Insulin resistance predicts progression of de novo atherosclerotic plaques in patients with coronary heart disease: a one-year follow-up study
Insulin resistance predicts progression of de novo atherosclerotic plaques in patients with coronary heart disease: a one-year follow-up study
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DOI：
10.1186/1475-2840-11-71
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发表时间：
2012-06-18
影响因子：
9.3
通讯作者：
Xiong, Xiaowei
中科院分区：
文献类型：
--
作者：
An, Xuanqi;Yu, Dong;Xiong, Xiaowei
背景：本研究的目的是探讨和评价胰岛素抵抗与冠状动脉粥样硬化斑块进展的关系。随着冠心病给个人带来沉重的负担，医疗保健专业人员已经开始根据预防医学来确定其潜在的可改变的风险因素。从2007年6月7日至2011年12月30日，上海交通大学医学院附属瑞金医院心内科连续进行了366例冠状动脉造影检查，发现有冠状动脉粥样硬化斑块或冠状动脉造影正常的患者366例。所有患者在评估冠状动脉病变进展的1年后都进行了随访血管造影。冠状动脉病变采用改良Gensini评分，胰岛素抵抗状态采用HOMA-IR法。结果：高胰岛素抵抗组和低胰岛素抵抗组之间的指数和随访Gensini评分相似(9.09+/-14.33vs9.44+/-12.88，p=0.813和17.21+/-18.46vs14.09+/-14.18，p=0.358)。然而，两次检查之间评估冠状动脉病变进展的Gensini评分在较高胰岛素抵抗组显著升高(8.13+/-11.83vs4.65+/-7.58，p=0.019)。多因素Logistic二项回归分析显示，胰岛素抵抗(HOMA-IR和GT；3.4583)是冠状动脉斑块进展的独立预测因素(OR=4.969，p=0.011)。我们还将所有参与者分为糖尿病组(n=136)和非糖尿病组(n=230)，HOMA-IR仍然是动脉粥样硬化斑块进展的独立预测因子。结论：在糖尿病和非糖尿病人群中，胰岛素抵抗是冠心病患者动脉粥样硬化斑块进展的独立预测因子。
Background: The aim of our study was to explore and evaluate the relationship between insulin resistance and progression of coronary atherosclerotic plaques. With the great burden coronary heart disease is imposing on individuals, healthcare professionals have already embarked on determining its potential modifiable risk factors in the light of preventive medicine. Insulin resistance has been generally recognized as a novel risk factor based on epidemiological studies; however, few researches have focused on its effect on coronary atherosclerotic plaque progression.Methods: From June 7, 2007 to December 30, 2011, 366 patients received their index coronary angiogram and were subsequently found to have coronary atherosclerotic plaques or normal angiograms were consecutively enrolled in the study by the department of cardiology at the Ruijin Hospital, which is affiliated to the Shanghai Jiaotong University School of Medicine. All patients had follow-up angiograms after the 1-year period for evaluating the progression of the coronary lesions. The modified Gensini score was adopted for assessing coronary lesions while the HOMA-IR method was utilized for determining the state of their insulin resistance. Baseline characteristics and laboratory test results were described and the binomial regression analysis was conducted to investigate the relationship between insulin resistance and coronary atherosclerotic plaque progression.Results: Index and follow-up Gensini scores were similar between the higher insulin lower insulin resistant groups (9.09 +/- 14.33 vs 9.44 +/- 12.88, p = 0.813 and 17.21 +/- 18.46 vs 14.09 +/- 14.18, p = 0.358). However the Gensini score assessing coronary lesion progression between both visits was significantly elevated in the higher insulin resistant group (8.13 +/- 11.83 versus 4.65 +/- 7.58, p = 0.019). Multivariate logistic binomial regression analysis revealed that insulin resistance (HOMA-IR > 3.4583) was an independent predictor for coronary arterial plaque progression (OR = 4.969, p = 0.011). We also divided all the participants into a diabetic (n = 136) and a non-diabetic group (n = 230), and HOMA-IR remained an independent predictor for atherosclerosis plaque progression.Conclusions: Insulin resistance is an independent predictor of atherosclerosis plaque progression in patients with coronary heart disease in both the diabetic and non-diabetic population.