title: Hyperinsulinemia is an independent predictor for complex atherosclerotic lesion of thoracic aorta in non-diabetic patients.
abstract: OBJECTIVE
  Hyperinsulinemia is a well known risk factor for cardiovascular event. However, it is not known whether hyperinsulinemia facilitates atherosclerotic complex lesions of aorta in non-diabetic patients. We investigated whether hyperinsulinemia is an independent marker of severity of atherosclerosis in thoracic aorta of non-diabetic patients using multiplane transesophageal echocardiography (TEE).
  
  
  METHODS
  Non-diabetic 90 patients with cardiovascular disease underwent TEE, and were analyzed for plasma insulin levels of oral glucose tolerance test, conventional atherosclerotic risk factors and coronary angiographic features.
  
  
  RESULTS
  Thoracic aortic plaques were detected in 84 patients (93%). The complex atherosclerotic lesions were observed in 35 (39%) patients, most frequently at the part of aortic arch (p<0.005), showing the greatest atheroma score in thoracic aorta (p<0.05). Univariate analysis showed age, male gender, smoking, coronary artery disease, HDL-cholesterol, insulin levels in glucose tolerance test and homeostasis model assessment insulin resistance index (HOMA index) were found to be significant predictors of complex atherosclerotic lesions. Multivariate regression analysis revealed that HOMA index was an independent predictor of complex atherosclerotic lesions (odds ratio 1.93, p=0.006). There was a significant positive correlation between HOMA index and the atheroma score of thoracic aorta (p<0.001).
  
  
  CONCLUSIONS
  Hyperinsulinemia is an independent predictor of complex atherosclerotic lesions detected by TEE in the thoracic aorta of non-diabetic patients.
authors.affiliation: First Department of Medicine, Asahikawa Medical College, 2-1-1-1 Midorigaoka-higashi, Asahikawa 078-8510, Japan.
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Takahashi
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Hasebe
authors.forename: Eiji
authors.initials: E
authors.lastname: Kawashima
authors.forename: Naofumi
authors.initials: N
authors.lastname: Takehara
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Aizawa
authors.forename: Kazumi
authors.initials: K
authors.lastname: Akasaka
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Kawamura
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Kikuchi
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D006946:Hyperinsulinism / Q000453:epidemiology*; D015994:Incidence; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index