Association of insulin resistance and coronary artery remodeling: an intravascular ultrasound study

Abstract

BackgroundThere are few studies that investigated the correlation between insulin resistance (IR) and the coronary artery remodeling. The aim of the study is to investigate the association of IR measured by homeostasis model assessment of insulin resistance (HOMA-IR) and coronary artery remodeling evaluated by intravascular ultrasound (IVUS).MethodsA total of 298 consecutive patients who received percutaneous coronary interventions under IVUS guidance were retrospectively enrolled. The value of HOMA-IR more than 2.5 was considered as IR positive. Metabolic syndrome was classified according to NCEP ATP III guidelines. The remodeling index was defined as the ratio of the external elastic membrane (EEM) area at the lesion site to the EEM area at the proximal reference site.ResultsA total of 369 lesions were analyzed (161 lesions in HOMA-IR positive and 208 lesions in HOMA-IR negative). Remodeling index was significantly higher in the HOMA-IR positive group compared with the negative group (HOMA-IR positive vs. negative: 1.074 ± 0.109 vs. 1.042 ± 0.131, p = 0.013). There was a significant positive correlation between remodeling index and HOMA-IR (p = 0.010). Analysis of HOMA-IR according to remodeling groups showed increasing tendency of HOMA-IR, and it was statistically significant (p = 0.045). Multivariate analysis revealed that only HOMA-IR was an independent predictor of remodeling index (r = 0.166, p = 0.018).ConclusionIncreased IR estimated by HOMA-IR was significantly associated with a higher remodeling index and positive coronary artery remodeling.

In Vivo and In Vitro Analysis in Coronary Artery Disease Related to Type 2 Diabetes

“…In agreement with the aforementioned works, in our study, DM + CAD + presented more diseased coronaries in terms of coronary calcium, significant stenoses, atherosclerotic burden, and extent of disease. Furthermore, we have quantified RI in diabetic patients by CTCA providing an additional prognostic value comparable only to invasive procedures such as intravascular ultrasound ( 55 , 56 ). A recent study analyzed CAD features comparing hypertensive, dyslipidemic, and diabetic patients by CTCA reporting the prevalence of positive remodeling as a qualitative parameter ( 57 ).…”

Plaque volume and plaque risk profile in diabetic vs. non-diabetic patients undergoing lipid-lowering therapy: a study based on 3D intravascular ultrasound and virtual histology

“…Metalloproteases are also important factor for development of positive vessel remodeling that is also known risk factor for plaque instability. Insulin resistance was shown as a factor related to positive vessel remodeling [ 38 ]. Neovessels are more fragile and therefore more prone to rupture, thus causing intra-plaque hemorrhage [ 39 ].…”

Factors associated with no apparent coronary artery disease in patients with type 2 diabetes mellitus for more than 10 years of duration: a case control study

“…A recent observation by recent Kim et al, where Intravascular Ultrasound (IVUS) a gold standard method to identify any vulnerable plaques in coronary arteries, was used to study the coronary artery remodeling [ 32 ]. The findings from the study reveals that, those with HOMA-IR >2.5 had positive coronary artery remodeling when compared to those HOMA-IR <2.5 [ 32 ]. Thus individuals with high HOMA-IR (HOMA-IR >2.5) are susceptible to develop future cardiovascular events.…”