Impact of Insulin Resistance on Acetylcholine-Induced Coronary Artery Spasm in Non-Diabetic Patients.
10.3349/ymj.2018.59.9.1057
- Author:
Kwan Woo KANG
1
;
Byoung Geol CHOI
;
Seung Woon RHA
Author Information
1. Department of Medicine, Korea University College of Medicine, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Coronary artery spasm;
insulin resistance;
acetylcholine
- MeSH:
Acetylcholine;
Blood Glucose;
Body Mass Index;
Chest Pain;
Cholesterol;
Coronary Artery Disease;
Coronary Vessels*;
Diabetes Mellitus;
Fasting;
Glucose;
Homeostasis;
Humans;
Insulin Resistance*;
Insulin*;
Nitroglycerin;
Spasm*;
Triglycerides
- From:Yonsei Medical Journal
2018;59(9):1057-1063
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Coronary artery spasm (CAS) and diabetes mellitus (DM) are implicated in endothelial dysfunction, and insulin resistance (IR) is a major etiological cause of type 2 DM. However, the association between CAS and IR in non-diabetic individuals has not been elucidated. The aim of the present study was to evaluate the impact of IR on CAS in patients without DM. MATERIALS AND METHODS: A total of 330 eligible patients without DM and coronary artery disease who underwent acetylcholine (Ach) provocation test were enrolled in this study. Inclusion criteria included both hemoglobin A1c < 6.0% and fasting glucose level < 110 mg/dL without type 2 DM. Patients were divided into quartile groups according the level of homeostasis model assessment of insulin resistance (HOMA-IR): 1Q (n=82; HOMA-IR < 1.35), 2Q (n=82; 1.35≤HOMA-IR < 1.93), 3Q (n=83; 1.93≤HOMA-IR < 2.73), and 4Q (n=83; HOMA-IR≥2.73). RESULTS: In the present study, the higher HOMA-IR group (3Q and 4Q) was older and had higher body mass index, fasting blood glucose, serum insulin, hemoglobin A1c, total cholesterol, and triglyceride levels than the lower HOMA-IR group (1Q). Also, poor IR (3Q and 4Q) was considerably associated with frequent CAS. Compared with Q1, the hazard ratios for Q3 and Q4 were 3.55 (95% CI: 1.79–7.03, p < 0.001) and 2.12 (95% CI: 1.07–4.21, p=0.031), respectively, after adjustment of baseline risk confounders. Also, diffuse spasm and accompanying chest pain during Ach test were more strongly associated with IR patients with CAS. CONCLUSION: HOMA-IR was significantly negatively correlated with reference diameter measured after nitroglycerin and significantly positively correlated with diffuse spasm and chest pain.
