doiSerbia

The degree of coronary atherosclerosis as a marker of insulin resistance in non-diabetics

Parapid Biljana (Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Šaponjski Jovica (Kliničko-bolnički centar 'Bežanijska kosa', Beograd)
Ostojić Mladen (Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Vukčević Vladan (Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Stojković Siniša (Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Obrenović-Kirćanski Biljana (Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Lalić Katarina (Institut za endokrinologiju, dijabetes i bolesti metabolizma, Klinički centar Srbije, Beograd)
Pavlović Siniša (Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Dikić Miodrag (Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Bubanja Dragana (Centar za endokrinologiju i bolesti metabolizma, Interna klinika, Klinički centar, Kragujevac)
Kostić Nada (Odeljenje endokrinologije, Klinika za internu medicinu, Kliničko-bolnički centar 'Dr Dragiša Mišović', Beograd)
Dragićević Svetomir (Institut za nefrologiju i urologiju, Klinički centar Srbije, Beograd)
Milić Nataša (Institut za medicinsku statistiku i informatiku, Medicinski fakultet, Beograd)
Lalić Nebojša (Institut za endokrinologiju, dijabetes i bolesti metabolizma, Klinički centar Srbije, Beograd)
Ostojić Miodrag (Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)

Introduction. The metabolic syndrome and its influence on coronary artery disease development and progression remains in focus of international research debates, while insulin resistance, which represents its core, is the key component of hypertension, dyslipidaemias, glucose intolerance and obesity. Objective. The aim of this study was to establish relationship between basal glucose and insulin levels, insulin sensitivity and lipid panel and the degree of coronary atherosclerosis in nondiabetic patients. Methods. The coronary angiograms were evaluated for the presence of significant stenosis, insulin sensitivity was assessed using the intravenous glucose tolerance test with a minimal model according to Bergman, while baseline glucose (G0), insulin (I0) and lipid panel measurements (TC, HDL, LDL, TG) were taken after a 12-hour fasting. Results. The protocol encompassed 40 patients (19 men and 21 women) treated at the Institute for Cardiovascular Diseases of the Clinical Centre of Serbia, Belgrade. All were non-diabetics who were divided into 3 groups based on their angios: Group A (6 patients, 15%, with no significant stenosis), Group B (18 patients, 45%, with a single-vessel disease) and Group C (16 patients, 40%, with multi-vessel disease). Presence of lower insulin sensitivity, higher I0 and TC in the group of patients with a more severe degree of coronary atherosclerosis (insulin sensitivity: F=4.279, p=0.023, A vs. C p=0.012, B vs. C p=0.038; I0: F=3.461 p=0.042, A vs. B p=0.045, A vs. C p=0.013; TC: F=2.572, p=0.09), while no significant difference was found for G0, LDL, HDL and TG. Conclusion. Baseline insulinaemia, more precisely, fasting hyperinsulinaemia could be a good predictor of significant coronary atherosclerosis in non-diabetic patients, which enables a more elegant cardiometabolic risk assessment in the setting of everyday clinical practice.

Keywords: insulin sensitivity, minimal model, coronary angiography, metabolic syndrome, coronary artery disease