Impact of Insulin Resistance on Acetylcholine-Induced Coronary Artery Spasm in Non-Diabetic Patients
Yonsei Medical Journal
;
: 1057-1063, 2018.
Article
in English
| WPRIM
| ID: wpr-718035
ABSTRACT
PURPOSE:
Coronary artery spasm (CAS) and diabetes mellitus (DM) are implicated in endothelial dysfunction, and insulin resistance (IR) is a major etiological cause of type 2 DM. However, the association between CAS and IR in non-diabetic individuals has not been elucidated. The aim of the present study was to evaluate the impact of IR on CAS in patients without DM. MATERIALS ANDMETHODS:
A total of 330 eligible patients without DM and coronary artery disease who underwent acetylcholine (Ach) provocation test were enrolled in this study. Inclusion criteria included both hemoglobin A1c < 6.0% and fasting glucose level < 110 mg/dL without type 2 DM. Patients were divided into quartile groups according the level of homeostasis model assessment of insulin resistance (HOMA-IR) 1Q (n=82; HOMA-IR < 1.35), 2Q (n=82; 1.35≤HOMA-IR < 1.93), 3Q (n=83; 1.93≤HOMA-IR < 2.73), and 4Q (n=83; HOMA-IR≥2.73).RESULTS:
In the present study, the higher HOMA-IR group (3Q and 4Q) was older and had higher body mass index, fasting blood glucose, serum insulin, hemoglobin A1c, total cholesterol, and triglyceride levels than the lower HOMA-IR group (1Q). Also, poor IR (3Q and 4Q) was considerably associated with frequent CAS. Compared with Q1, the hazard ratios for Q3 and Q4 were 3.55 (95% CI 1.79–7.03, p < 0.001) and 2.12 (95% CI 1.07–4.21, p=0.031), respectively, after adjustment of baseline risk confounders. Also, diffuse spasm and accompanying chest pain during Ach test were more strongly associated with IR patients with CAS.CONCLUSION:
HOMA-IR was significantly negatively correlated with reference diameter measured after nitroglycerin and significantly positively correlated with diffuse spasm and chest pain.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Spasm
/
Triglycerides
/
Blood Glucose
/
Chest Pain
/
Coronary Artery Disease
/
Insulin Resistance
/
Acetylcholine
/
Body Mass Index
/
Cholesterol
/
Fasting
Type of study:
Prognostic study
Limits:
Humans
Language:
English
Journal:
Yonsei Medical Journal
Year:
2018
Type:
Article
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