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Larsson J, Auscher S, Shamoun A, Pararajasingam G, Heinsen LJ, Andersen TR, Lindholt JS, Diederichsen ACP, Lambrechtsen J, Egstrup K. Insulin resistance is associated with high-risk coronary artery plaque composition in asymptomatic men between 65 and 75 years and no diabetes: A DANCAVAS cross-sectional sub-study. Atherosclerosis 2023; 385:117328. [PMID: 38390826 DOI: 10.1016/j.atherosclerosis.2023.117328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND AND AIMS Insulin resistance (IR) and pre-diabetes are associated with an increased risk of cardiovascular disease (CVD). We aimed to investigate vulnerable plaque composition in relation to IR and pre-diabetes in asymptomatic non-diabetic men. METHODS All participants underwent a contrast-enhanced coronary computed tomography angiography (CCTA) to evaluate coronary artery plaque burden and plaque composition (necrotic core, dense calcium, fibrotic and fibrous-fatty volume). Homeostasis model assessment of IR (HOMA-IR) was used, and participants were stratified into tertiles. Participants underwent a standard oral glucose tolerance test (OGTT) and were categorized into 2 groups (normal glucose tolerance (NGT) or pre-diabetes). A multivariable linear regression model was used to evaluate the association between vulnerable plaque composition and IR or glycemic group. RESULTS Four-hundred-and-fifty non-diabetic men without known CAD were included. The mean age was 70 ± 3 years. Participants in the higher HOMA-IR tertile (H-IR) had higher median necrotic plaque volume compared to the lower HOMA-IR tertile (L-IR) (18.2 vs. 11.0 mm3, p = 0.02). H-IR tertile (β 0.37 [95% CI 0.10-0.65], p = 0.008), pack-years (β 0.07 [95% CI 0.007-0.14], p = 0.03) and total atheroma volume (TAV) (β 0.47 [95% CI 0.36-0.57], p < 0.001) remained associated with necrotic plaque volume in the multivariable linear regression model. CONCLUSIONS IR was associated with necrotic plaque volume in asymptomatic men without diabetes. Thus, even in asymptomatic men without diabetes, IR seems to have an incremental effect on necrotic plaque volume and vulnerable plaque composition.
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Affiliation(s)
- Johanna Larsson
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark.
| | - Søren Auscher
- Department of Cardiology, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
| | - André Shamoun
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
| | - Gokulan Pararajasingam
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
| | - Laurits Juhl Heinsen
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
| | - Thomas Rueskov Andersen
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
| | - Jes Sanddal Lindholt
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital Odense, J.B. Winsløws Vej 4, 5000, Odense, Denmark
| | | | - Jess Lambrechtsen
- Department of Cardiology, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
| | - Kenneth Egstrup
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
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Okada K, Hibi K. Intravascular Ultrasound in Vulnerable Plaque and Acute Coronary Syndrome. Interv Cardiol Clin 2023; 12:155-165. [PMID: 36922057 DOI: 10.1016/j.iccl.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Vulnerable plaque plays a pivotal role in the pathogenesis of acute coronary syndrome (ACS), being responsible for most ACS. The concept of vulnerable plaque has evolved with advancements in basic and clinical investigations along with developments and rapid expansion of coronary imaging modalities. Intravascular ultrasound (IVUS) is the first widely applied clinical technology with sufficient tissue penetration and enables us to identify vulnerable plaque and comprehensively understand the pathophysiology of ACS. In this review, we summarize current clinical evidence established by IVUS and the recent advancements in our understanding of vulnerable plaque and its role in ACS management.
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Affiliation(s)
- Kozo Okada
- Division of Cardiology, Yokohama City University Medical Center
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center.
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Chen L, Ding XH, Fan KJ, Gao MX, Yu WY, Liu HL, Yu Y. Association Between Triglyceride-Glucose Index and 2-Year Adverse Cardiovascular and Cerebrovascular Events in Patients with Type 2 Diabetes Mellitus Who Underwent Off-Pump Coronary Artery Bypass Grafting. Diabetes Metab Syndr Obes 2022; 15:439-450. [PMID: 35210794 PMCID: PMC8858766 DOI: 10.2147/dmso.s343374] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/02/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Data on the relationship between the triglyceride glucose (TyG) index and prognosis after off-pump coronary artery bypass grafting (OPCABG) are limited. This retrospective observational cohort study evaluated the association of the TyG index with prognosis in patients with diabetes mellitus who underwent OPCABG. METHODS The TyG index was calculated using the following equation: TyG index = ln (fasting triglyceride level [mg/dL] × fasting glucose level [mg/dL]/2). The primary outcomes included the occurrence of major adverse cardiovascular and cerebrovascular events (MACCEs), which were defined as all-cause death, nonfatal myocardial infarction, nonfatal stroke and symptomatic graft failure. The association between the TyG index and MACCEs was assessed by Cox proportional hazards regression analysis. RESULTS A total of 1578 patients with diabetes who underwent OPCABG (mean age, 62.9 ± 8.0 years; men, 72.7%) were enrolled in this study. Over the follow-up of 2 years, 176 patients (11.2%) had at least 1 primary endpoint event. The follow-up incidence of the primary endpoint rose with increasing TyG index tertiles. The multivariate Cox proportional hazards regression analysis adjusted for multiple confounders revealed a hazard ratio for the primary endpoint of 2.133 (95% CI 1.347-3.377; P for trend = 0.001) when the highest and lowest TyG index tertiles were compared. CONCLUSION The TyG index was significantly and positively associated with MACCEs, suggesting that the TyG index may be a valuable predictor of adverse cardiovascular and cerebrovascular outcomes after OPCABG in patients with T2DM.
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Affiliation(s)
- Liang Chen
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People’s Republic of China
| | - Xiao-Hang Ding
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People’s Republic of China
| | - Kang-Jun Fan
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People’s Republic of China
| | - Ming-Xin Gao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People’s Republic of China
| | - Wen-Yuan Yu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People’s Republic of China
| | - Hong-Li Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People’s Republic of China
| | - Yang Yu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People’s Republic of China
- Correspondence: Yang Yu, Email
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Röhling M, Kempf K, Kolb H, Martin T, Schneider M, Martin S. The Epidemiological Boehringer Ingelheim Employee Study (Part 3): Association of Elevated Fasting Insulin Levels but Not HOMA-IR With Increased Intima Media Thickness and Arteriosclerosis in Middle-Aged Persons. Front Cardiovasc Med 2021; 8:752789. [PMID: 34746266 PMCID: PMC8569239 DOI: 10.3389/fcvm.2021.752789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/27/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Recently published genetic studies have indicated a causal link between elevated insulin levels and cardiovascular disease (CVD) risk. We, therefore, hypothesized that increased fasting insulin levels are also associated with precursors of CVD such as endothelial lesions. Methods: Middle-aged (≥40 years, n = 1,639) employees were followed up for the occurrence of increased intima media thickness (IMT ≥ 1 mm) or plaques in abdominal or cervical arteries (arteriosclerosis). Multivariable logistic regression analyses determined the incidence of increased IMT or arteriosclerosis. Adjusted relative risk (ARR) for increased IMT and arteriosclerosis was calculated by using Mantel-Haenszel analysis. Results: Increased IMT was diagnosed in 238 participants (15 %) and 328 (20 %) developed arteriosclerosis after 5 years of follow-up. Logistic regression analysis identified fasting insulin, BMI and smoking as risk factors for both cardiovascular endpoints (all p < 0.05), whereas age and diastolic blood pressure were risk factors for increased IMT only, and male sex was associated with incident arteriosclerosis only (all p < 0.01). Additional adjustment for BMI change during follow-up did not modify these associations (including fasting insulin), but adjustment for fasting insulin change during follow-up removed BMI as risk factor for both cardiovascular endpoints. Fasting insulin change during follow-up but not BMI change associated with increased IMT and arteriosclerosis (both p < 0.001). ARR analysis indicated that high fasting insulin and BMI added to age and sex as risk factors. Homeostatic model assessment of insulin resistance (HOMA-IR) did not associate with either cardiovascular endpoint in any model and smoking did not increase the risk conferred by high fasting insulin levels. Conclusions: Higher fasting insulin levels and increases in fasting insulin over time are associated with atherogenic progression and supersede BMI as well as HOMA-IR as risk factors.
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Affiliation(s)
- Martin Röhling
- West-German Center of Diabetes and Health, Düsseldorf Catholic Hospital Group, Düsseldorf, Germany
| | - Kerstin Kempf
- West-German Center of Diabetes and Health, Düsseldorf Catholic Hospital Group, Düsseldorf, Germany
| | - Hubert Kolb
- Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Tobias Martin
- West-German Center of Diabetes and Health, Düsseldorf Catholic Hospital Group, Düsseldorf, Germany
| | - Michael Schneider
- Occupational Health and Medical Services, Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany
| | - Stephan Martin
- West-German Center of Diabetes and Health, Düsseldorf Catholic Hospital Group, Düsseldorf, Germany.,Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Missel AL, Saslow LR, Griauzde DH, Marvicsin D, Sen A, Richardson CR, Liu X. Association between fasting insulin and C-reactive protein among adults without diabetes using a two-part model: NHANES 2005-2010. Diabetol Metab Syndr 2021; 13:29. [PMID: 33691751 PMCID: PMC7944601 DOI: 10.1186/s13098-021-00645-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/26/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Chronic inflammation is associated with the development, progression and long-term complications of type 2 diabetes. Hyperglycemia is associated with chronic low-grade inflammation, and thus has become the focus of many screening and treatment recommendations. We hypothesize that insulin may also be associated with inflammation and may be an additional factor to consider in screening and treatment. METHODS This study used National Health and Nutrition Examination Survey data from 2005 to 2010 to analyze the association between fasting insulin and C-reactive protein (CRP). A two-part model was used due to the high number of values reported as 0.1 mg/L. Two models were analyzed, both with and without the addition of waist circumference to other covariates in the model. RESULTS The final sample included 4527 adults with a mean age of 43.31 years. In the first model, higher fasting insulin was associated with increased odds of CRP > 0.1 mg/L (OR = 1.02, p < .001) and with higher CRP (β = 0.03, p < .001). In the adjusted model, including waist circumference as a covariate, higher fasting insulin was not associated with CRP > 0.1 mg/L (OR = 1.00, p = .307) but the association between higher fasting insulin and higher continuous CRP remained significant (β = 0.01, p = .012). CONCLUSION This study found that higher fasting insulin is associated with higher CRP. These results suggest that treatment approaches that simultaneously decrease insulin levels as well as glucose levels may provide additive anti-inflammatory effects, and therefore may improve long-term outcomes for adults with type 2 diabetes.
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Affiliation(s)
- Amanda L Missel
- Department of Learning Health Sciences, Medical School, University of Michigan, 1160 NIB 300, Ann Arbor, MI, 48104, USA.
| | - Laura R Saslow
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Dina H Griauzde
- Internal Medicine, Medical School, University of Michigan, Ann Arbor, MI, USA
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Donna Marvicsin
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Ananda Sen
- Family Medicine, Medical School, University of Michigan, Ann Arbor, MI, USA
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Xuefeng Liu
- Systems, Populations and Leadership, University of Michigan, Ann Arbor, MI, USA
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Farhan S, Redfors B, Maehara A, McAndrew T, Ben-Yehuda O, De Bruyne B, Mehran R, Vogel B, Giustino G, Serruys PW, Mintz GS, Stone GW. Relationship between insulin resistance, coronary plaque, and clinical outcomes in patients with acute coronary syndromes: an analysis from the PROSPECT study. Cardiovasc Diabetol 2021; 20:10. [PMID: 33413366 PMCID: PMC7791845 DOI: 10.1186/s12933-020-01207-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/26/2020] [Indexed: 02/08/2023] Open
Abstract
Background We investigated the association of insulin resistance (IR) with coronary plaque morphology and the risk of cardiovascular events in patients enrolled in the Providing Regional Observations to Study Predictors of Events in Coronary Tree (PROSPECT) study. Methods Patients with acute coronary syndromes (ACS) were divided based on DM status. Non-DM patients were further stratified according to homeostasis-model-assessment IR (HOMA-IR) index as insulin sensitive (IS; HOMA-IR ≤ 2), likely-IR (LIR; 2 < HOMA-IR < 5), or diabetic-IR (DIR; HOMA-IR ≥ 5). Coronary plaque characteristics were investigated by intravascular ultrasound. The primary endpoint was major adverse cardiac events (MACE); a composite of cardiac death, cardiac arrest, myocardial infarction, and rehospitalization for unstable/progressive angina. Results Among non-diabetic patients, 109 patients (21.5%) were categorized as LIR, and 65 patients (12.8%) as DIR. Patients with DIR or DM had significantly higher rates of echolucent plaque compared with LIR and IS. In addition, DIR and DM were independently associated with increased risk of MACE compared with IS (adjusted hazard ratio [aHR] 2.29, 95% confidence interval [CI] 1.22–4.29, p = 0.01 and aHR 2.12, 95% CI 1.19–3.75, p = 0.009, respectively). Conclusions IR is common among patients with ACS. DM and advanced but not early stages of IR are independently associated with increased risk of adverse cardiovascular events. Trial Registration ClinicalTrials.gov Identifier: NCT00180466.
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Affiliation(s)
- Serdar Farhan
- Icahn School of Medicine At Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation/ Columbia University Medical Center, 1700 Broadway, 9th Floor, New York, NY, 10019, USA.,NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation/ Columbia University Medical Center, 1700 Broadway, 9th Floor, New York, NY, 10019, USA. .,NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA.
| | - Thomas McAndrew
- Clinical Trials Center, Cardiovascular Research Foundation/ Columbia University Medical Center, 1700 Broadway, 9th Floor, New York, NY, 10019, USA
| | - Ori Ben-Yehuda
- Clinical Trials Center, Cardiovascular Research Foundation/ Columbia University Medical Center, 1700 Broadway, 9th Floor, New York, NY, 10019, USA.,NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | | | - Roxana Mehran
- Icahn School of Medicine At Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA.,Clinical Trials Center, Cardiovascular Research Foundation/ Columbia University Medical Center, 1700 Broadway, 9th Floor, New York, NY, 10019, USA
| | - Birgit Vogel
- Icahn School of Medicine At Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA
| | - Gennaro Giustino
- Icahn School of Medicine At Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA
| | - Patrick W Serruys
- Department of Cardiology, NUIG, National University of Ireland, Galway, Ireland.,Imperial College of Science, Technology and Medicine, London, UK
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation/ Columbia University Medical Center, 1700 Broadway, 9th Floor, New York, NY, 10019, USA
| | - Gregg W Stone
- Icahn School of Medicine At Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA.,Clinical Trials Center, Cardiovascular Research Foundation/ Columbia University Medical Center, 1700 Broadway, 9th Floor, New York, NY, 10019, USA
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Shigemoto E, Iwata A, Futami M, Kato Y, Yamashita M, Imaizumi S, Kuwano T, Ike A, Sugihara M, Saku K, Miura SI. Influence of chronic kidney disease on coronary plaque components in coronary artery disease patients with both diabetes mellitus and hypertension. Heart Vessels 2019; 34:1065-1075. [DOI: 10.1007/s00380-018-01334-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/28/2018] [Indexed: 01/19/2023]
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Impact of the triglyceride level on coronary plaque components in female patients with coronary artery disease treated with statins. Heart Vessels 2018; 33:1175-1184. [PMID: 29696358 DOI: 10.1007/s00380-018-1173-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/20/2018] [Indexed: 01/13/2023]
Abstract
Several studies have reported that elevated triglyceride (TG) levels may be more strongly associated with an increased risk of coronary artery disease (CAD) in females than in males. We examined gender differences in the relationship between TG levels and coronary atherosclerosis using integrated backscatter intravascular ultrasound (IB IVUS) in CAD patients treated with statins. Three hundred seventy-eight CAD patients (105 females and 273 males) who underwent percutaneous coronary intervention using IB IVUS, and who were already receiving statin treatment, were included. Gray-scale and IB IVUS examinations were performed for the non-culprit segment of a coronary artery and fasting serum TG concentrations were measured. We found that TG levels were significantly correlated with increased lipid (r = 0.40, p < 0.001) and decreased fibrous (r = - 0.37, p < 0.001) plaque components in females, but not in males. Low-density lipoprotein cholesterol and high-density lipoprotein cholesterol levels were not related to either the gray-scale or IB IVUS parameters in both genders. After adjustment for conventional coronary risk factors by a multivariate stepwise regression analysis, higher TG levels in females were independently associated with increased lipid (β = 0.31, p< 0.001) contents in coronary plaques. In conclusion, among CAD patients treated with statins, TG levels were associated with lipid-rich coronary plaques in females, but not in males. TG levels may be more important indicators of residual risk after statin treatment in females than in males.
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Hibi K, Sonoda S, Kawasaki M, Otsuji Y, Murohara T, Ishii H, Sato K, Koshida R, Ozaki Y, Sata M, Morino Y, Miyamoto T, Amano T, Morita S, Kozuma K, Kimura K, Fujiwara H. Effects of Ezetimibe-Statin Combination Therapy on Coronary Atherosclerosis in Acute Coronary Syndrome. Circ J 2018; 82:757-766. [DOI: 10.1253/circj.cj-17-0598] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center
| | - Shinjo Sonoda
- Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health
| | - Masanori Kawasaki
- Department of Cardiology, Gifu University Graduate School of Medicine
| | - Yutaka Otsuji
- Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health
| | | | | | | | | | - Yukio Ozaki
- Department of Cardiology, Fujita Health University School of Medicine
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University School of Medicine
| | - Tadashi Miyamoto
- Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki Hospital
| | | | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine
| | - Ken Kozuma
- Division of Cardiology, Teikyo University School of Medicine
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Hisayoshi Fujiwara
- Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki Hospital
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Gruzdeva O, Uchasova E, Dyleva Y, Akbasheva O, Karetnikova V, Shilov A, Barbarash O. Effect of different doses of statins on the development of type 2 diabetes mellitus in patients with myocardial infarction. Diabetes Metab Syndr Obes 2017; 10:481-489. [PMID: 29255368 PMCID: PMC5722009 DOI: 10.2147/dmso.s149463] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cardiovascular diseases and type 2 diabetes mellitus (T2DM) may have common developmental mechanisms associated with lipid metabolism disorders. Dyslipidemia and progression of atherosclerosis in people with T2DM are accompanied by an increase in cardiovascular mortality. This study examined the dose-dependent action of atorvastatin on carbohydrate metabolism and adipokine status in patients within 12 months after myocardial infarction (MI). METHODS A total of 156 male MI patients who had received atorvastatin 20 mg/day (78 patients) or 40 mg/day (78 patients) starting from day 1 of onset were enrolled. Glucose, insulin, C-peptide, resistin, adiponectin, and ghrelin levels were measured at baseline, day 12, and months 3 and 12. Patients were monitored for new incidences of T2DM for 12 months after MI. RESULTS For acute phase MI, patients had moderate insulin resistance, hyperglycemia, and hyper-insulinemia, high leptin and resistin levels, and low ghrelin and adiponectin levels. Atorvastatin 20 mg/day was more effective at correcting the imbalances. Patients taking atorvastatin 40 mg/day (group 2) following MI showed increases in levels of glucose, insulin, and C-peptide and insulin resistance progression after 12 months of therapy, as evidenced by increased quantitative insulin sensitivity check index scores and detection of new T2DM cases. CONCLUSION Atorvastatin improved adipokine profiles and ghrelin levels, with low doses showing more significant effects. Atorvastatin dose prescribed for MI patients should take into account the degree of insulin resistance and adipokine status.
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Affiliation(s)
- Olga Gruzdeva
- Federal State Budgetary Institution, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Evgenya Uchasova
- Federal State Budgetary Institution, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
- Correspondence: Evgenya Uchasova, Federal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular Disease, 6 Sosnovy Boulevard, Kemerovo 650002, Russia, Tel +7 3842 64 0553, Fax +7 3842 64 3410, Email
| | - Yulia Dyleva
- Federal State Budgetary Institution, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Olga Akbasheva
- State Budget Educational Institution of Higher Professional Education, Siberian State Medical University, Russian Federation Ministry of Health, Tomsk, Russia
| | - Victoria Karetnikova
- Federal State Budgetary Institution, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Aleksandr Shilov
- Federal State Budgetary Institution, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Olga Barbarash
- Federal State Budgetary Institution, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
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Imbalanced insulin action in chronic over nutrition: Clinical harm, molecular mechanisms, and a way forward. Atherosclerosis 2016; 247:225-82. [PMID: 26967715 DOI: 10.1016/j.atherosclerosis.2016.02.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 12/31/2015] [Accepted: 02/02/2016] [Indexed: 02/08/2023]
Abstract
The growing worldwide prevalence of overnutrition and underexertion threatens the gains that we have made against atherosclerotic cardiovascular disease and other maladies. Chronic overnutrition causes the atherometabolic syndrome, which is a cluster of seemingly unrelated health problems characterized by increased abdominal girth and body-mass index, high fasting and postprandial concentrations of cholesterol- and triglyceride-rich apoB-lipoproteins (C-TRLs), low plasma HDL levels, impaired regulation of plasma glucose concentrations, hypertension, and a significant risk of developing overt type 2 diabetes mellitus (T2DM). In addition, individuals with this syndrome exhibit fatty liver, hypercoagulability, sympathetic overactivity, a gradually rising set-point for body adiposity, a substantially increased risk of atherosclerotic cardiovascular morbidity and mortality, and--crucially--hyperinsulinemia. Many lines of evidence indicate that each component of the atherometabolic syndrome arises, or is worsened by, pathway-selective insulin resistance and responsiveness (SEIRR). Individuals with SEIRR require compensatory hyperinsulinemia to control plasma glucose levels. The result is overdrive of those pathways that remain insulin-responsive, particularly ERK activation and hepatic de-novo lipogenesis (DNL), while carbohydrate regulation deteriorates. The effects are easily summarized: if hyperinsulinemia does something bad in a tissue or organ, that effect remains responsive in the atherometabolic syndrome and T2DM; and if hyperinsulinemia might do something good, that effect becomes resistant. It is a deadly imbalance in insulin action. From the standpoint of human health, it is the worst possible combination of effects. In this review, we discuss the origins of the atherometabolic syndrome in our historically unprecedented environment that only recently has become full of poorly satiating calories and incessant enticements to sit. Data are examined that indicate the magnitude of daily caloric imbalance that causes obesity. We also cover key aspects of healthy, balanced insulin action in liver, endothelium, brain, and elsewhere. Recent insights into the molecular basis and pathophysiologic harm from SEIRR in these organs are discussed. Importantly, a newly discovered oxide transport chain functions as the master regulator of the balance amongst different limbs of the insulin signaling cascade. This oxide transport chain--abbreviated 'NSAPP' after its five major proteins--fails to function properly during chronic overnutrition, resulting in this harmful pattern of SEIRR. We also review the origins of widespread, chronic overnutrition. Despite its apparent complexity, one factor stands out. A sophisticated junk food industry, aided by subsidies from willing governments, has devoted years of careful effort to promote overeating through the creation of a new class of food and drink that is low- or no-cost to the consumer, convenient, savory, calorically dense, yet weakly satiating. It is past time for the rest of us to overcome these foes of good health and solve this man-made epidemic.
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Blædel M, Sams A, Boonen HCM, Sheykhzade M. Increased Contractile Response to Noradrenaline Induced By Factors Associated with the Metabolic Syndrome in Cultured Small Mesenteric Arteries. Pharmacology 2015; 97:48-56. [PMID: 26587661 DOI: 10.1159/000442259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 11/04/2015] [Indexed: 11/19/2022]
Abstract
UNLABELLED This study investigated the effect of the metabolic syndrome associated risk factors hyperglycemia (glucose [Glc]), hyperinsulinemia (insulin [Ins]) and low-grade inflammation (tumor necrosis factor α [TNFα]) on the vasomotor responses of resistance arteries. Isolated small mesenteric arteries from 3-month-old Sprague-Dawley rats, were suspended for 21-23 h in tissue cultures containing either elevated Glc (30 mmol/l), Ins (100 nmol/l), TNFα (100 ng/ml) or combinations thereof. After incubation, the vascular response to noradrenaline (NA), phenylephrine, isoprenaline and NA in the presence of propranolol (10 µmol/l) was measured by wire myography. RESULTS Arteries exposed only to combinations of the risk factors showed a significant 1.6-fold increase in the contractile NA sensitivity, which suggests that complex combinations of metabolic risk factors might lead to changes in vascular tone.
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Affiliation(s)
- Martin Blædel
- Diabetes Biology, Novo Nordisk A/S, Novo Nordisk Park, Mx00E5;lx00F8;v, Denmark
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13
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Gohbara M, Hibi K, Mitsuhashi T, Maejima N, Iwahashi N, Kataoka S, Akiyama E, Tsukahara K, Kosuge M, Ebina T, Umemura S, Kimura K. Glycemic Variability on Continuous Glucose Monitoring System Correlates With Non-Culprit Vessel Coronary Plaque Vulnerability in Patients With First-Episode Acute Coronary Syndrome - Optical Coherence Tomography Study. Circ J 2015; 80:202-10. [PMID: 26511357 DOI: 10.1253/circj.cj-15-0790] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Glycemic variability (GV) is associated with coronary plaque rupture at the culprit lesion in acute myocardial infarction (AMI). The present study determined the relationship between GV and coronary plaque vulnerability in the non-culprit vessel. METHODS AND RESULTS The present prospective study involved 46 patients with first-episode acute coronary syndrome (ACS) who underwent optical coherence tomography in the non-culprit vessel. The relationship between GV, assessed with continuous glucose monitoring system, and the presence of thin-cap fibroatheroma (TCFA) at the non-culprit plaque with mild-to-moderate stenosis in the non-culprit vessel, was assessed. GV was quantified using mean amplitude of glycemic excursion (MAGE). Patients were divided into tertiles according to MAGE. TCFA was observed in 13 (28%) of the 46 patients. Fibrous cap thickness was thinner (MAGE tertiles: high, 80±40 µm; intermediate, 152±122 µm; low, 155±102 µm; P=0.01), and TCFA was more common (MAGE tertiles: high, 50%; intermediate, 27%; low, 7%; P=0.03) in patients with high MAGE. On multivariate logistic analysis high MAGE was the only significant determinant of TCFA, independent of coronary risk factors (OR, 5.000; P=0.021), homeostasis model assessment of insulin resistance, and hemoglobin A1c(OR, 5.674; P=0.018). CONCLUSIONS High MAGE measured early after the onset of first-episode ACS correlated with thinner fibrous cap thickness and higher prevalence of TCFA at the non-culprit plaque in the non-culprit vessel.
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Affiliation(s)
- Masaomi Gohbara
- Division of Cardiology, Yokohama City University Medical Center
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14
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Okada K, Hibi K, Gohbara M, Kataoka S, Takano K, Akiyama E, Matsuzawa Y, Saka K, Maejima N, Endo M, Iwahashi N, Tsukahara K, Kosuge M, Ebina T, Fitzgerald PJ, Honda Y, Umemura S, Kimura K. Association between blood glucose variability and coronary plaque instability in patients with acute coronary syndromes. Cardiovasc Diabetol 2015; 14:111. [PMID: 26289581 PMCID: PMC4546046 DOI: 10.1186/s12933-015-0275-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 08/08/2015] [Indexed: 11/10/2022] Open
Abstract
Background Blood glucose variability is receiving considerable attention as a new risk factor for coronary artery disease. This study aimed to investigate the association between blood glucose variability and coronary plaque tissue characteristics. Methods In 57 patients with acute coronary syndrome, integrated backscatter intravascular ultrasound (IB-IVUS) and gray-scale IVUS were performed before balloon dilatation or stent implantation in the culprit vessels. Standard IVUS indices were evaluated for volume index (volume/length), and plaque components were measured by IB-IVUS for percent tissue volume. In addition to conventional glucose indicators, blood glucose variability in a stable state was determined by calculating the mean amplitude of glycemic excursions (MAGE) using a continuous glucose monitoring system. Results Higher MAGE values were significantly correlated with larger percent plaque volumes (r = 0.32, p = 0.015), and increased lipid (r = 0.44, p = 0.0006) and decreased fibrous (r = −0.45, p = 0.0005) plaque components. In contrast, HbA1c or fasting plasma glucose values were not significantly correlated with plaque volumes and percent plaque components. Homeostasis model assessment of insulin resistance values were positively correlated with vessel (r = 0.35, p = 0.007) and plaque (r = 0.27, p = 0.046) volumes, but not with percent plaque components. In multiple regression analysis, higher MAGE values were independently associated with increased lipid (β = 0.80, p = 0.0035) and decreased fibrous (β = -0.79, p = 0.0034) contents in coronary plaques. Conclusions Among all glucose indicators studied, only higher blood glucose variability was an independent determinant of increased lipid and decreased fibrous contents with larger plaque burden, suggesting blood glucose variability as one of the important factors related to coronary plaque vulnerability.
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Affiliation(s)
- Kozo Okada
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Masaomi Gohbara
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Shunsuke Kataoka
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Keiko Takano
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Eiichi Akiyama
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Yasushi Matsuzawa
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Kenichiro Saka
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Nobuhiko Maejima
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Mitsuaki Endo
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Noriaki Iwahashi
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Kengo Tsukahara
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Toshiaki Ebina
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Peter J Fitzgerald
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, USA.
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, USA.
| | - Satoshi Umemura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
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Park YM, Han SH, Seo JG, Lee S, Oh PC, Koh KK, Lee K, Suh SY, Kang WC, Ahn T, Choi IS, Shin EK. The role of insulin resistance and metabolic risk factors on culprit coronary plaque. Int J Cardiol 2015; 190:56-62. [DOI: 10.1016/j.ijcard.2015.04.163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/15/2015] [Accepted: 04/18/2015] [Indexed: 11/24/2022]
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Kim SH, Moon JY, Lim YM, Kim KH, Yang WI, Sung JH, Yoo SM, Kim IJ, Lim SW, Cha DH, Cho SY. Association of insulin resistance and coronary artery remodeling: an intravascular ultrasound study. Cardiovasc Diabetol 2015; 14:74. [PMID: 26047939 PMCID: PMC4472609 DOI: 10.1186/s12933-015-0238-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/02/2015] [Indexed: 02/06/2023] Open
Abstract
Background There are few studies that investigated the correlation between insulin resistance (IR) and the coronary artery remodeling. The aim of the study is to investigate the association of IR measured by homeostasis model assessment of insulin resistance (HOMA-IR) and coronary artery remodeling evaluated by intravascular ultrasound (IVUS). Methods A total of 298 consecutive patients who received percutaneous coronary interventions under IVUS guidance were retrospectively enrolled. The value of HOMA-IR more than 2.5 was considered as IR positive. Metabolic syndrome was classified according to NCEP ATP III guidelines. The remodeling index was defined as the ratio of the external elastic membrane (EEM) area at the lesion site to the EEM area at the proximal reference site. Results A total of 369 lesions were analyzed (161 lesions in HOMA-IR positive and 208 lesions in HOMA-IR negative). Remodeling index was significantly higher in the HOMA-IR positive group compared with the negative group (HOMA-IR positive vs. negative: 1.074 ± 0.109 vs. 1.042 ± 0.131, p = 0.013). There was a significant positive correlation between remodeling index and HOMA-IR (p = 0.010). Analysis of HOMA-IR according to remodeling groups showed increasing tendency of HOMA-IR, and it was statistically significant (p = 0.045). Multivariate analysis revealed that only HOMA-IR was an independent predictor of remodeling index (r = 0.166, p = 0.018). Conclusion Increased IR estimated by HOMA-IR was significantly associated with a higher remodeling index and positive coronary artery remodeling.
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Affiliation(s)
- Sang-Hoon Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Jae-Youn Moon
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
| | - Yeong Min Lim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Kyung Ho Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Woo-In Yang
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Jung-Hoon Sung
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Seung Min Yoo
- Department of Diagnostic Radiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - In Jai Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Sang-Wook Lim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Dong-Hun Cha
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Seung-Yun Cho
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
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Maejima N, Hibi K, Saka K, Nakayama N, Matsuzawa Y, Endo M, Iwahashi N, Okuda J, Tsukahara K, Tahara Y, Kosuge M, Ebina T, Umemura S, Kimura K. Morphological features of non-culprit plaques on optical coherence tomography and integrated backscatter intravascular ultrasound in patients with acute coronary syndromes. Eur Heart J Cardiovasc Imaging 2014; 16:190-7. [PMID: 25240169 DOI: 10.1093/ehjci/jeu173] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS We sought to compare the morphological features of non-culprit plaques with >50% diameter stenosis in patients with acute coronary syndromes (ACS) with those of culprit plaques in patients with ACS and stable angina pectoris (SAP) using optical coherence tomography (OCT) and integrated backscatter intravascular ultrasound (IB-IVUS). METHODS AND RESULTS A total of 150 culprit and non-culprit coronary plaques (non-culprit vessels) in 150 patients with coronary artery disease were interrogated by OCT before percutaneous coronary intervention (PCI). Patients were categorized as follows: 73 culprit plaques in patients with ACS (ACS-C), 32 non-culprit plaques in patients with ACS (ACS-NC), and 45 culprit plaques in patients with SAP. The fibrous cap thickness was thinner in the ACS-C and ACS-NC groups than in the SAP group and was thinnest in the ACS-C group (ACS-C vs. ACS-NC vs. SAP, 60 vs. 82 vs. 114 μm, P < 0.001). IB-IVUS sub-analysis of 95 patients demonstrated that % lipid volume was greater and % fibrous volume was lower in the ACS-NC group than those in the SAP group (ACS-C vs. ACS-NC vs. SAP, 56.3 ± 11.0 vs. 59.9 ± 11.2 vs. 50.1 ± 13.9%, P < 0.05 and 39.5 ± 9.0 vs. 35.0 ± 9.0 vs. 43.9 ± 11.3%, P < 0.01, respectively). CONCLUSION Plaques of non-culprit vessels in patients with ACS had a thinner fibrous cap and a higher percentage of lipid content than culprit plaques in patients with SAP. However, the fibrous cap thickness was thinner in the culprit lesions in patients with ACS than in the non-culprit lesions in patients with ACS, while plaque compositions were not significantly different between the groups.
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Affiliation(s)
- Nobuhiko Maejima
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Kenichiro Saka
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Naoki Nakayama
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Yasushi Matsuzawa
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Mitsuaki Endo
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Noriaki Iwahashi
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Jun Okuda
- Yokosuka City Hospital, Yokosuka, Japan
| | - Kengo Tsukahara
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Yoshio Tahara
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Toshiaki Ebina
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Satoshi Umemura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
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Martín-Timón I, Sevillano-Collantes C, Segura-Galindo A, Cañizo-Gómez FJD. Type 2 diabetes and cardiovascular disease: Have all risk factors the same strength? World J Diabetes 2014; 5:444-470. [PMID: 25126392 PMCID: PMC4127581 DOI: 10.4239/wjd.v5.i4.444] [Citation(s) in RCA: 485] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 03/11/2014] [Accepted: 06/20/2014] [Indexed: 02/05/2023] Open
Abstract
Diabetes mellitus is a chronic condition that occurs when the body cannot produce enough or effectively use of insulin. Compared with individuals without diabetes, patients with type 2 diabetes mellitus have a considerably higher risk of cardiovascular morbidity and mortality, and are disproportionately affected by cardiovascular disease. Most of this excess risk is it associated with an augmented prevalence of well-known risk factors such as hypertension, dyslipidaemia and obesity in these patients. However the improved cardiovascular disease in type 2 diabetes mellitus patients can not be attributed solely to the higher prevalence of traditional risk factors. Therefore other non-traditional risk factors may be important in people with type 2 diabetes mellitus. Cardiovascular disease is increased in type 2 diabetes mellitus subjects due to a complex combination of various traditional and non-traditional risk factors that have an important role to play in the beginning and the evolution of atherosclerosis over its long natural history from endothelial function to clinical events. Many of these risk factors could be common history for both diabetes mellitus and cardiovascular disease, reinforcing the postulate that both disorders come independently from “common soil”. The objective of this review is to highlight the weight of traditional and non-traditional risk factors for cardiovascular disease in the setting of type 2 diabetes mellitus and discuss their position in the pathogenesis of the excess cardiovascular disease mortality and morbidity in these patients.
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Obesity, insulin resistance, and metabolic syndrome: a study in WNIN/Ob rats from a pancreatic perspective. BIOMED RESEARCH INTERNATIONAL 2013; 2013:617569. [PMID: 24455710 PMCID: PMC3876834 DOI: 10.1155/2013/617569] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 11/09/2013] [Accepted: 11/11/2013] [Indexed: 12/16/2022]
Abstract
Alterations in pancreatic milieu to adapt to physiological shifts occurring in conditions of obesity and metabolic syndrome (MS) have been documented, though mechanisms leading to such a state have remained elusive so far. The data presented here tries to look at the gravity of metabolic insult during the early and prolonged phases of obesity/insulin resistance (IR) depicted in WNIN/Ob strain of rats—an obese euglycemic mutant rat model developed indigenously at our institute which is highly vulnerable for a variety of degenerative diseases. The present results in situ show the participation of several confounding factors in the pancreatic milieu that collectively coprecipitates for a state of profound inflammation in the pancreas (among Mutant compared to Lean/Control) which gets worsened with age. These include hypertrophy, macrophage infiltration (CD11b/TNFα/IL6), apoptosis, β-cell vacuolation, hyperinsulinemia (HI), and stress markers (RL-77/HSP104/TBARS) all of which correlated well with indices for obesity (2-3 fold), IR (1.5-3 fold), and HI (2-3 fold). Further, supportive data was also obtained from in vitro studies using islet cell cultures amongst phenotypes. Taken together, these results advocate that inflammation was the major precipitating factor to cause islet cell dysfunctions (in situ and in vitro) in these Mutant rats compared to their Lean littermates and parental Control.
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20
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A Review of JACC Journal Articles on the Topic of Interventional Cardiology: 2011–2012. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Iguchi T, Hasegawa T, Otsuka K, Matsumoto K, Yamazaki T, Nishimura S, Nakata S, Ehara S, Kataoka T, Shimada K, Yoshiyama M. Insulin resistance is associated with coronary plaque vulnerability: insight from optical coherence tomography analysis. Eur Heart J Cardiovasc Imaging 2013; 15:284-91. [PMID: 24022065 DOI: 10.1093/ehjci/jet158] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
AIMS 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). METHODS AND RESULTS 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 (<1.4) tertiles were 50, 29, and 26% (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. CONCLUSION This study suggests that insulin resistance might be associated with coronary plaque vulnerability.
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Affiliation(s)
- Tomokazu Iguchi
- Department of Cardiovascular Medicine, Osaka City University, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
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Karrowni W, Li Y, Jones PG, Cresci S, Abdallah MS, Lanfear DE, Maddox TM, McGuire DK, Spertus JA, Horwitz PA. Insulin resistance is associated with significant clinical atherosclerosis in nondiabetic patients with acute myocardial infarction. Arterioscler Thromb Vasc Biol 2013; 33:2245-51. [PMID: 23868937 DOI: 10.1161/atvbaha.113.301585] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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. APPROACH AND 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.
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Affiliation(s)
- Wassef Karrowni
- Division of Cardiovascular Diseases, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA.
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Madonna R, De Caterina R. Aterogénesis y diabetes: resistencia a la insulina e hiperinsulinemia. Rev Esp Cardiol 2012; 65:309-13. [DOI: 10.1016/j.recesp.2011.11.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 11/11/2011] [Indexed: 01/04/2023]
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Ohota M, Kawasaki M, Ismail TF, Hattori K, Serruys PW, Ozaki Y. A Histological and Clinical Comparison of New and Conventional Integrated Backscatter Intravascular Ultrasound (IB-IVUS). Circ J 2012; 76:1678-86. [DOI: 10.1253/circj.cj-11-1157] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Masaya Ohota
- Department of Cardiology, Fujita Health University Hospital
- Department of Cardiology, Fujita Health University Hospital
| | - Masanori Kawasaki
- Department of Cardiology, Graduate School of Medicine, Gifu University
- Department of Cardiology, Graduate School of Medicine, Gifu University
| | - Tevfik F. Ismail
- Royal Brompton Hospital & Imperial College
- Royal Brompton Hospital & Imperial College
| | - Kousuke Hattori
- Department of Cardiology, Fujita Health University Hospital
- Department of Cardiology, Fujita Health University Hospital
| | | | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital
- Department of Cardiology, Fujita Health University Hospital
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25
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Araki T, Nakamura M, Utsunomiya M, Sugi K. Visualization of coronary plaque in type 2 diabetes mellitus patients using a new 40 MHz intravascular ultrasound imaging system. J Cardiol 2011; 59:42-9. [PMID: 21890326 DOI: 10.1016/j.jjcc.2011.07.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 07/11/2011] [Accepted: 07/29/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Previous epidemiological studies demonstrated plaque vulnerability to be high in diabetic patients. iMap-intravascular ultrasound (IVUS) is a recently developed radiofrequency 40 MHz IVUS imaging system for tissue characterization. This study aimed to characterize coronary plaque in target lesions of diabetic patients using iMap-IVUS. METHODS We studied 175 treated vessels in 146 patients with stable angina pectoris and analyzed plaque components of culprit lesions by iMAP-IVUS. Patients were divided into 2 groups: non-diabetic (non-DM: 112 vessels, 93 patients) and diabetic (DM: 63 vessels, 53 patients). RESULTS In gray-scale IVUS 2D analysis, there were no differences in IVUS parameters. In 3D analysis, the DM group tended to have a larger plaque volume (p=0.07) and plaque burden (p=0.10). At minimum lumen sites, the absolute lipidic and necrotic areas (0.84 ± 0.44 mm(2) vs. 0.58 ± 0.41 mm(2), p<0.001, and 2.42 ± 1.65 mm(2) vs. 1.46 ± 1.76 mm(2), p<0.001, respectively) and percent lipidic and necrotic areas were significantly greater in the DM than in the non-DM group (8.39 ± 3.38% vs. 5.25 ± 2.30%, p<0.0001, and 23.65 ± 11.54% vs. 12.99 ± 10.71%, p<0.0001, respectively). In addition, the absolute lipidic and necrotic volumes (11.75 ± 10.59 mm(3) vs. 8.18 ± 6.24 mm(3), p<0.01, and 29.99 ± 28.90 mm(3) vs. 19.44 ± 19.35 mm(3), p<0.01, respectively) and percent lipidic and necrotic volumes were significantly greater in the DM than in the non-DM group (6.27 ± 1.92% vs. 5.13 ± 1.82%, p<0.0001, and 16.54 ± 7.56% vs. 12.08 ± 6.05%, p<0.0001, respectively). CONCLUSION Characterization of coronary plaque by iMAP-IVUS in diabetic patients showed increased lipidic amount and necrotic plaque volume relative to subjects without DM.
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Affiliation(s)
- Tadashi Araki
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, 2-17-6, Ohashi, Meguro-ku, Tokyo 153-8515, Japan
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