Insulin resistance is associated with coronary plaque vulnerability: insight from optical coherence tomography analysis
Open Access
- 9 September 2013
- journal article
- research article
- Published by Oxford University Press (OUP) in European Heart Journal – Cardiovascular Imaging
- Vol. 15 (3), 284-291
- https://doi.org/10.1093/ehjci/jet158
Abstract
Previous studies have reported that insulin resistance plays an important role in the progression of atherosclerosis. However, the relationship between insulin resistance and coronary plaque instability is not well established. The purpose of this study was to assess the relationship between insulin resistance and coronary plaque characteristics identified by optical coherence tomography (OCT). This study enrolled 155 consecutive patients undergoing percutaneous coronary intervention. OCT image acquisitions were performed in the culprit lesions. Insulin resistance was identified using the homeostasis model assessment of insulin resistance (HOMA-IR). Subjects were divided into three tertiles according to the HOMA-IR values. Patients in the higher HOMA tertile had more frequent prevalence of lipid-rich plaques than those in the middle and lower tertiles (83 vs. 62 vs. 57%; P = 0.01). The thin-cap fibroatheroma (TCFA) prevalence rates among the higher (>2.5), middle (1.4–2.5), and lower HOMA-IR (P = 0.02). The microvessel prevalence rates of the three tertiles were 54, 39, and 28% (P = 0.02). Furthermore, in the higher HOMA-IR group, the fibrous cap was significantly thinner compared with the other two tertiles (vs. lower HOMA-IR, P = 0.009; vs. middle HOMA-IR, P = 0.008). On multivariate analysis, acute coronary syndrome [odds ratio (OR): 17.98; 95% confidence interval (CI): 7.12−52.02; P < 0.0001] and HOMA-IR >2.50 (OR: 3.57; 95% CI: 1.42−9.55; P = 0.007) were independent predictors for the presence of TCFA. This study suggests that insulin resistance might be associated with coronary plaque vulnerability.Keywords
This publication has 35 references indexed in Scilit:
- Insulin resistance predicts progression of de novo atherosclerotic plaques in patients with coronary heart disease: a one-year follow-up studyCardiovascular Diabetology, 2012
- Prognostic significance of hemoglobin A1c level in patients hospitalized with coronary artery disease. A systematic review and meta-analysisCardiovascular Diabetology, 2011
- Thin-cap fibroatheroma and microchannel findings in optical coherence tomography correlate with subsequent progression of coronary atheromatous plaquesEuropean Heart Journal, 2011
- Impact of insulin resistance on enhanced monocyte adhesion to endothelial cells and atherosclerogenesis independent of LDL cholesterol levelBiochemical and Biophysical Research Communications, 2010
- Macrophages, Inflammation, and Insulin ResistanceAnnual Review of Physiology, 2010
- Thin-Walled Microvessels in Human Coronary Atherosclerotic Plaques Show Incomplete Endothelial Junctions: Relevance of Compromised Structural Integrity for Intraplaque Microvascular LeakageJournal of the American College of Cardiology, 2009
- Comparison of coronary plaque characteristics between diabetic and non-diabetic subjects: An in vivo optical coherence tomography studyDiabetes Research and Clinical Practice, 2008
- Effects of Intensive Glucose Lowering in Type 2 DiabetesThe New England Journal of Medicine, 2008
- Plaque characterisation by Virtual Histology intravascular ultrasound analysis in patients with type 2 diabetesHeart, 2007
- Assessment of short-, medium-, and long-term variations in arterial dimensions from computer-assisted quantitation of coronary cineangiograms.Circulation, 1985