Relationship between insulin resistance and some coagulation and fibrinolytic parameters in patients with metabolic syndrome.

BACKGROUND: Insulin resistance syndrome has been shown to be associated with many coagulation and fibrinolytic proteins, and these associations suggest that some coagulation and fibrinolytic proteins have a role in atherothrombotic disorders. This study was conducted to determine the levels of some of the hemostatic parameters in subjects having metabolic syndrome and to correlate these values with the anthropometric and metabolic variables associated with this syndrome. SUBJECTS AND METHODS: The participants were 46 obese nondiabetic subjects, 28 (group 1) who fulfilled the Adult Treatment Panel III criteria of the metabolic syndrome and 18 (group 2) who did not have metabolic syndrome, and a control group of 14 lean subjects (group 3) of matched age and sex. Clinical and laboratory evaluation of the study groups focused on anthropometric measurements (weight, height, body mass index, waist circumference, and sagittal abdominal diameter), blood pressure, and laboratory measurements of fasting plasma glucose, fasting insulin, serum lipids, tissue plasminogen activator (t-PA), antithrombin III activity (AT III), protein C, and von Willebrand factor (vWf) antigen.
RESULTS: We observed significant increase in the concentrations of t-PA and vWf antigens in subjects having metabolic syndrome (group 1) compared to the other groups, along with nonsignificant changes in the levels of protein C antigen and AT III activity. Both t-PA and vWf showed significant correlation with HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) as a measure of insulin sensitivity. t-PA concentrations showed significant correlations with most of the variables associated with metabolic syndrome, including waist circumference, body mass index, systolic blood pressure, fasting plasma glucose, fasting insulin, and high-density lipoprotein cholesterol. On the other hand, vWf showed significant correlations with fasting plasma glucose, fasting insulin, and sagittal abdominal diameter, with nonsignificant correlations with the other variables.
CONCLUSION: Hemostatic and fibrinolytic parameters should be included in characterization of the insulin resistance syndrome. t-PA and vWf-antigen concentrations were increased in subjects with metabolic syndrome and correlated with the HOMA-IR measure of insulin sensitivity. Because both t-PA and vWf are mainly released from vascular endothelium, these findings could be an indicator of endothelial dysfunction in subjects with insulin resistance and metabolic syndrome.