Insulin resistance, haemostatic and inflammatory markers and coronary heart disease risk factors in Type 2 diabetic men with and without coronary heart disease.
OBJECTIVE
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 [95% CI: 0.92-3.44] in the third tertile; p=0.04 for trend).


CONCLUSIONS
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.
Wannamethee
S G
SG
Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Rowland Hill St, London, NW3 2PF, UK. goya@pcps.ucl.ac.uk.
Lowe
G D O
GD
Shaper
A G
AG
Rumley
A
A
Lennon
L
L
Whincup
P H
PH
D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D003327:Coronary Disease / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000097:blood* / Q000503:physiopathology*; D006487:Hemostasis; D006801:Humans; D007249:Inflammation; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D014280:Triglycerides / Q000097:blood; D006113:United Kingdom
D007328:Insulin; D014280:Triglycerides; D002097:C-Reactive Protein