Associations between insulin resistance and thrombotic risk factors in high‐risk South Asian subjects

Kain, Kirti; Catto, Andrew J.; Grant, Peter J.

doi:10.1046/j.1464-5491.2003.00958.x

Cited by 41 publications

(35 citation statements)

References 30 publications

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“…SAs do indeed have a number of metabolic abnormalities, including high serum levels of apolipoprotein B, triglycerides, lipoprotein a, 7 36 37 as well as low levels of high density lipoproteins and apolipoprotein A 37. This unique lipid profile combined with higher levels of thrombotic factors of homocysteine, fibrinogen and the plasminogen activator inhibitor (PAI-1)37 along with insulin resistance38 may indicate that vascular disease risk in this ethnic group has less to do with the amount or location of the atherosclerotic plaque and more with its thrombotic tendency. In addition, C reactive protein (CRP), an inflammatory mediator, has been shown to be independently associated with cardiovascular disease even after adjustment of known confounders 39.…”

Section: Discussionmentioning

confidence: 99%

Paradoxically lower prevalence of peripheral arterial disease in South Asians: a systematic review and meta-analysis

Sebastianski

Makowsky

Dorgan

et al. 2013

Heart

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Section: Discussionmentioning

confidence: 99%

Paradoxically lower prevalence of peripheral arterial disease in South Asians: a systematic review and meta-analysis

Sebastianski

Makowsky

Dorgan

et al. 2013

Heart

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“…A functional role for factor XIII in atherothrombotic disease is suggested by the finding that the Leu allele at the common Val34Leu polymorphism in the factor, XIII A-subunit gene appears to protect against myocardial infarction [159]. Factor XIII B-subunit levels correlate with features of the metabolic syndrome in both healthy south Asian subjects [160] and in the first degree relatives of subjects with type 2 diabetes [161] (two subject groups known to be at increased risk of developing both CVD and insulin resistance [95,162]). The lack of an association between insulin resistance and the A-subunit may arise because the A-subunits circulate in complex with Bsubunits, whereas B-subunits circulate in both tetrameric and free dimeric forms.…”

Section: Factor Xiii-b Subunitmentioning

confidence: 97%

Type 2 Diabetes: An Atherothrombotic Syndrome

Dunn¹,

Grant

2005

CMM

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Insulin resistance is found in around 80-90% of subjects with older onset (type 2) diabetes and in approximately 25% of the general population. Insulin resistance prior to the development of frank type 2 diabetes and type 2 diabetes itself is associated with a significant increase in the risk of atherothrombotic disease, which is due in part to a disruption in the balance of factors regulating coagulation and fibrinolysis. Both insulin resistance and type 2 diabetes are associated with the development of endothelial dysfunction, and enhanced platelet aggregation and activation. Whilst the plasma levels of many clotting factors including fibrinogen, FVII, FVIII, FXII, FXIII b-subunit are elevated, the fibrinolytic system is relatively inhibited as a consequence of an increase in plasminogen activator inhibitor type-1 (PAI-1) levels. These changes favour the development of a hypercoagulable pro-thrombotic state, which may in turn enhance cardiovascular risk by increasing the likelihood of developing an occlusive thrombus within a coronary/cerebral artery, and/or contributing to the development of atherosclerotic lesions. This article reviews the current published evidence of the pro-thrombotic changes that occur in association with type 2 diabetes and insulin resistance, and the putative underlying mechanisms which lead to these changes.

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“…25 In healthy subjects, PAI-1 and fibrinogen levels are elevated in South Asians compared to Europeans; and insulin resistance in South Asians is significantly clustered with prothrombotic factors such as PAI-1 and vonWillebrand Factor. 26,27 More recently, and consistent with elevations in PAI-1 in South Asians, Forouhi et al demonstrated a specific elevation in t-PA antigen, the endogenous inhibitor of PAI-1 in this ethnic group. 28 Elevations in t-PA antigen predict both diabetes 29 and CHD 30 in populations of European descent.…”

Section: Role Of Novel Risk Factorsmentioning

confidence: 68%

Review: Diabetes and cardiac disease in South Asians

Mukhopadhyay

Sattar

Fisher

2005

Diabetes & Vascular Disease

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S outh Asians have a higher prevalence of diabetes, coronary heart disease and cardiovascular death. Their predisposition to insulin resistance partly explains this excess risk. After immigration, the adoption of a western diet allied to increased sedentary behaviour leads to weight gain, hypertension and hyperlipidaemia, factors which in turn combine to amplify the chances of getting heart disease. Further contributory factors are increased sub-clinical inflammation, increased thrombogenic tendency and higher serum homocysteine levels. South Asians with diabetes might do as well as White people with respect to intensive glycaemic and blood pressure control. However, there is little evidence for measures to reduce cardiovascular risk as South Asians have not been included as a subgroup in most large trials. Future prospective studies, including studies on the prevention of diabetes and cardiovascular disease in this high-risk population, are therefore urgently required. Br J Diabetes Vasc Dis 2005;5:253-9

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Associations between insulin resistance and thrombotic risk factors in high‐risk South Asian subjects

Abstract: Insulin resistance significantly clusters with fibrinolytic and coagulation factors in South Asians, which may contribute to high prevalence of vascular disease in this population.

Cited by 41 publications

References 30 publications

Paradoxically lower prevalence of peripheral arterial disease in South Asians: a systematic review and meta-analysis

Paradoxically lower prevalence of peripheral arterial disease in South Asians: a systematic review and meta-analysis

Type 2 Diabetes: An Atherothrombotic Syndrome

Review: Diabetes and cardiac disease in South Asians

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