic plaque progression.ResultsIndex and follow-up Gensini scores were similar between the higher insulin lower insulin resistant groups (9.09 ± 14.33 vs 9.44 ± 12.88, p = 0.813 and 17.21 ± 18.46 vs 14.09 ± 14.18, p =0.358). However the Gensini score assessing coronary lesion progression between both visits was significantly elevated in the higher insulin resistant group (8.13 ± 11.83 versus 4.65 ± 7.58, p = 0.019). Multivariate logistic binomial regression analysis revealed that insulin resistance (HOMA-IR > 3.4583) was an independent predictor for coronary arterial plaque progression (OR = 4.969, p = 0.011). We also divided all the participants into a diabetic (n = 136) and a non-diabetic group (n = 230), and HOMA-IR remained an independent predictor for atherosclerosis plaque progression.ConclusionsInsulin resistance is an independent predictor of atherosclerosis plaque progression in patients with coronary heart disease in both the diabetic and non-diabetic population.
Highlights
The aim of our study was to explore and evaluate the relationship between insulin resistance and progression of coronary atherosclerotic plaques
Baseline demographics and lab results in the progression group versus non-progression group A total of 377 patients were consecutively included during the 4-year period and 366 participants received their follow-up angiography, with 198 individuals included in a b the progression group and 168 in the nonprogression group
No significant difference can be seen between the two groups except for Diabetic mellitus (DM) prevalence (42.9% versus 30.4%, p = 0.013), Normal glucose regulation (NGR) prevalence (33.8% versus 51.2%, p = 0.001) and oral glucose lowering agent (35.9% versus 21.6%, p = 0.002)
Summary
The aim of our study was to explore and evaluate the relationship between insulin resistance and progression of coronary atherosclerotic plaques. More cost-effective preventive treatments are called for; various studies have been conducted to identify the risk factors for CHD, which are classified into classical versus novel categories [2]. The former consists of aging, female sex, genetic factors, obesity, smoking, dyslipidemia, hypertension and diabetes mellitus while the latter includes several inflammatory markers such as hsCRP, IL-6, TNF-α, PAI-1, MCP-1 and adhesion factors such as ICAM-1 and VCAM-1 [2].
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