ABSTRACT
ObjectiveTo investigate the association between estimated glucose disposal rate （eGDR） and the severity of coronary heart disease. MethodsWe conducted a hospital-based cross-sectional study that included 1258 patients （mean age： 62（53-68） years） who underwent coronary angiography for suspected coronary artery disease （53.9% were male）. Insulin resistance level （IR） was calculated according to eGDR formula： eGDR = 21.158 - （0.09 × WC） - （3.407 × hypertension） - （0.551 × HbA1c） ［hypertension （yes = 1 / no = 0）， HbA1c = HbA1c （%）］. Subjects were grouped according to the eGDR quantile. CAD severity was determined by the number of narrowed vessels： no-obstructive CAD group （all coronary stenosis were<50%， n=704）， Single-vessel CAD group （only one involved major coronary artery stenosis≥50%， n=205）， Multi-vessel CAD group （two or more involved major coronary arteries stenosis≥50%， n=349）； Multivariate logistic regression model was used to analyze the association between eGDR and CAD severity. The linear relationship between eGDR and CAD in the whole range of eGDR was analyzed using restricted cubic spline. Subgroup analyses were used to assess the association between eGDR and CAD severity in different diabetic states. Receiver operating characteristic （ROC） curve analysis were used to evaluate the value of eGDR in improving CAD recognition. ResultsA decrease in the eGDR index was significantly associated with an increased risk of CAD severity （OR： 2.79； 95%CI： 1.72~4.55； P<0.001）. In multivariate logistic regression models， individuals with the lowest quantile of eGDR （T1） were 2.79 times more likely to develop multi-vessel CAD than those with the highest quantile of eGDR （T3） （OR： 2.79； 95%CI： 1.72~4.55； P<0.001）. Multivariate restricted cubic spline analysis showed that eGDR was negatively associated with CAD and multi-vessel CAD （P-nonlinear>0.05）. In non-diabetic patients， compared with the reference group （T3）， the T1 group had a significantly increased risk of CAD （OR： 1.42； 95% CI： 1.00~2.01； P<0.05） and multi-vessel CAD （OR： 1.86； 95%CI： 1.21~2.86； P<0.05）. No statistical association was found between eGDR and CAD in diabetic patients. In ROC curve analysis， when eGDR was added to traditional model for CAD， significant improvements were observed in the model's recognition of CAD and multi-vessel CAD. ConclusionOur study shows eGDR levels are inversely associated with CAD and CAD severity. eGDR， as a non-insulin measure to assess IR， could be a valuable indicator of CAD severity for population.
ABSTRACT
BACKGROUND: Insulin resistance is known as the common denominator of risk factors of atheros-clerosis as well as the major pathogenic process of type 2 diabetes mellitus (DM). Recently some investigators indicated the relationship of chronic inflammatory reaction to atherosclerosis and insulin resistance. We examined the relationship between insulin resistance and high sensitivity CRP (hs-CRP) in Koreans. METHODS: Twenty-five patients with type 2 DM and eleven healthy men were examined. Glucose disposal rate (GDR, mg/kg/min) was determined as the index of insulin resistance by the euglycemic insulin clamp test with De Fronzo method. The serum hs-CRP level was determined by Behring nephelometric assay, fibrinogen by functional assay, and plasminogen activator inhibitor-1 (PAI-1) by ELISA. We also included 81 healthy subjects to determine the reference range of hs-CRP. RESULTS: The reference range (median) of hs-CRP was 0-5.20 (0.56) mg/L. The hs-CRP concentration was not significantly different between control and DM groups. The GDR of DM (3.8+/-1.7) showed significantly decreased value compared with normal (8.4+/-1.5) group (P<0.001). In all subjects, there was no significant correlation of GDR and hs-CRP. CONCLUSTIONS: There was no significant correlation of GDR and hs-CRP. We think the interventional prospective study with anti-inflammatory drug is warranted to elucidate the independent relationship between insulin resistance and hs-CRP.