title: Insulin resistance and fasting hyperinsulinemia are risk factors for new cardiovascular events in patients with prior coronary artery disease and normal glucose tolerance.
abstract: BACKGROUND
  Insulin resistance and hyperinsulinemia are important risk factors for coronary artery disease (CAD) and cardiovascular event (CVE). However, their independent relationship to new CVE in patients with normal glucose tolerance (NGT) and CAD is not known.
  
  
  RESULTS
  Subjects of this 3-year observational study were 102 patients with CAD. Plasma glucose and insulin concentrations were determined at 2 time points (baseline and post oral glucose tolerance test [OGTT]. The fasting plasma glucose <110 mg/dl and post-OGTT <140 mg/dl was diagnosed as NGT (World Health Organization criteria). Insulin resistance was evaluated by the homeostasis model assessment of insulin resistance (HOMA-IR). Of the 102 patients, 23 had onset of new CVE, including 19 with new CAD. They had significantly higher fasting and post-OGTT insulin levels and HOMA-IR than those without new CVE (P<0.01, 0.031 and <0.01, respectively). Using the univariate Cox proportional hazards model, fasting and post-OGTT insulin values, HOMA-IR and high density lipoprotein (HDL) cholesterol differed significantly between the 2 groups. The multivariate Cox model showed that the effect of fasting plasma insulin and HOMA-IR remained significant and independent of HDL cholesterol.
  
  
  CONCLUSIONS
  Fasting hyperinsulinemia and high insulin resistance increased the risk of new CVE in patients with NGT and CAD.
authors.affiliation: Division of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, Aichi, Japan. yanase@kosei.anjo.aichi.jp
authors.forename: Masanobu
authors.initials: M
authors.lastname: Yanase
authors.forename: Fumimaro
authors.initials: F
authors.lastname: Takatsu
authors.forename: Takayuki
authors.initials: T
authors.lastname: Tagawa
authors.forename: Tomoko
authors.initials: T
authors.lastname: Kato
authors.forename: Kosuke
authors.initials: K
authors.lastname: Arai
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Koyasu
authors.forename: Hideki
authors.initials: H
authors.lastname: Horibe
authors.forename: Shigeru
authors.initials: S
authors.lastname: Nomoto
authors.forename: Kenji
authors.initials: K
authors.lastname: Takemoto
authors.forename: Seiji
authors.initials: S
authors.lastname: Shimizu
authors.forename: Masato
authors.initials: M
authors.lastname: Watarai
mesh_terms: D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism*; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000453:epidemiology*; D005215:Fasting; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D006946:Hyperinsulinism / Q000097:blood*; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D007328:Insulin