Insulin resistance in nondiabetic patients with acute myocardial infarction

Nishio, Kazuaki; Shigemitsu, Meiei; Kusuyama, Taro; Fukui, Tomoyasu; Kawamura, Kitaro; Itoh, Seiji; Konno, Noburu; Katagiri, Takashi

doi:10.1016/j.carrev.2005.12.004

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Volume 7, Issue 2 , Pages 54-60, April 2006

Insulin resistance in nondiabetic patients with acute myocardial infarction

Kazuaki Nishio
- The Third Department of Internal Medicine, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
- Corresponding author. Heights Matsugaoka 202, 4105 Katsuyama, Fijikawaguchiko-machi, Minamitsuru-gun, Yamanashi 401-0310, Japan. Tel.: +81 555 72 2764; fax: +81 555 72 2764.
Meiei Shigemitsu
- The Third Department of Internal Medicine, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
Taro Kusuyama
- The Third Department of Internal Medicine, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
Tomoyasu Fukui
- The First Department of Internal Medicine, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
Kitaro Kawamura
- The Third Department of Internal Medicine, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
Seiji Itoh
- The Third Department of Internal Medicine, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
Noburu Konno
- The Third Department of Internal Medicine, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
Takashi Katagiri
- The Third Department of Internal Medicine, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan

Received 8 November 2005; received in revised form 5 December 2005; accepted 5 December 2005.

Abstract

Background

Recent studies have shown that insulin resistance (IR) is an independent predictor of early restenosis after coronary stenting. The aim of this study was to examine the effects of IR and its linkage to late loss with bare metal stenting in nondiabetic patients with acute myocardial infarction (AMI).

Materials and Methods

We enrolled 61 nondiabetic patients with AMI who have undergone coronary stenting. Quantitative analyses of coronary angiographic data before and after the procedure and at 4 months were performed. Fasting plasma glucose (FPG) and insulin were measured every week until the subjects' hospital discharge. Stress hormones, endothelial nitric oxide synthase, tumor necrosis factor α, interleukin-6, leptin, and adiponectin were measured on admission and at 4 months after coronary stenting.

Results

Simple linear regression analyses showed a relationship between FPG and insulin [IR group: r=0.297, P=.0428; no insulin resistance (NIR) group: r=0.539, P=.0466] and that late loss was associated with the homeostasis model assessment of IR (HOMA-IR) at 4 months (r=0.435, P=.03). At multiple regression analyses, HOMA-IR on admission in the IR group significantly correlated with thyroid-stimulating hormone, glucagon, and cortisol. The HOMA-IR at 4 months correlated with leptin.

Conclusions

Nondiabetic patients with AMI can be classified into two groups: the IR group and the NIR group. The IR consisted of the transient IR, which correlated with stress hormones, and the continuous IR, which correlated with leptin and contributed to restenosis after coronary stenting.

Keywords: Acute myocardial infarction, eNOS, Insulin resistance, Leptin, Stress hormones