Association of insulin resistance, hyperleptinemia, and impaired nitric oxide release with in-stent restenosis in patients undergoing coronary stenting.
BACKGROUND
Previously undiagnosed diabetes, impaired glucose tolerance, and insulin resistance are common in patients with acute myocardial infarction and coronary heart disease (CHD) and might be involved in early restenosis after stent implantation. To evaluate whether markers of insulin resistance syndrome, including leptin, and endothelial dysfunction are related to increased rate of early restenosis, we studied nondiabetic patients with CHD after successful coronary stenting.


RESULTS
Both patients with CHD undergoing coronary stenting (120 patients) and control subjects (58 patients) were submitted to an oral glucose tolerance test (OGTT). Fasting leptin levels and fasting and postglucose load insulin sensitivity were assessed. Endothelial function was measured by nitrite and nitrate release (NOx) during OGTT. More than 50% of patients treated with stent implantation presented impaired glucose tolerance or type 2 diabetes, which was previously undiagnosed. These patients also had higher glucose, insulin, and leptin levels than control subjects. Among the stented patients, insulin and leptin levels were higher in patients with restenosis than in patients without restenosis. A significant increase in NOx levels was found during OGTT both in patients without restenosis and in control subjects. On the contrary, NOx profiles were blunted in patients with restenosis. At multiple regression analysis, only DeltaAUC-NOx areas and insulin sensitivity index showed an independent correlation with the minimal lumen diameter at follow-up.


CONCLUSIONS
We demonstrated that insulin resistance and endothelial dysfunction are independent predictors of early restenosis after coronary stenting.
Piatti
PierMarco
P
Cardiovascular and Metabolic Rehabilitation Unit, Rehabilitation and Functional Reeducation Division, IRCCS H. San Raffaele, Milan, Italy. piermarco.piatti@hsr.it
Di Mario
Carlo
C
Monti
Lucilla D
LD
Fragasso
Gabriele
G
Sgura
Fabio
F
Caumo
Andrea
A
Setola
Emanuela
E
Lucotti
Pietro
P
Galluccio
Elena
E
Ronchi
Cristina
C
Origgi
Anna
A
Zavaroni
Ivana
I
Margonato
Alberto
A
Colombo
Antonio
A
D019540:Area Under Curve; D001786:Blood Glucose; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D017023:Coronary Angiography; D003327:Coronary Disease / Q000601:surgery; D023903:Coronary Restenosis / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis; D004730:Endothelium, Vascular / Q000503:physiopathology; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D020738:Leptin / Q000097:blood*; D008875:Middle Aged; D009569:Nitric Oxide / Q000097:blood*; D011237:Predictive Value of Tests; D012044:Regression Analysis; D015607:Stents / Q000009:adverse effects; D014654:Vascular Patency
D001786:Blood Glucose; D007328:Insulin; D020738:Leptin; D009569:Nitric Oxide