Insulin Resistance Predicts Severity of Coronary Atherosclerotic Disease in Non-Diabetic Patients.

Teresa Strisciuglio,Valerio Pergola,Carmine Morisco,Danilo Franco,Giuseppe Ammirati,Bruno Trimarco,Antonio Rapacciuolo,Raffaele Izzo,Giuseppe Di Gioia,Giovanni Esposito,Antonella Fiordelisi,Emanuele Barbato,Jozef Bartunek,Livio Imparato,Iginio Colaiori

doi:10.3390/jcm9072144

Abstract

Background: Insulin resistance (IR) in patients with type 2 diabetes mellitus (T2DM) represents a predictor of coronary artery disease (CAD). However, how IR is able to impact the severity of coronary atherosclerosis in non-diabetic patients is unknown. Objectives. We investigated the relation between the IR and the extent and severity of coronary atherosclerosis in non-diabetic patients referred to coronary angiography (CA) Methods: Consecutive patients undergoing to CA for acute coronary syndromes or stable angina were analyzed. The IR was assessed by mean of the homeostasis model assessment of insulin resistance (HOMA-IR) whereas the SYNTAX score (SS) was used as index of the severity of coronary atherosclerosis Results: Overall, 126 patients were included, with a median SS of 12 (IQR 5.25–20.5). Patients were divided in four groups according to the distribution in quartiles of SS (SS1-2-3-4). A significant correlation between HOMA-IR and SS was observed, especially in women. A progressive increase of HOMA-IR was observed in parallel with the increasing severity (from SS1 to SS4) and extension (1-2-3-vessel disease) of coronary atherosclerosis. Multivariable analysis showed that the HOMA-IR was the strongest independent predictor of severe (SS4) and extensive (three-vessel disease) coronary atherosclerosis. Conclusion: Insulin resistance goes hand in hand with the extension and severity of coronary atherosclerosis in non-diabetic patients. The HOMA index is an independent predictor of three-vessel disease at CA. The HOMA index could be useful for risk stratification of CAD even in absence of T2DM.

Highlights

The major cause of death in patients affected by type 2 diabetes mellitus (T2DM) is cardiovascular disease (CVD) with coronary artery disease (CAD) and stroke being the main contributors [1]
The homeostasis model assessment of insulin resistance (HOMA-Insulin resistance (IR)) [5] is an index based on a mathematical model that considers serum levels of fasting glucose and insulin and because it has been demonstrated to have a high correlation with the hyperinsulinemic-euglycemic clamp it is considered a reliable indicator of IR [6]
The current study showed, for the first time, that in non-diabetic patients: (1) There is a moderate correlation between HOMA-IR and SYNTAX score (SS), especially in women; (2) insulin resistance goes hand in hand with the extent and the severity of coronary atherosclerosis; (3) HOMA-IR is a strong and independent predictor of severe CAD and of three-vessel disease; and (4) A HOMA-IR value of 10.22 or above should be considered a warning mark in non-diabetic patients as they may have a severe atherosclerosis involving the three coronary arteries

Summary

Introduction

The major cause of death in patients affected by type 2 diabetes mellitus (T2DM) is cardiovascular disease (CVD) with coronary artery disease (CAD) and stroke being the main contributors [1]. Pyörälä et al investigated the relevance of IR syndrome in healthy subjects [4] The latter, along with other clustering risk factors (i.e., body mass index, mean blood pressure, tryglicerides, subscapular skinfold, levels of insulin and glucose during oral glucose tolerance test), was evaluated in a large population of 970 middle-aged healthy men (34–64 years) followed-up for 22 years and was demonstrated to increase the risk of CAD and stroke [4]. Insulin resistance measured by HOMA index was demonstrated to be a risk factor for carotid atherosclerosis in subjects with normal fasting glucose and normal glucose tolerance [7]. Insulin resistance (IR) in patients with type 2 diabetes mellitus (T2DM) represents a predictor of coronary artery disease (CAD). Conclusion: Insulin resistance goes hand in hand with the extension and severity of coronary atherosclerosis in non-diabetic patients. The HOMA index could be useful for risk stratification of CAD even in absence of T2DM

Methods

Results

Discussion

Conclusion