Insulin resistance is associated with coronary plaque vulnerability: insight from optical coherence tomography analysis

Iguchi, Taro; Hasegawa, Takao; Otsuka, Kenichiro; Matsumoto, Kenji; Yamazaki, Takanori; Nishimura, Satoshi; Nakata, Satoshi; Ehara, Shoichi; Kataoka, Toru; Shimada, Kenei; Yoshiyama, Minoru

doi:10.1093/ehjci/jet158

Cited by 65 publications

(55 citation statements)

References 35 publications

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“…In addition, we also identified the optimal cut-off of TyG index for predicting MACE. We found the AUC of the optimal cut-off value 9.456 is poor, suggesting that it is As a reliable maker of severity of IR, the proatherogenic property may partly account for the association [35,36]. In the present study, TyG index levels were positively associated with BMI, HbA1c and uric acid, and were negatively associated with HDL-C and eGFR, suggesting that the observed association between TyG index and poor prognosis may be explained by the presence of cardiovascular risk factors.…”

Section: Baseline Characteristics Of Patientsmentioning

confidence: 88%

“…Atherosclerotic CVD is the most cause of death in patients with diabetes. independent association between TyG index and CAD or obstructive CAD in 996 established diabetic patients after adjusting for traditional cardiovascular risk factors [35]. The differences in subject selection, event definition or research methods may contribute to the disparity of these results.…”

Section: Baseline Characteristics Of Patientsmentioning

confidence: 99%

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Triglyceride-glucose index predicts adverse cardiovascular events in patients with diabetes and acute coronary syndrome

Wang

Cong

Zhang

et al. 2020

Preprint

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Background: Triglyceride-glucose index (TyG index) has been regarded as a reliable alternative marker of insulin resistance and an independent predictor of cardiovascular outcomes. Whether TyG index predicts adverse cardiovascular events in patients with diabetes and acute coronary syndrome (ACS) remains uncertain. The aim of the present study was to investigate the prognostic value of TyG index in patients with diabetes and ACS.Methods: A total of 2531 consecutive patients with diabetes who underwent coronary angiography for ACS were enrolled in the study. Patients were divided into 3 tertiles according to TyG index. The primary outcomes included the occurrence of major adverse cardiovascular events (MACE), defined as all-cause death, non-fatal myocardial infarction and non-fatal stroke. The TyG index was calculated as ln (fasting triglyceride level (mg/dL) ×fasting glucose level (mg/dL)/2).Results: The incidence of MACE increased with TyG index tertiles after 3-year follow-up. Kaplan-Meier curves showed significant differences in event-free survival rates among TyG index tertiles (P=0.005).Multivariate Cox hazards regression analysis revealed that TyG index was an independent predictor of MACE (95% CI 1.201-1.746; P<0.001). The optimal TyG index cut-off for predicting MACE was 9.323 (sensitivity 46.0% ; specificity 63.6%; area under the curve 0.560; P=0.001 ).Furthermore, adding TyG index to the prognostic model for MACE improved the C-statistic value (P=0.010), the integrated discrimination improvement value(P=0.001) and the net reclassification improvement value(P=0.019).Conclusions TyG index predicts future recurrent cardiovascular events in patients with diabetes and ACS, independently of known cardiovascular risk factors suggesting that TyG index may be a useful marker for risk stratification and prognosis in patients with diabetes and ACS.

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Section: Baseline Characteristics Of Patientsmentioning

confidence: 88%

Section: Baseline Characteristics Of Patientsmentioning

confidence: 99%

Triglyceride-glucose index predicts adverse cardiovascular events in patients with diabetes and acute coronary syndrome

Wang

Cong

Zhang

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Regarding development of insulin resistance, miscellaneous environmental factors, such as a Western-style diet and a sedentary lifestyle, increase insulin resistance, where glucotoxicity and lipotoxicity as well as chronic inflammation are deeply involved [22]. When insulin resistance progresses gradually, these factors play central roles in the coronary endothelial dysfunction, leading to coronary spasm and thrombus formation, both of which can induce ACS attack [23]. It is of clinically importance, an additional physical and mental stresses and high anxiety can become the final straw, inducing an attack.…”

Section: Discussionmentioning

confidence: 99%

Possible increase in insulin resistance and concealed glucose-coupled potassium-lowering mechanisms during acute coronary syndrome documented by covariance structure analysis

et al. 2017

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ObjectiveAlthough glucose-insulin-potassium (GIK) therapy ought to be beneficial for ischemic heart disease in general, variable outcomes in many clinical trials of GIK in acute coronary syndrome (ACS) had a controversial impact. This study was designed to examine whether “insulin resistance” is involved in ACS and to clarify other potential intrinsic compensatory mechanisms for GIK tolerance through highly statistical procedure.Methods and resultsWe compared the degree of insulin resistance during ACS attack and remission phase after treatment in individual patients (n = 104). During ACS, homeostasis model assessment of insulin resistance (HOMA-IR) values were significantly increased (P<0.001), while serum potassium levels were transiently decreased (degree of which was indicated by ΔK) (P<0.001). This finding provides a renewed paradox, as ΔK, a surrogate marker of intrinsic GIK cascade activation, probably reflects the validated glucose metabolism during ischemic attack. Indeed, multiple regression analysis revealed that plasma glucose level during ACS was positively correlated with ΔK (P = 0.026), whereas HOMA-IR had no impact on ΔK. This positive correlation between ΔK and glucose was confirmed by covariance structure analysis with a strong impact (β: 0.398, P = 0.015). Intriguingly, a higher incidence of myocardial infarction relative to unstable angina pectoris, as well as a longer hospitalization period were observed in patients with larger ΔK, indicating that ΔK also reflects disease severity of ACS.ConclusionsInsulin resistance most likely increases during ACS; however, ΔK was positively correlated with plasma glucose level, which overwhelmed insulin resistance condition. The present study with covariance structure analysis suggests that there are potential endogenous glucose-coupled potassium lowering mechanisms, other than insulin, regulating glucose metabolism during ACS.

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“…Так, при проведении ангиографического исследования коронарных сосудов с использованием современного и информативного метода внутрикоронарного ультразвука (IVUS) исследователи обнаружили тесную взаимосвязь между гиперинсулинемией и увеличением содержания липидов в атеросклеротической бляшке [7,8]. В недавнем исследовании Iguchi et al был применен метод оптической когерентной томографии, позволяющий детально охарактеризовать структуру атеросклеротической бляшки: было показано, что инсулинорезистентность тесно взаимосвязана с большей склонностью атеросклеротической бляшки к тромбообразованию, что проявлялось меньшей толщиной фиброзной оболочки, большим содержанием липидов в бляшке у группы обследованных лиц с наибольшей выраженностью инсулинорезистентности [9]. В проспективных наблюдениях больных, перенесших острый коронарный синдром, обнаружено, что инсулинорезистентность была сопряжена со значительно худшим прогнозом [10], а также с развитием повторных острых коронарных синдромов [11].…”

Section: рис 1 содержание инсулина в плазме крови натощак и через 2unclassified

Уровень Инсулина В Плазме Крови У Больных Ишемической Болезнью Сердца В Зависимости От Выраженности Атеросклеротического Поражения Коронарных Сосудов

Mankovskii¹,

Stepura²

2017

ujcvs

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Цель работы – изучение содержание инсулина в крови у пациентов с ишемической болезнью сердца (ИБС) в зависимости от количества пораженных коронарных артерий. Материалы и методы. Обследовано 78 больных с ИБС без указаний на наличие явного сахарного диабета (СД) 2 типа или нарушения толерантности к глюкозе. Всем больным был проведен нагрузочный тест, коронаровентрикулография, а также пероральный тест на толерантность к глюкозе. Забор крови из вены проводился натощак и через 2 часа после употребления глюкозы. В каждом из полученных образцов крови проводилось определение содержания глюкозы и инсулина в плазме крови. Инсулин определяли иммуносорбентным анализом (ELISA). Результаты и обсуждение. Все обследованные лица были распределены на 3 группы в зависимости от количества пораженных сосудов. У обследованных пациентов с ИБС не было СД 2 типа или нарушения толерантности к глюкозе (преддиабета или латентного СД). Так, средний уровень гликемии натощак составил 6,31±0,21 ммоль/л, 5,78±0,15 ммоль/л и 5,74±0,26 ммоль/л, а через 2 часа после приема глюкозы гликемия была 8,15±0,60 ммоль/л, 8,56±0,47 ммоль/л, 7,26±0,61 ммоль/л у пациентов с поражением 1, 2 или 3 коронарных сосудов соответственно, р>0,05 при сравнении показателей между группами. Также не было выявлено повышения уровня гликозилированного гемоглобина или достоверных различий между тремя обследованными группами пациентов. Выявлено статистически значимое возрастание содержания инсулина в плазме крови у больных с ИБС, у которых атеросклеротическое поражение охватывало два или три коронарных сосуда по сравнению с пациентами, у которых стеноз был локализован в рамках только одной венечной артерии сердца. Выводы. Гиперинсулинемия, представляющая собой отражение инсулинорезистентности, взаимосвязана с более выраженным, ангиографически документированным атеросклеротическим поражением коронарных сосудов у больных с ИБС.

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Insulin resistance is associated with coronary plaque vulnerability: insight from optical coherence tomography analysis

Abstract: This study suggests that insulin resistance might be associated with coronary plaque vulnerability.

Cited by 65 publications

References 35 publications

Triglyceride-glucose index predicts adverse cardiovascular events in patients with diabetes and acute coronary syndrome

Triglyceride-glucose index predicts adverse cardiovascular events in patients with diabetes and acute coronary syndrome

Possible increase in insulin resistance and concealed glucose-coupled potassium-lowering mechanisms during acute coronary syndrome documented by covariance structure analysis

Уровень Инсулина В Плазме Крови У Больных Ишемической Болезнью Сердца В Зависимости От Выраженности Атеросклеротического Поражения Коронарных Сосудов

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