Serdar Farhan1, Björn Redfors2,3,4, Akiko Maehara5,6, Thomas McAndrew2, Ori Ben-Yehuda2,3, Bernard De Bruyne7, Roxana Mehran1,2, Birgit Vogel1, Gennaro Giustino1, Patrick W Serruys8,9, Gary S Mintz2, Gregg W Stone1,2. 1. Icahn School of Medicine At Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA. 2. Clinical Trials Center, Cardiovascular Research Foundation/ Columbia University Medical Center, 1700 Broadway, 9th Floor, New York, NY, 10019, USA. 3. NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA. 4. Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden. 5. Clinical Trials Center, Cardiovascular Research Foundation/ Columbia University Medical Center, 1700 Broadway, 9th Floor, New York, NY, 10019, USA. amaehara@crf.org. 6. NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA. amaehara@crf.org. 7. The Cardiovascular Center, OLV Hospital, Aalst, Belgium. 8. Department of Cardiology, NUIG, National University of Ireland, Galway, Ireland. 9. Imperial College of Science, Technology and Medicine, London, UK.
Abstract
BACKGROUND: We investigated the association of insulin resistance (IR) with coronary plaque morphology and the risk of cardiovascular events in patients enrolled in the Providing Regional Observations to Study Predictors of Events in Coronary Tree (PROSPECT) study. METHODS: Patients with acute coronary syndromes (ACS) were divided based on DM status. Non-DM patients were further stratified according to homeostasis-model-assessment IR (HOMA-IR) index as insulin sensitive (IS; HOMA-IR ≤ 2), likely-IR (LIR; 2 < HOMA-IR < 5), or diabetic-IR (DIR; HOMA-IR ≥ 5). Coronary plaque characteristics were investigated by intravascular ultrasound. The primary endpoint was major adverse cardiac events (MACE); a composite of cardiac death, cardiac arrest, myocardial infarction, and rehospitalization for unstable/progressive angina. RESULTS: Among non-diabetic patients, 109 patients (21.5%) were categorized as LIR, and 65 patients (12.8%) as DIR. Patients with DIR or DM had significantly higher rates of echolucent plaque compared with LIR and IS. In addition, DIR and DM were independently associated with increased risk of MACE compared with IS (adjusted hazard ratio [aHR] 2.29, 95% confidence interval [CI] 1.22-4.29, p = 0.01 and aHR 2.12, 95% CI 1.19-3.75, p = 0.009, respectively). CONCLUSIONS: IR is common among patients with ACS. DM and advanced but not early stages of IR are independently associated with increased risk of adverse cardiovascular events. Trial Registration ClinicalTrials.gov Identifier: NCT00180466.
BACKGROUND: We investigated the association of insulin resistance (IR) with coronary plaque morphology and the risk of cardiovascular events in patients enrolled in the Providing Regional Observations to Study Predictors of Events in Coronary Tree (PROSPECT) study. METHODS:Patients with acute coronary syndromes (ACS) were divided based on DM status. Non-DMpatients were further stratified according to homeostasis-model-assessment IR (HOMA-IR) index as insulin sensitive (IS; HOMA-IR ≤ 2), likely-IR (LIR; 2 < HOMA-IR < 5), or diabetic-IR (DIR; HOMA-IR ≥ 5). Coronary plaque characteristics were investigated by intravascular ultrasound. The primary endpoint was major adverse cardiac events (MACE); a composite of cardiac death, cardiac arrest, myocardial infarction, and rehospitalization for unstable/progressive angina. RESULTS: Among non-diabeticpatients, 109 patients (21.5%) were categorized as LIR, and 65 patients (12.8%) as DIR. Patients with DIR or DM had significantly higher rates of echolucent plaque compared with LIR and IS. In addition, DIR and DM were independently associated with increased risk of MACE compared with IS (adjusted hazard ratio [aHR] 2.29, 95% confidence interval [CI] 1.22-4.29, p = 0.01 and aHR 2.12, 95% CI 1.19-3.75, p = 0.009, respectively). CONCLUSIONS:IR is common among patients with ACS. DM and advanced but not early stages of IR are independently associated with increased risk of adverse cardiovascular events. Trial Registration ClinicalTrials.gov Identifier: NCT00180466.
Authors: Filipe A Moura; Luiz Sergio F Carvalho; Riobaldo M R Cintra; Naiara V Martins; Valeria N Figueiredo; Jose C Quinaglia e Silva; Osorio L R Almeida; Otavio R Coelho; Andrei C Sposito Journal: Am J Physiol Endocrinol Metab Date: 2013-12-17 Impact factor: 4.310
Authors: Serdar Farhan; Björn Redfors; Akiko Maehara; Thomas McAndrew; Ori Ben-Yehuda; Bernard De Bruyne; Roxana Mehran; Gennaro Giustino; Ajay J Kirtane; Patrick W Serruys; Gary S Mintz; Gregg W Stone Journal: JACC Cardiovasc Imaging Date: 2017-10-18