Impact of Insulin Resistance on Acetylcholine-Induced Coronary Artery Spasm in Non-Diabetic Patients
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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 hasnot 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 glucoselevel <110 mg/dL without type 2 DM. Patients were divided into quartile groups according the level of homeostasis model assessmentof 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≤HOMAIR<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 bloodglucose, serum insulin, hemoglobin A1c, total cholesterol, and triglyceride levels than the lower HOMA-IR group (1Q). Also, poorIR (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 significantlypositively correlated with diffuse spasm and chest pain.
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 hasnot 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 glucoselevel <110 mg/dL without type 2 DM. Patients were divided into quartile groups according the level of homeostasis model assessmentof 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≤HOMAIR<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 bloodglucose, serum insulin, hemoglobin A1c, total cholesterol, and triglyceride levels than the lower HOMA-IR group (1Q). Also, poorIR (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 significantlypositively correlated with diffuse spasm and chest pain.
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