Insulin resistance, haemostatic and inflammatory markers and coronary heart disease risk factors in Type 2 diabetic men with and without coronary heart disease

Abstract

Aims/hypothesis. We have examined markers of haemostasis and inflammation in men with diabetes, coronary heart disease (CHD) or both, and assessed their associations with insulin resistance in men with Type 2 diabetes. Methods. The study was carried out in 4066 British men aged 60 to 79 years who were not on warfarin or insulin, of whom there were 426 men with prevalent Type 2 diabetes and 842 with prevalent CHD. Results. Men with Type 2 diabetes were more likely to have multiple risk factors and higher levels of haemostatic and inflammatory markers than men without, irrespective of CHD status. Compared with men with CHD only, men with diabetes only showed increased levels of tissue plasminogen activator antigen, increased plasma and blood viscosity, and increased levels of coagulation factors VII, VIII and IX. They also had dyslipidaemia. In men with diabetes, increased insulin resistance (homeostasis model assessment, HOMA) was associated with increased levels of haemostatic markers and dyslipidaemia. The prevalence of CHD increased significantly with increasing tertiles of HOMA (adjusted odds ratio 1.32 [95% CI: 0.72-2.42] in the second, and 1.70 in the third tertile; p=0.04 for trend). Conclusions/interpretation. Increased insulin resistance among men with Type 2 diabetes is associated with increased prevalence of CHD and of activated haemostasis and dyslipidaemia. Reducing insulin resistance in men with diabetes may reduce their tendency to develop thrombosis and hence CHD risk.

Do women exhibit greater differences in established and novel risk factors between diabetes and non-diabetes than men? The British Regional Heart Study and British Women’s Heart Health Study

“…All participants provided written informed consent to the investigation and ethics approval was provided by all relevant local research ethics committees. All men and women with pre-existing MI were excluded from the analyses to avoid potential biases because many haemostatic and inflammatory markers are raised as a consequence of having an MI [27], and many of them will be on medication to control their risk factors.…”

Reply to Comment on: Wannamethee SG, Lowe GDO, Shaper AG, Rumley A, Lennon L, Whincup PH (2004) Insulin resistance, haemostatic and inflammatory markers and coronary heart disease risk factors in Type 2 diabetic men with and without coronary heart disease. Diabetologia 47:1557–1565

“…To the Editor: We thank the authors for their letter regarding our paper, drawing attention to concerns about the validity of the homeostasis model assessment (HOMA) in elderly people with diabetes [1]. The two papers that the authors refer to suggest that the relation between HOMA and the insulin-glucose clamp gold standard may be weak or perhaps absent in patients with diabetes, although both these studies are based on small numbers of subjects [2,3].…”

Third Annual World Congress on the Insulin Resistance Syndrome

“…Diabetes, insulin resistance, and the components of the insulin resistance sydrome are associated with CRP, plasma viscosity, the leukocyte count (white blood cells [WBCs]), fibrinogen, and a variety of clotting factors (47). In a study comparing 325 men with and 2,899 without diabetes between 60 and 79 years of age, the diabetic patients had 20% higher levels of CRP and ϳ10% higher WBCs, viscosity, fibrinogen, clotting factors, and tissue plasminogen activator (tPA) (48). Among nondiabetic men, BMI and, even more strongly, waist circumference and plasma insulin are associated with CRP, viscosity, clotting factors, and tPA, with a particular relationship of waist circumference with tPA and of insulin with factor VII/von Willenbrand factor (vWF) and tPA, while there is little association of HDL with these inflammatory/thrombotic measures (49).…”