title: Insulin resistance is associated with significant clinical atherosclerosis in nondiabetic patients with acute myocardial infarction.
abstract: OBJECTIVE
  The prevalence of insulin resistance (IR) is increasing worldwide because of increasing age, obesity, and physical inactivity. Emerging evidence supports a direct proatherogenic effect of IR on the coronary vasculature, but the relation between IR and angiographic atherosclerosis in a real-world clinical setting is uncertain. In this work, we assessed whether IR is independently associated with clinically significant angiographic atherosclerosis in nondiabetic individuals.
  
  
  RESULTS
  We examined the association between IR and the extent of coronary atherosclerosis determined by angiography in 1073 nondiabetic patients surviving acute myocardial infarction. Patients were divided into quartiles on the basis of the homeostasis model assessment grading of IR, and associations between IR and multivessel coronary artery disease, defined as ≥ 2 arteries with ≥ 70% stenosis (or ≥ 50% left main stenosis), were analyzed in bivariate and multivariable modeling. Overall, the cohort had a median age of 56 years; 28.9% women and 21.8% nonwhite. The crude prevalence of multivessel coronary artery disease was 37.8%, 42.3%, 47.2%, and 48.0% for homeostasis model assessment grading of IR quartiles 1, 2, 3, and 4, respectively (P(trend) = 0.009). In multivariable modeling, compared with quartile 1, both quartile 3 (relative risk [95% confidence interval], 1.31 [1.07-1.60]) and quartile 4 (1.29 [1.03-1.60]) were independently associated with multivessel coronary artery disease. Covariates in the model included patient demographic and clinical characteristics and metabolic factors (low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, triglyceride, glycosylated hemoglobin, and high-sensitivity C-reactive protein).
  
  
  CONCLUSIONS
  We demonstrate an independent association between IR and multivessel coronary artery disease in nondiabetic postmyocardial infarction patients. Our findings strengthen the experimental evidence for a direct atherogenic effect of IR independent of glucose control and other components of the metabolic syndrome.
authors.affiliation: Division of Cardiovascular Diseases, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA. wassef@hotmail.com
authors.forename: Wassef
authors.initials: W
authors.lastname: Karrowni
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.forename: Philip G
authors.initials: PG
authors.lastname: Jones
authors.forename: Sharon
authors.initials: S
authors.lastname: Cresci
authors.forename: Mouin S
authors.initials: MS
authors.lastname: Abdallah
authors.forename: David E
authors.initials: DE
authors.lastname: Lanfear
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Maddox
authors.forename: Darren K
authors.initials: DK
authors.lastname: McGuire
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Phillip A
authors.initials: PA
authors.lastname: Horwitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology*; D023921:Coronary Stenosis / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D002097:C-Reactive Protein; D006442:Glycated Hemoglobin; D018836:Inflammation Mediators; D007328:Insulin; D008055:Lipids; C517652:hemoglobin A1c protein, human
keywords: atherosclerosis; insulin resistance