SULM – Schweizerische Union für Labormedizin | Union Suisse de Médecine de Laboratoire | Swiss Union of Laboratory Medicine

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T. Marte1 , C.H. Saely1 , S. Aczel1 , G. Hoefle2 , P. Langer1 , H. Drexel1

1Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria, 2Department of Internal Medicine, Academic Teaching Hospital Feldkirch, Feldkirch, Austria

Background: Patients with both diabetes and established coronary artery disease (CAD) are at a high risk of cardiovascular events. Insulin resistance (IR) is a central feature of diabetes mellitus type 2 (DM2). Therefore, the impact of IR on the incidence of vascular events in diabetic patients with established CAD is of particular interest.
Methods: We estimated insulin resistance by the HOMA index in 495 patients with angiographically proven CAD and recorded the incidence of vascular events over a mean follow-up time of 2.3 ± 0.4 years.
Results: The HOMA index was higher in coronary patients with DM2 (n = 127) than in nondiabetic coronary patients (6.5 ± 5.9 vs. 3.0 ± 4.2; p < 0.001). Thirty-one (23.8%) patients with DM 2 and 60 nondiabetic patients (14.5%) experienced at least 1 vascular event. In Cox regression analysis adjusting for age, gender, and baseline extent of coronary artery disease (number of angiographic stenoses 󖾦%) diabetes was an independent predictor for the incidence of vascular events (OR = 1.725 [1.116 – 2.667]; p = 0.014). Equally, the HOMA index proved independently predictive for the incidence of vascular events in the total study cohort: the standardized OR adjusted for age, gender, and baseline extent of CAD was 1.178 [1.026-1.351]; p = 0.010. In subgroup analyses with respect to diabetes status, the HOMA index was significantly predictive for vascular events in patients with diabetes (OR = 1.354 [1.083 – 1.694; p = 0.008]), but not among nondiabetic patients (OR = 1.022 [0.729 – 1.432]; p = 0.901).
Conclusions: In the setting of secondary prevention, IR is a strong and independent predictor of vascular events among patients with DM2. Thus, the degree of IR significantly contributes to the adverse effects of diabetes on the prognosis in coronary patients.

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