Crouching tiger, hidden dragon: insulin resistance and the risk of atrial fibrillation

Polovina, Marija; Krljanać, Gordana; Ašanin, Milika; Seferović, Petar

doi:10.1177/2047487320912626

Cited by 6 publications

(5 citation statements)

References 16 publications

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“…For example, fasting insulin has generally not been shown to increase the risk of incident AF (4). Other study showed AF development increased at the homeostatic model of insulin resistance (HOMA-IR) levels between 1 to 2.5, whereas no further increase occurred above HOMA-IR as 2.5, indicated a nonlinear relationship between IR and AF in non-diabetics (5,6). Since the calculation of HOMA-IR depends on atypical measurement of serum insulin levels, it has limited application in clinical practice (7).…”

Section: Introductionmentioning

confidence: 99%

Association between triglyceride-glucose index and atrial fibrillation: A retrospective observational study

et al. 2022

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BackgroundInsulin resistance is associated with atrial remodeling as well as atrial fibrillation (AF). However, there was limited evidence on the relationship of triglyceride-glucose index (TyG) index, a simple, valuable marker of insulin resistance, with AF. Thus, we aimed to investigate the association between TyG index and AF among hospitalized patients.MethodsA retrospective observational study was conducted in Daping Hospital, which included 356 hospitalized patients from the Department of Cardiology. Clinical and biochemical parameters were collected from electronic medical records and AF was diagnosed from electrocardiogram (ECG) findings.ResultsWe found that the TyG index was significantly higher in the AF group than in the group without AF. Multivariate logistic regression revealed that hypertension (OR = 1.756, 95%CI 1.135-2.717, P = 0.011) and TyG index (OR = 2.092, 95%CI 1.412-3.100, P<0.001) were positively associated with AF. The analysis of the area under the ROC curve was performed and revealed that area under curve (AUC) of TyG index was 0.600 (95%CI, 0.542-0.659, P = 0.001), the optimal critical value was 8.35, the sensitivity was 65.4%, and the specificity was 52.0%. Additional subgroup analyses of diabetic and non-diabetic subjects were also performed and found the TyG index was increased in non-diabetic subjects with AF. Furthermore, a logistic regression analysis showed TyG index was associated with AF (OR = 3.065, 95% CI, 1.819-5.166, P<0.001) in non-diabetic subjects. However, TyG index was not associated with AF in diabetic subjects.ConclusionElevated TyG index is an independent risk factor for AF among non-diabetic hospitalized patients.

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Section: Introductionmentioning

confidence: 99%

Association between triglyceride-glucose index and atrial fibrillation: A retrospective observational study

et al. 2022

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“…Insulin resistance(IR) is a state of decreased insulin response, which shows signs including obesity, elevated blood glucose, dyslipidemia and elevated blood pressure [5].IR is generally a component of metabolic syndrome and a precursor of diabetes mellitus(DM),metabolic syndrome and diabetes mellitus are independent risk factors for recurrence after AF ablation [6,7],IR also could increase the susceptibility to AF [8][9][10].At present, the relationship between the recurrence rate after ablation and IR in patients with AF is not clear, the aim of this study was to investigate the effect of IR on the recurrence after RFCA in patients with AF.…”

Section: Introductionmentioning

confidence: 99%

Effect of Insulin Resistance on Recurrence after Radiofrequency Catheter Ablation in Patients with Atrial Fibrillation

Wang

Liu

et al. 2022

Cardiovasc Drugs Ther

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BackgroundRecurrence after atrial brillation(AF) ablation has many risk factors. the relationship between the recurrence rate after ablation and IR in the non-diabetic patients with AF is not clear. MethodsRetrospective cohort study enrolled AF patients without diabetes who underwent ablation between 2018~2019 in the rst a liated hospital of zhengzhou university. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated and a value of ≥2.69 was de ned as insulin resistant(IR). The patients were categaried into two groups: those with HOMA-IR<2.69 in group 1(n=163); HOMA-IR≥2.69 in group 2 (n=69). Multivariable adjusted Cox proportional hazard models were performed to compare the risk of AF recurrence after ablation. The de nition of AF recurrence was documented AF, atrial utter, or atrial tachycardia lasting >30 seconds recorded in ECG or 24-hour Holter monitoring after 3 months blanking period. Results232 AF patients receiving ablation were enrolled and the median age was 59.5±11.3 years . There were 166 cases of paroxysmal AF and 66 cases of persistent AF. Patients with IR (n=69)were more likely to have Dyslipidemia, higher fasting blood glucose and fasting insulin than those in non-IR group. Patients with IR also were more likely to recieve antiarrhythmic drugs before ablation. After a mean follow-up of 322±85 days, 62(26.7%) patients had documented recurrence of AF. Multivariable analysis showed that HOMA-IR value and left atrial diameter LAD were independent risk factors for recurrence after AF ablation (HR: 1.

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“…As reported by prior studies, higher level of HOMA-IR was accompanied by lower LAS and higher LASI in general population [ 39 , 40 ]. IR also increased the susceptibility to incident atrial fibrillation (AF) and AF recurrence after ablation partly due to the atrial electrical remodeling [ 41 , 42 ]. In this study, we first found that higher IR degree was responsible for more significant LAAR but not LV structural and functional deterioration during and after TT.…”

Section: Discussionmentioning

confidence: 99%

Association between insulin resistance and cardiac remodeling in HER2-positive breast cancer patients: a real-world study

Shi

Qiu

et al. 2023

BMC Cancer

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Background Insulin resistance is an overlapping risk factor for both heart and breast cancer, while its interaction with cardiotoxicity in breast cancer (BC) patients is not clear. This study investigated the impact of insulin resistance on cardiac remodeling in patients with human epidermal growth factor receptor 2 (HER2)-positive BC during and after trastuzumab therapy in real-world clinical practice. Methods HER2-positive BC patients who received trastuzumab treatment between December 2012 and December 2017 were reviewed and 441 patients with baseline metabolic indices and serial echocardiographic measurements (baseline, 6, 12, and 18 months) after trastuzumab therapy initiation were included. Repeated measurement analysis of variance was used to evaluate temporal trends in multiparameter echocardiography. Linear mixed model was applied to further evaluate the role of insulin resistance in forementioned changes. Correlation of homeostasis model assessment-estimated insulin resistance (HOMA-IR) and triglyceride-glucose index (TyG) levels to changes in echocardiography parameters was explored. Results Of 441 patients (mean age 54 ± 10 [SD] years), 61.8% received anthracycline-based chemotherapy, 33.5% received left-sided radiotherapy, 46% received endocrine therapy. No symptomatic cardiac dysfunction was observed over the therapy course. A total of 19 (4.3%) participants experienced asymptomatic cancer therapy-related cardiac dysfunction (CTRCD), and the peak onset time was 12 months after the initiation of trastuzumab. Albeit relatively low CTRCD incidence, cardiac geometry remodeling, especially left atrial (LA) dilation over therapy was notable and was more severe in high HOMA-IR and TyG level groups (P < 0.01). Noteworthy, a partial reversibility of cardiac remodeling was observed with treatment cessation. Additionally, HOMA-IR level positively correlated to changes in LA diameter from baseline to 12 months (r = 0.178, P = 0.003). No significant association (all P > 0.10) was detected between HOMA-IR or TyG level and dynamic left ventricular parameter evaluation. Multivariate linear regression analysis demonstrated that higher HOMA-IR level was an independent determinant for LA enlargement in BC patients during anti-HER2 targeted therapy course after adjusting for confounding risk factors (P = 0.006). Conclusion Insulin resistance was associated with left atrial adverse remodeling (LAAR) in HER2-positive BC patients that received standard trastuzumab therapy, indicating that insulin resistance could be a supplementation to baseline cardiovascular risk stratification proforma for HER2-targeted antitumor therapies.

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Crouching tiger, hidden dragon: insulin resistance and the risk of atrial fibrillation

Cited by 6 publications

References 16 publications

Association between triglyceride-glucose index and atrial fibrillation: A retrospective observational study

Association between triglyceride-glucose index and atrial fibrillation: A retrospective observational study

Effect of Insulin Resistance on Recurrence after Radiofrequency Catheter Ablation in Patients with Atrial Fibrillation

Association between insulin resistance and cardiac remodeling in HER2-positive breast cancer patients: a real-world study

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