Homeostasis Model Assessment of Insulin Resistance and Survival in Patients with Diabetes and Acute Coronary Syndrome

Homeostasis Model Assessment of Insulin Resistance and Survival in Patients with Diabetes and... Abstract Purpose Insulin resistance has been linked to development and progression of atherosclerosis and is present in most patients with type 2 diabetes (T2D). Whether the degree of insulin resistance predicts adverse outcomes in patients with T2D and acute coronary syndrome (ACS) is uncertain. Methods The AleCardio trial compared the peroxisome proliferator-activated receptor-α/γ agonist aleglitazar with placebo in patients with T2D and recent ACS. In participants not treated with insulin, we determined whether baseline homeostasis model assessment of insulin resistance (HOMA-IR, n=4303) or the change in HOMA-IR on assigned study treatment (n=3568) was related to the risk of death or major adverse cardiovascular events (MACE: cardiovascular death, myocardial infarction, and stroke) in unadjusted and adjusted models. Because an inverse association of HOMA-IR with N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been described, we specifically examined effects of adjustment for the latter. Results In unadjusted analysis, two-fold higher baseline HOMA-IR was associated with lower risk of death (HR 0.79, 95% CI 0.68-0.91, p=0.002). Adjustment for 24 standard demographic and clinical variables had minimal effect on this association. However, after further adjustment for NT-proBNP, the association of HOMA-IR with death was no longer present (adjusted HR 0.99, 95% CI 0.83-1.19, p=0.94). Baseline HOMA-IR was not associated with MACE, nor was the change in HOMA-IR on study treatment associated with death or MACE. Conclusions After accounting for levels of NT-proBNP, insulin resistance assessed by HOMA-IR is not related to the risk of death or MACE in patients with T2D and ACS. Copyright © 2018 Endocrine Society http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Clinical Endocrinology and Metabolism Oxford University Press

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Publisher
Endocrine Society
Copyright
Copyright © 2018 Endocrine Society
ISSN
0021-972X
eISSN
1945-7197
D.O.I.
10.1210/jc.2017-02772
Publisher site
See Article on Publisher Site

Abstract

Abstract Purpose Insulin resistance has been linked to development and progression of atherosclerosis and is present in most patients with type 2 diabetes (T2D). Whether the degree of insulin resistance predicts adverse outcomes in patients with T2D and acute coronary syndrome (ACS) is uncertain. Methods The AleCardio trial compared the peroxisome proliferator-activated receptor-α/γ agonist aleglitazar with placebo in patients with T2D and recent ACS. In participants not treated with insulin, we determined whether baseline homeostasis model assessment of insulin resistance (HOMA-IR, n=4303) or the change in HOMA-IR on assigned study treatment (n=3568) was related to the risk of death or major adverse cardiovascular events (MACE: cardiovascular death, myocardial infarction, and stroke) in unadjusted and adjusted models. Because an inverse association of HOMA-IR with N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been described, we specifically examined effects of adjustment for the latter. Results In unadjusted analysis, two-fold higher baseline HOMA-IR was associated with lower risk of death (HR 0.79, 95% CI 0.68-0.91, p=0.002). Adjustment for 24 standard demographic and clinical variables had minimal effect on this association. However, after further adjustment for NT-proBNP, the association of HOMA-IR with death was no longer present (adjusted HR 0.99, 95% CI 0.83-1.19, p=0.94). Baseline HOMA-IR was not associated with MACE, nor was the change in HOMA-IR on study treatment associated with death or MACE. Conclusions After accounting for levels of NT-proBNP, insulin resistance assessed by HOMA-IR is not related to the risk of death or MACE in patients with T2D and ACS. Copyright © 2018 Endocrine Society

Journal

Journal of Clinical Endocrinology and MetabolismOxford University Press

Published: Apr 6, 2018

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