Insulin Resistance and Fasting Hyperinsulinemia Are Risk Factors for New Cardiovascular Events in Patients With Prior Coronary Artery Disease and Normal Glucose Tolerance

Masanobu Yanase; Fumimaro Takatsu; Takayuki Tagawa; Tomoko Kato; Kosuke Arai; Masayoshi Koyasu; Hideki Horibe; Shigeru Nomoto; Kenji Takemoto; Seiji Shimizu; Masato Watarai

doi:10.1253/circj.68.47

Clinical Investigation

Insulin Resistance and Fasting Hyperinsulinemia Are Risk Factors for New Cardiovascular Events in Patients With Prior Coronary Artery Disease and Normal Glucose Tolerance

Masanobu Yanase, Fumimaro Takatsu, Takayuki Tagawa, Tomoko Kato, Kosuke Arai, Masayoshi Koyasu, Hideki Horibe, Shigeru Nomoto, Kenji Takemoto, Seiji Shimizu, Masato Watarai

Author information

Masanobu Yanase
Division of Cardiology, Cardiovascular Center, Anjo Kosei Hospital
Fumimaro Takatsu
Division of Cardiology, Cardiovascular Center, Anjo Kosei Hospital
Takayuki Tagawa
Department of Radiological technology, Anjo Kosei Hospital
Tomoko Kato
Division of Cardiology, Cardiovascular Center, Anjo Kosei Hospital
Kosuke Arai
Division of Cardiology, Cardiovascular Center, Anjo Kosei Hospital
Masayoshi Koyasu
Division of Cardiology, Cardiovascular Center, Anjo Kosei Hospital
Hideki Horibe
Division of Cardiology, Cardiovascular Center, Anjo Kosei Hospital
Shigeru Nomoto
Division of Cardiology, Cardiovascular Center, Anjo Kosei Hospital
Kenji Takemoto
Division of Cardiology, Cardiovascular Center, Anjo Kosei Hospital
Seiji Shimizu
Division of Cardiology, Cardiovascular Center, Anjo Kosei Hospital
Masato Watarai
Division of Cardiology, Cardiovascular Center, Anjo Kosei Hospital

Keywords: Cardiovascular disease, Coronary artery disease, Homeostasis model, Hyperinsulinemia, Insulin resistance, Normal glucose tolerance

JOURNAL FREE ACCESS

2004 Volume 68 Issue 1 Pages 47-52

DOI https://doi.org/10.1253/circj.68.47

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Abstract

Background Insulin resistance and hyperinsulinemia are important risk factors for coronary artery disease (CAD) and cardiovascular event (CVE). However, their independent relationship to new CVE in patients with normal glucose tolerance (NGT) and CAD is not known. Methods and Results Subjects of this 3-year observational study were 102 patients with CAD. Plasma glucose and insulin concentrations were determined at 2 time points (baseline and post oral glucose tolerance test [OGTT]. The fasting plasma glucose <110 mg/dl and post-OGTT <140 mg/dl was diagnosed as NGT (World Health Organization criteria). Insulin resistance was evaluated by the homeostasis model assessment of insulin resistance (HOMA-IR). Of the 102 patients, 23 had onset of new CVE, including 19 with new CAD. They had significantly higher fasting and post-OGTT insulin levels and HOMA-IR than those without new CVE (P<0.01, 0.031 and <0.01, respectively). Using the univariate Cox proportional hazards model, fasting and post-OGTT insulin values, HOMA-IR and high density lipoprotein (HDL) cholesterol differed significantly between the 2 groups. The multivariate Cox model showed that the effect of fasting plasma insulin and HOMA-IR remained significant and independent of HDL cholesterol. Conclusion Fasting hyperinsulinemia and high insulin resistance increased the risk of new CVE in patients with NGT and CAD. (Circ J 2004; 68: 47 - 52)

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