Insulin resistance as a predictor for restenosis after coronary stenting

Nishio, Kazuaki; Fukui, Tetsuya; Tsunoda, Fumiyoshi; Kawamura, Kitaro; Itoh, Seiji; Konno, Noburu; K, Ozawa; Kubo, Takashi

doi:10.1016/j.ijcard.2004.08.039

Cited by 26 publications

(28 citation statements)

References 34 publications

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“…On the other hand, analysis of the effect of IR, assessed by the insulin concentration 2 h after glucose loading, 17 showed that the rate of recurrence was significantly higher in the IR group than in the NR group. These results suggest that IR rather than hyperglycemia increases the risk of recurrence of ischemic episodes, which agrees with an earlier study 29 showing association of IR with coro- nary restenosis after PCI. Lipid profile did not differ between the recurrence group and the non-recurrence group except for TC, which was significantly lower in the recurrence group, presumably because of the strict control of TC level in the subjects during their hospitalization.…”

Section: Relationships Between Risk Factors and Recurrence Of Ischemisupporting

confidence: 92%

Impact of Abnormal Glucose Tolerance, Hypertension and Other Risk Factors on Coronary Artery Disease

Nakamura

Saitoh

Takagi

et al. 2007

Circ J

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Background The degree to which abnormal glucose tolerance contributes to the development of coronary artery disease (CAD) has not been clarified in Japanese. The relationship between abnormal glucose tolerance and severity of coronary artery stenosis, as well as the contributions of hypertension, diabetes and other risk factors for CAD to recurrence of the disease, were investigated in the present study. Methods and ResultsThe subjects were 474 consecutive patients (mean age: 63.8±11.3 years) with suspected CAD who were admitted to Sapporo Medical University Hospital during April 1, 1997 to March 31, 2004. The coronary index and stenosis score were higher in subjects with diabetes mellitus (DM) and in subjects with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) than in subjects with normal glucose tolerance (NGT). Ischemic episodes recurred during the observation period (mean 2.5 years) in 61 of 341 patients diagnosed as having CAD. In the follow-up subjects, systolic blood pressure (SBP) was significantly higher in the recurrence group than in the non-recurrence group, and SBP was a significant variable in logistic regression analysis after adjustment for age, gender, hemoglobin A1c, total cholesterol, body mass index, smoking history, family history and stenosis score. The relative risk of recurrence became 1.7-fold higher with a rise in SBP of 10 mmHg (95% confidence interval: 1.252-2.250). Analysis of the relationship between glucose tolerance and recurrence showed that the rate of recurrence was higher in patients with IFG + IGT + DM than in those with NGT. Conclusions CAD progresses not only in patients with DM but also in those with IGT. The rate of recurrence of ischemic episodes increases in individuals with IGT or DM, and suggesting that hypertension is a risk factor for recurrence of ischemic episodes. Management of glucose tolerance and blood pressure is therefore important for prevention of CAD in Japanese. (Circ J 2007; 71: 20 -25)

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Section: Relationships Between Risk Factors and Recurrence Of Ischemisupporting

confidence: 92%

Impact of Abnormal Glucose Tolerance, Hypertension and Other Risk Factors on Coronary Artery Disease

Nakamura

Saitoh

Takagi

et al. 2007

Circ J

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“…Moreover, the relation of IR to restenosis is even more elusive because the few studies addressing this issue used different methodology, and the results were highly heterogeneous (13)(14)(15)(16)30,31). For instance, an unexpected inverse relationship between insulinemia levels and restenosis rate was described following excimer laser coronary angioplasty (30).…”

Section: Discussionmentioning

confidence: 99%

“…Other studies also described a relationship between restenosis and IR, but in most of them diabetic patients were excluded and no IVUS measurements were performed (13,15,31). In the only published study in which diabetic patients were included and a direct relationship between plasma insulin levels and restenosis was described, IVUS was not used, and, unexpectedly, QCA parameters related to vessel diameter were not considered to be predictors of restenosis (14). In our study, as in previous trials, RVD was a significant predictor of restenosis (4,33).…”

Section: Discussionmentioning

confidence: 99%

“…However, the role of insulin resistance (IR) in the development of cardiovascular disease is not well defined (10,11) despite the fact that IR is present in prediabetic states such as impaired glucose tolerance (IGT) or impaired fasting glycemia (IFG) (12). The role of these pre-diabetic hyperinsulinemic states in the development of restenosis after PCI is even less understood, although a direct correlation of neo-intimal hyperplasia after PCI and IR has been suggested (13)(14)(15)(16). Therefore, the aim of the present study was to correlate glucose metabolism www.bjournal.com.br Braz J Med Biol Res 43 (6) 2010 parameters with intravascular ultra-sound (IVUS) and quantitative coronary angiographic (QCA) characteristics of restenosis in a population of non-selected consecutive patients undergoing PCI with BMS.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Predictors of restenosis after percutaneous coronary intervention using bare-metal stents: a comparison between patients with and without dysglycemia

Lima-Filho

Figueiredo

Foss‐Freitas

et al. 2010

Braz J Med Biol Res

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2.063 (RR = 0.44; 95%CI = 0.14-0.64; P = 0.027), and fasting plasma glucose (FPG): ≤108.8 mg/dL (RR = 0.53; 95%CI = 0.13-0.75; P = 0.046). SV was an independent predictor of restenosis by multivariable analysis. Dysglycemia is a common clinical condition in patients submitted to PCI. The degree of insulin resistance, FPG, RVD, SA, and SV were correlated with restenosis. SV was inversely correlated with an independent predictor of restenosis in patients treated with a bare-metal stent.]]>

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“…It is now well accepted that metabolic syndrome and type 2 diabetes are strongly associated with adverse cardiovascular events in humans, although the underlying reasons for these associations have not been clarified (3,12,44,49,55). Several recent studies have reported that hyperinsulinemia is associated with vascular remodeling and enhanced neointima formation in models of experimental vascular injury as well as in humans (20,28,37,39,55). Moreover, hyperinsulinemia, but not hyperglycemia, has been reported to induce enhanced neointima formation in models of rat vascular injury (11, 28).…”

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confidence: 99%

Chronic insulin treatment suppresses PTP1B function, induces increased PDGF signaling, and amplifies neointima formation in the balloon-injured rat artery

Chang²,

Zhang³

et al. 2009

American Journal of Physiology-Heart and Circulatory Physiology

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. Chronic insulin treatment suppresses PTP1B function, induces increased PDGF signaling, and amplifies neointima formation in the balloon-injured rat artery. Am J Physiol Heart Circ Physiol 296: H132-H139, 2009. First published November 14, 2008 doi:10.1152/ajpheart.00370.2008.-We tested the hypothesis that hyperinsulinemia induces the suppression of protein tyrosine phosphatase 1B (PTP1B) function, leading to enhanced PDGF receptor (PDGFR) signaling and neointimal hyperplasia. Rats were implanted with insulin-releasing pellets or sham pellets. Blood glucose levels, insulin levels, food and water intake, body weights, and blood pressures were measured. Neointimal hyperplasia was assessed by computerized morphometry 14 days after carotid balloon injury. PTP1B protein expression in injured arteries was determined via Western blot analysis, whereas PTP1B activity was determined via an immunophosphatase assay. Serum insulin levels were two-to threefold greater in hyperinsulinemic rats, whereas systolic blood pressures, food and water intake, serum triglyceride levels, plasma cortisol levels, and urinary catecholamine levels were not affected. Fourteen days after injury, neointima-to-media area ratios were 0.89 Ϯ 0.23 and 1.35 Ϯ 0.22 in control and hyperinsulinemic rats, respectively (P Ͻ 0.01). PTP1B protein levels and total PTP1B activity in injured carotid arteries from the insulin-treated group were significantly decreased 7 or 14 days after injury, whereas PTP1B specific activity was decreased only 14 days after injury. These findings were associated with decreased PTP1B mRNA levels and increased PDGFR tyrosyl phosphorylation in insulin-treated rats. These observations support the hypothesis that hyperinsulinemia induces the suppression of PTP1B function, leading to enhanced PDGFR signaling and neointimal hyperplasia. restenosis; reverse transcription-polymerase chain reaction; vascular injury; protein tyrosine phosphatase 1B; platelet-derived growth factor HYPERINSULINEMIA is a key feature of metabolic syndrome and type 2 diabetes (18). Moreover, plasma insulin levels in the population of the United States appear to have increased by ϳ35% during the last decade (32). It is now well accepted that metabolic syndrome and type 2 diabetes are strongly associated with adverse cardiovascular events in humans, although the underlying reasons for these associations have not been clarified (3,12,44,49,55). Several recent studies have reported that hyperinsulinemia is associated with vascular remodeling and enhanced neointima formation in models of experimental vascular injury as well as in humans (20,28,37,39,55). Moreover, hyperinsulinemia, but not hyperglycemia, has been reported to induce enhanced neointima formation in models of rat vascular injury (11, 28).The migration of medial vascular smooth muscle cells to the intima and the subsequent cell proliferation are thought to be necessary for the vascular remodeling that occurs after injury or in atherosclerosis. Acute treatment with insulin has been reported to atte...

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Insulin resistance as a predictor for restenosis after coronary stenting

Cited by 26 publications

References 34 publications

Impact of Abnormal Glucose Tolerance, Hypertension and Other Risk Factors on Coronary Artery Disease

Impact of Abnormal Glucose Tolerance, Hypertension and Other Risk Factors on Coronary Artery Disease

Predictors of restenosis after percutaneous coronary intervention using bare-metal stents: a comparison between patients with and without dysglycemia

Chronic insulin treatment suppresses PTP1B function, induces increased PDGF signaling, and amplifies neointima formation in the balloon-injured rat artery

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