title: Effect of insulin resistance associated with compensatory hyperinsulinemia on the long-term prognosis in patients with vasospastic angina.
abstract: BACKGROUND
  Insulin resistance associated with compensatory hyperinsulinemia plays a significant role in the pathogenesis of cardiovascular diseases, including vasospastic angina (VSA). However, the effects of insulin resistance associated with hyperinsulinemia on the long-term prognosis in patients with VSA remain unclear.
  
  
  METHODS
  A total of 265 selected patients with VSA and 56 control subjects with atypical chest pain were enrolled in the present study. Patients with VSA had a positive acetylcholine (ACh) provocation test with normal coronary angiograms, and control subjects had a negative ACh test and normal coronary angiograms. A 75-g oral glucose tolerance test was performed, and the plasma glucose and immunoreactive insulin (IRI) levels were measured before, and 30 min and 120 min (IRI 120) after the 75-g glucose load.
  
  
  RESULTS
  During the median follow-up period of 90.0 months, thirty-one patients developed cardiac events, including 6 sudden cardiac deaths and 25 readmissions for acute coronary syndrome. Cardiac events occurred in 38.9% of the patients with an IRI 120 ≥ 80 μU/ml and only 1.6% of the patients with an IRI 120<80 μU/ml (log rank 77.220, p<0.001). A multivariate analysis showed that an IRI 120 ≥ 80 μU/ml (hazard ratio 27.49, 95% confidence interval: 4.66-162.10, p<0.001) was an independent predictor of cardiac events.
  
  
  CONCLUSIONS
  These data indicate that insulin resistance associated with compensatory hyperinsulinemia increases the risk of cardiac events in VSA patients.
authors: Department of Internal Medicine and Cardiology, Tama-Nagayama Hospital, Nippon Medical School, Tokyo, Japan. nakagomi@nms.ac.jp
authors: Akihiro
authors: A
authors: Nakagomi
authors: Yoshiyuki
authors: Y
authors: Saiki
authors: Munenori
authors: M
authors: Kosugi
authors: Keiichi
authors: K
authors: Kohashi
authors: Yoshitomo
authors: Y
authors: Yoshikawa
authors: Yoshito
authors: Y
authors: Yamane
authors: Eitaro
authors: E
authors: Kodani
authors: Yoshiki
authors: Y
authors: Kusama
authors: Hirotsugu
authors: H
authors: Atarashi
authors: Kyoichi
authors: K
authors: Mizuno
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000097:blood / Q000000981:diagnostic imaging* / Q000453:epidemiology; D015331:Cohort Studies; D003329:Coronary Vasospasm / Q000097:blood / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006946:Hyperinsulinism / Q000097:blood / Q000000981:diagnostic imaging* / Q000453:epidemiology; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D013997:Time Factors