Relationship between insulin resistance, coronary plaque, and clinical outcomes in patients with acute coronary syndromes: an analysis from the PROSPECT study
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 acut...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-01-01
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| Series: | Cardiovascular Diabetology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12933-020-01207-0 |
| _version_ | 1818728047476473856 |
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| author | Serdar Farhan Björn Redfors Akiko Maehara Thomas McAndrew Ori Ben-Yehuda Bernard De Bruyne Roxana Mehran Birgit Vogel Gennaro Giustino Patrick W. Serruys Gary S. Mintz Gregg W. Stone |
| author_facet | Serdar Farhan Björn Redfors Akiko Maehara Thomas McAndrew Ori Ben-Yehuda Bernard De Bruyne Roxana Mehran Birgit Vogel Gennaro Giustino Patrick W. Serruys Gary S. Mintz Gregg W. Stone |
| author_sort | Serdar Farhan |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-17T22:23:47Z |
| format | Article |
| id | doaj.art-df526e13098d4ef38349b0490ea468e7 |
| institution | Directory Open Access Journal |
| issn | 1475-2840 |
| language | English |
| last_indexed | 2024-12-17T22:23:47Z |
| publishDate | 2021-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj.art-df526e13098d4ef38349b0490ea468e72022-12-21T21:30:24ZengBMCCardiovascular Diabetology1475-28402021-01-0120111010.1186/s12933-020-01207-0Relationship between insulin resistance, coronary plaque, and clinical outcomes in patients with acute coronary syndromes: an analysis from the PROSPECT studySerdar Farhan0Björn Redfors1Akiko Maehara2Thomas McAndrew3Ori Ben-Yehuda4Bernard De Bruyne5Roxana Mehran6Birgit Vogel7Gennaro Giustino8Patrick W. Serruys9Gary S. Mintz10Gregg W. Stone11Icahn School of Medicine At Mount Sinai, The Zena and Michael A. Wiener Cardiovascular InstituteClinical Trials Center, Cardiovascular Research Foundation/ Columbia University Medical CenterClinical Trials Center, Cardiovascular Research Foundation/ Columbia University Medical CenterClinical Trials Center, Cardiovascular Research Foundation/ Columbia University Medical CenterClinical Trials Center, Cardiovascular Research Foundation/ Columbia University Medical CenterThe Cardiovascular Center, OLV HospitalIcahn School of Medicine At Mount Sinai, The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine At Mount Sinai, The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine At Mount Sinai, The Zena and Michael A. Wiener Cardiovascular InstituteDepartment of Cardiology, NUIG, National University of IrelandClinical Trials Center, Cardiovascular Research Foundation/ Columbia University Medical CenterIcahn School of Medicine At Mount Sinai, The Zena and Michael A. Wiener Cardiovascular InstituteAbstract 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.https://doi.org/10.1186/s12933-020-01207-0Acute coronary syndromeInsulin resistanceInsulinGlucoseCulprit and non-culprit lesion events |
| spellingShingle | Serdar Farhan Björn Redfors Akiko Maehara Thomas McAndrew Ori Ben-Yehuda Bernard De Bruyne Roxana Mehran Birgit Vogel Gennaro Giustino Patrick W. Serruys Gary S. Mintz Gregg W. Stone Relationship between insulin resistance, coronary plaque, and clinical outcomes in patients with acute coronary syndromes: an analysis from the PROSPECT study Cardiovascular Diabetology Acute coronary syndrome Insulin resistance Insulin Glucose Culprit and non-culprit lesion events |
| title | Relationship between insulin resistance, coronary plaque, and clinical outcomes in patients with acute coronary syndromes: an analysis from the PROSPECT study |
| title_full | Relationship between insulin resistance, coronary plaque, and clinical outcomes in patients with acute coronary syndromes: an analysis from the PROSPECT study |
| title_fullStr | Relationship between insulin resistance, coronary plaque, and clinical outcomes in patients with acute coronary syndromes: an analysis from the PROSPECT study |
| title_full_unstemmed | Relationship between insulin resistance, coronary plaque, and clinical outcomes in patients with acute coronary syndromes: an analysis from the PROSPECT study |
| title_short | Relationship between insulin resistance, coronary plaque, and clinical outcomes in patients with acute coronary syndromes: an analysis from the PROSPECT study |
| title_sort | relationship between insulin resistance coronary plaque and clinical outcomes in patients with acute coronary syndromes an analysis from the prospect study |
| topic | Acute coronary syndrome Insulin resistance Insulin Glucose Culprit and non-culprit lesion events |
| url | https://doi.org/10.1186/s12933-020-01207-0 |
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