Relation of fasting insulin plasma levels to restenosis after elective coronary stent implantation in patients without diabetes mellitus

Predictors of restenosis after percutaneous coronary intervention using bare-metal stents: a comparison between patients with and without dysglycemia

“…Our results agree with published data describing a relationship between greater neointimal index area (not measured with IVUS as in our study) and IR (16). Other studies also described a relationship between restenosis and IR, but in most of them diabetic patients were excluded and no IVUS measurements were performed (13,15,31). In the only published study in which diabetic patients were included and a direct relationship between plasma insulin levels and restenosis was described, IVUS was not used, and, unexpectedly, QCA parameters related to vessel diameter were not considered to be predictors of restenosis (14).…”

“…Moreover, the relation of IR to restenosis is even more elusive because the few studies addressing this issue used different methodology, and the results were highly heterogeneous (13)(14)(15)(16)30,31). For instance, an unexpected inverse relationship between insulinemia levels and restenosis rate was described following excimer laser coronary angioplasty (30).…”

Hyperinsulinemia and impaired leptin-adiponectin ratio associate with endothelial nitric oxide synthase polymorphisms in subjects with in-stent restenosis

“…In addition, reactive hyperemia, an index of vascular reactivity, was decreased in subjects homozygous for the two SNPs. The present study reinforces previous evidence demonstrating that the presence of hyperinsulinemia (32,33,42) and peripheral endothelial dysfunction are predictors of cardiovascular events (14,27), linking these findings with a specific genetic background, i.e., NOS3 gene variants. Asp polymorphism (n ϭ 35); GT, heterozygous subjects (n ϭ 52); TT, homozygous subjects for the minor allele (n ϭ 19); AA, homozygous subjects for the major allele of intron 18 (rs753482) polymorphism (n ϭ 56); AC, heterozygous subjects (n ϭ 34); CC, homozygous subjects for the minor allele (n ϭ 16).…”

Remnant-like lipoprotein particle level and insulin resistance are associated with in-stent restenosis in patients with stable angina

“…Recent studies have shown that hyperinsulinemia or insulin resistance has associations with in-stent restenosis in nondiabetic patients undergoing elective coronary stenting [5,6,22]. The mechanisms include endothelial dysfunction [23][24][25][26], development of arteriosclerosis by plasminogen activator inhibitor-1 activation [27], reninangiotensin system activation [28], and endothelin-1 secretion [29], in association with hyperinsulinemia.…”

“…Diabetes mellitus is a major determinant of in-stent restenosis, and the major mechanism of instent restenosis is an excessive proliferation of neointimal tissue [3,4]. Recent studies have shown that, even in nondiabetics, high fasting-insulin level and insulin resistance are also associated with in-stent restenosis [5,6]. On the other hand, remnant-like lipoprotein particles, formed from triglyceride-rich lipoproteins, have been associated with coronary artery disease [7], coronary events [8], and restenosis after coronary balloon angioplasty [9].…”