1. Insulin resistance is associated with coronary plaque vulnerability: insight from optical coherence tomography analysis
- Author
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Toru Kataoka, Kenichiro Otsuka, Satoshi Nishimura, Kenji Matsumoto, Shinji Nakata, Takao Hasegawa, Takanori Yamazaki, Shoichi Ehara, Kenei Shimada, Tomokazu Iguchi, and Minoru Yoshiyama
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Prevalence ,Coronary Artery Disease ,medicine.disease_cause ,Coronary Angiography ,Culprit ,Risk Assessment ,Severity of Illness Index ,Cohort Studies ,Insulin resistance ,Optical coherence tomography ,Coronary plaque ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Angioplasty, Balloon, Coronary ,Aged ,Retrospective Studies ,Analysis of Variance ,Emotional vulnerability ,medicine.diagnostic_test ,business.industry ,Percutaneous coronary intervention ,General Medicine ,Middle Aged ,medicine.disease ,Vulnerable plaque ,Plaque, Atherosclerotic ,Logistic Models ,Multivariate Analysis ,Cardiology ,Disease Progression ,Linear Models ,Female ,Insulin Resistance ,Cardiology and Cardiovascular Medicine ,business ,Tomography, Optical Coherence ,Follow-Up Studies - 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 (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; P0.0001] and HOMA-IR2.50 (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.
- Published
- 2013