Association of Insulin Resistance and Inflammation With Peripheral Arterial Disease

Abstract

Background-Although the role of inflammation in the pathophysiology of peripheral arterial disease (PAD) is well established, the contribution of insulin resistance (IR) to PAD is less clear. We hypothesized that IR is associated with PAD and that the presence of IR would influence the association between C-reactive protein (CRP) and PAD, an association established predominantly in healthy individuals. Methods and Results-We analyzed data from 3242 adults in the National Health and Nutrition Examination Survey (NHANES) 1999 to 2004 who underwent measurement of ankle brachial index, CRP, and fasting glucose and insulin, enabling calculation of homeostasis model of IR (HOMA-IR). Odds ratios (ORs) and 95% CIs were estimated by logistic regression. The mean prevalence of PAD (defined as an ankle brachial index Յ0.9) was 5.5% (SE, 0.47%). HOMA-IR was independently associated with PAD (OR, 2.06; 95% CI, 1.1 to 4.0; Pϭ0.03 for quartile 4, P for trend across quartilesϭ0.047) after adjustment for age, gender, race/ethnicity, hypertension, hyperlipidemia, smoking, body mass index, chronic kidney disease, and CRP. Elevated CRP (Ͼ3 mg/L) also was strongly associated with PAD (OR, 2.2; 95% CI, 1.3 to 3.6; Pϭ0.003 versus CRP Ͻ1 mg/L). Stratifying subjects on the basis of median HOMA-IR, we found that CRP Ͼ3 mg/L was no longer significantly associated with PAD in subjects with IR (OR, 1.3; 95% CI, 0.8 to 2.1; Pϭ0.3, P for interactionϭ0.08). Conclusions-These

Inferior outcomes of autogenous infrainguinal bypass in Hispanics: An analysis of ethnicity, graft function, and limb salvage

“…Recent studies have elaborated the strong association between metabolic syndrome, insulin resistance, inflammation, and severity and progression of PAD. [29][30][31][32][33][34] HI and AA have high rates of obesity, metabolic syndrome, and inflammation. [35][36][37][38][39] In addition, evidence shows that metabolic syndrome and vascular inflammation are intricately related, including within specific HI populations.…”

Treatment with beta-blockers is associated with lower levels of Lp-PLA2 and suPAR in carotid plaques

“…1 In recent decades, multiple efforts have been carried out in order to reduce the risk of atherogenesis that showed to be triggered by an underlying inflammatory process. 2,3 Among the factors initiating the inflammatory response which lead to the atherogenic process a major role has been attributed to a high sympathetic nerve beta1-activity. 4 The laminar flow patterns produced by inhibiting the beta-adrenergic system in patients with carotid artery stenosis (CAS) 5,6 have been suggested as one of the mechanisms behind the protective effect of betablockers with respect to the development of carotid artery plaque.…”

Impaired Skeletal Muscle Glucose Uptake by [ 18 F]Fluorodeoxyglucose–Positron Emission Tomography in Patients With Peripheral Artery Disease and Intermittent Claudication

“…Using data from the National Health and Nutrition Examination Survey, we have indeed previously established that insulin resistance is associated with PAD. 9 There is evidence of skeletal muscle mitochondrial dysfunction and reduced ATP generation in insulin-resistant states. 10,11 In this context, it has also been shown that individuals with insulin resistance have reduced expression of a series of genes that are critical for mitochondrial function and oxidative metabolism.…”