Association Between Insulin Resistance, Oxidative Stress, Sympathetic Activity and Coronary Microvascular Function in Patients With Early Stage Impaired Glucose Metabolism

Takei, Yasuyoshi; Tomiyama, Hirofumi; Tanaka, Nobuhiro; Yamashina, Akira; Chikamori, Taishiro

doi:10.1253/circj.cj-21-0549

Cited by 6 publications

(6 citation statements)

References 35 publications

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“…Type 2 diabetes mellitus (T2DM) is characterized by IR, which has been identified as a CVD risk factor and as a contributor to the development of CMD [ 10 , 11 , 32 ]. IR can decrease the production of vasoprotective nitric oxide (NO) by reducing the activity of the endothelial NO synthase leading to CMD [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, hyperinsulinemia can also promote oxidative stress and the release of pro-inflammatory cytokines by increasing free fatty acids, reactive oxygen species (ROS) production, and dyslipidemia, thus promoting CMD [ 11 ]. Recently, A small study also suggested that CMD is significantly associated with the severity of IR during acute hyperglycemia [ 10 ]. Currently, IR detection methods are expensive, time-consuming, difficult to use in clinical practice, and have significant bias [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Insulin resistance (IR) refers to the decrease in insulin sensitivity that requires an increase in the amount of insulin to achieve its normal function. It has been proven to be one of the major risk factors, which is closely related to the occurrence and development of CMD [ 10 , 11 ]. However, challenges in implementing existing detection methods for IR in clinical practice and a lack of studies investigating its prognostic value in CMD patients underscore the need for further research.…”

Section: Introductionmentioning

confidence: 99%

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Association between the triglyceride-glucose index and the presence and prognosis of coronary microvascular dysfunction in patients with chronic coronary syndrome

Zhang

Liu

et al. 2023

Cardiovasc Diabetol

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Background Coronary microvascular dysfunction (CMD) is a strong determinant of prognosis in patients with chronic coronary syndrome (CCS). The triglyceride-glucose index (TyG index), an alternative method to evaluate insulin resistance, is positively correlated with the incidence and adverse outcomes of cardiovascular diseases. However, the relationship between the TyG index and the presence and prognosis of CMD in CCS patients has not been investigated. Therefore, we aimed to evaluate the association between the TyG index and the presence and clinical outcomes of CMD among CCS patients. Methods CCS patients who underwent coronary angiography between June 2015 to June 2019 were included. The TyG index was calculated as Ln[fasting triglycerides (mg/dL) × fasting blood glucose (mg/dL)/2]. Coronary angiography‑derived index of microvascular resistance (caIMR) was used to measure microvascular function, and CMD was defined as caIMR ≥ 25U. Patients with CMD were divided into three groups (T1, T2, and T3 groups) according to TyG tertiles. The primary endpoint was major adverse cardiac event (MACE). Results Of 430 CCS patients, 221 patients had CMD. CMD patients had significantly higher TyG index than those without CMD. Sixty-three MACE was recorded during the follow-up duration among CMD patients, and the incidence rate of MACE was higher in the T3 group compared to T1/T2 groups (39.2% vs. 20.5% vs. 25.7%; P = 0.035). Multivariable logistic regression analysis showed that the TyG index was an independent predictor of CMD (OR, 1.436; 95% CI, 1.014–2.034; P = 0.042). Compared to the T1 group, the T3 group strongly correlated with the risk of MACE in CMD patients even after adjusting for additional confounding risk factors (HR, 2.132; 95%CI, 1.066–4.261; P = 0.032). Conclusion TyG index is significantly associated with the risk of CMD, and it is an independent predictor of MACE among CMD patients with CCS. This study suggests that the TyG index has important clinical significance for the early prevention and risk stratification of CMD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association between the triglyceride-glucose index and the presence and prognosis of coronary microvascular dysfunction in patients with chronic coronary syndrome

Zhang

Liu

et al. 2023

Cardiovasc Diabetol

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“…However, Takei et al reported that insulin resistance rather than oxidative stress and sympathetic activity, as assessed using plasma catecholamines, was associated with the reduction in coronary flow reserve after acute hyperglycaemia, probably due to increased myocardial oxygen demands and declined reactivity of vasodilation in the early stages of impaired glucose metabolism [ 35 ]. Indeed, in the current study, CFR was reduced significantly in FDRs and dysglycaemic subjects, likely on the grounds of insulin resistance, despite the fact that oxidative stress markers remained unchanged after the glucose challenge.…”

Section: Discussionmentioning

confidence: 99%

Endothelial Dysfunction Is Associated with Decreased Nitric Oxide Bioavailability in Dysglycaemic Subjects and First-Degree Relatives of Type 2 Diabetic Patients

Ikonomidis

Pavlidis

Tsoumani

et al. 2022

JCM

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Oxidative stress plays an important role in the pathogenesis of diabetes. We investigated oxidative stress and nitrite/nitrate concentrations at baseline and during postprandial hyperglycaemia in 40 first-degree relatives (FDRs) of diabetic patients with normal oral glucose tolerance test (OGTT) results, 40 subjects with abnormal OGTT results (dysglycaemic) and 20 subjects with normal OGTT results (normoglycaemic). Malondialdehyde (MDA), protein carbonyls (PCs), nitrite/nitrate plasma levels, the perfused boundary region (PBR—Glycocheck) of the sublingual microvessels, a marker of glycocalyx integrity, coronary flow reserve (CFR) and left ventricular global longitudinal strain (GLS) were assessed at 0 and 120 min of the OGTT. Insulin sensitivity was evaluated using Matsuda and the insulin sensitivity index (ISI). In all subjects, there were no significant changes in MDA or PC after the OGTT (p > 0.05). Compared with normoglycaemic subjects, FDRs and dysglycaemic subjects had significantly decreased nitrite/nitrate levels (−3% vs. −24% vs. −30%, respectively), an increased PBR and reduced CFR and GLS at 120 min (p < 0.05). The percent reduction in nitrite/nitrate was associated with abnormal Matsuda and ISI results, reversely related with the percent increase in PBR (r = −0.60) and positively related with the percent decrease in CFR (r = 0.39) and GLS (r = 0.48) (p < 0.05). Insulin resistance is associated with reduced nitric oxide bioavailability and coronary and myocardial dysfunction in FDRs and dysglycaemic subjects.

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“…23 In this study, IMRangio did not significantly differ among the 3 groups, which may partially be attributed to the contrastinduced submaximal hyperemia and bimodal pattern of microvascular involvement (decreased baseline microvascular resistance and increased hyperemic microvascular resistance) in DM patients. 38,39 In addition, the possible influence of diffuseness of coronary atherosclerosis on anatomical and functional discordance in diabetes was evaluated using the QFR-derived PPG index, which has been shown to discriminate focal from diffuse coronary disease. 19-21 Intriguingly, the longitudinal lesion complexity determined by the QFR-derived PPG index was equally index was equally distributed among the 3 groups.…”

Section: Study Limitationsmentioning

confidence: 99%

Anatomical and Functional Discrepancy in Diabetic Patients With Intermediate Coronary Lesions　― An Intravascular Ultrasound and Quantitative Flow Ratio Study ―

Geng

Shi

Yuan

et al. 2023

Circ J

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Background: Data regarding the performance of computational fractional flow reserve in patients with diabetes mellitus (DM) remain scarce. This study sought to explore the impact of DM on quantitative flow ratio (QFR) and its association with intravascular ultrasound (IVUS)-derived anatomical references.Methods and Results: IVUS and QFR were retrospectively analyzed in 237 non-diabetic and 93 diabetic patients with 250 and 102 intermediate lesions, respectively. Diabetics were further categorized based on adequate (HbA1c <7.0%: 47 patients with 53 lesions) or poor (HbA1c ≥7.0%: 46 patients with 49 lesions) glycemic control. Lesions with QFR ≤0.8 or minimum lumen area (MLA) ≤4.0 mm 2 and plaque burden (PB, %) ≥70 were considered functionally or anatomically significant, respectively. PB increased, and MLA decreased stepwise across non-diabetics, diabetics with adequate glycemic control and those with poor glycemic control. In contrast, QFR was similar among the 3 groups. PB correlated significantly with the QFR for lesions in non-diabetics, but not for lesions in diabetics. DM was independently correlated with the functionally non-significant lesions (QFR >0.8) with high-risk IVUS features (MLA ≤4.0 mm 2 and PB ≥70; OR 2.053, 95% CI: 1.137-3.707, P=0.017). When considering the effect of glycemic control, HbA1c was an independent predictor of anatomical-functional discordance (OR 1.347, 95% CI: 1.089-1.667, P=0.006).Conclusions: Anatomical-functional discordance of intermediate coronary lesions assessed by IVUS and QFR is exacerbated in patients with diabetes, especially when glycemia is poorly controlled.

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Association Between Insulin Resistance, Oxidative Stress, Sympathetic Activity and Coronary Microvascular Function in Patients With Early Stage Impaired Glucose Metabolism

Cited by 6 publications

References 35 publications

Association between the triglyceride-glucose index and the presence and prognosis of coronary microvascular dysfunction in patients with chronic coronary syndrome

Association between the triglyceride-glucose index and the presence and prognosis of coronary microvascular dysfunction in patients with chronic coronary syndrome

Endothelial Dysfunction Is Associated with Decreased Nitric Oxide Bioavailability in Dysglycaemic Subjects and First-Degree Relatives of Type 2 Diabetic Patients

Anatomical and Functional Discrepancy in Diabetic Patients With Intermediate Coronary Lesions　― An Intravascular Ultrasound and Quantitative Flow Ratio Study ―

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Association Between Insulin Resistance, Oxidative Stress, Sympathetic Activity and Coronary Microvascular Function in Patients With Early Stage Impaired Glucose Metabolism

Cited by 6 publications

References 35 publications

Association between the triglyceride-glucose index and the presence and prognosis of coronary microvascular dysfunction in patients with chronic coronary syndrome

Association between the triglyceride-glucose index and the presence and prognosis of coronary microvascular dysfunction in patients with chronic coronary syndrome

Endothelial Dysfunction Is Associated with Decreased Nitric Oxide Bioavailability in Dysglycaemic Subjects and First-Degree Relatives of Type 2 Diabetic Patients

Anatomical and Functional Discrepancy in Diabetic Patients With Intermediate Coronary Lesions ― An Intravascular Ultrasound and Quantitative Flow Ratio Study ―

Contact Info

Product

Resources

About

Anatomical and Functional Discrepancy in Diabetic Patients With Intermediate Coronary Lesions　― An Intravascular Ultrasound and Quantitative Flow Ratio Study ―