Evaluation of Serum Fasting Insulin Concentration in Non-diabetic Patients with and without Coronary Artery Disease

Document Type : Original Article (s)

Authors

1 Assistant Professor, Department of Cardiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran

2 Professor, Department of Cardiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran

3 Student of Medicine, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran

4 Department of Parasitology and Mycology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran

Abstract

Background: Previous studies have been demonstrated the effect of fasting insulin concentration in coronary artery disease of patients with diabetes mellitus. Because of discrepancy in recent studies about this association in non-diabetic patients, we evaluated this effect.Methods: In this cross-sectional study, coronary artery angiography was done for 110 non-diabetic patients, and they were divided into two groups of normal coronary artery as control group and those with coronary artery stenosis as case group. Serum levels of glucose, cholesterol, triglycerides, low-density lipoprotein (LDL), and insulin were evaluated after 12 hours fasting period. One-way ANOVA and t tests were used for statistical analysis.Findings: Fasting blood sugar (FBS) in non-diabetic patients with and without coronary artery disease was 94.4 ± 14.9 and 90.52 ± 13.82 mg/dl, respectively (P = 0.150). The mean insulin concentration was 12.77 ± 3.29 mIU/l in case and 7.01 ± 3.25 mIU/l in control group (P = 0.001). We did not find any difference between men and women according to their fasting insulin concentration (P = 0.210).Conclusion: Higher serum level of fasting insulin seems to have correlation with coronary artery disease in non-diabetic patients; but further studies with larger population study are needed for better evaluation.

Keywords


  1. D'Agostino RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 2008; 117(6): 743-53.
  2. Ginsberg HN. Insulin resistance and cardiovascular disease. J Clin Invest 2000; 106(4): 453-8.
  3. Kido Y, Nakae J, Accili D. Clinical review 125: The insulin receptor and its cellular targets. J Clin Endocrinol Metab 2001; 86(3): 972-9.
  4. Johnstone MT, Creager SJ, Scales KM, Cusco JA, Lee BK, Creager MA. Impaired endothelium-dependent vasodilation in patients with insulin-dependent diabetes mellitus. Circulation 1993; 88(6): 2510-6.
  5. McVeigh GE, Brennan GM, Johnston GD, McDermott BJ, McGrath LT, Henry WR, et al. Impaired endothelium-dependent and independent vasodilation in patients with type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia 1992; 35(8): 771-6.
  6. Banskota NK, Taub R, Zellner K, King GL. Insulin, insulin-like growth factor I and platelet-derived growth factor interact additively in the induction of the protooncogene c-myc and cellular proliferation in cultured bovine aortic smooth muscle cells. Mol Endocrinol 1989; 3(8): 1183-90.
  7. Juhan-Vague I, Alessi MC, Vague P. Thrombogenic and fibrinolytic factors and cardiovascular risk in non-insulin-dependent diabetes mellitus. Ann Med 1996; 28(4): 371-80.
  8. Schneider DJ, Nordt TK, Sobel BE. Attenuated fibrinolysis and accelerated atherogenesis in type II diabetic patients. Diabetes 1993; 42(1): 1-7.
  9. Calles-Escandon J, Mirza SA, Sobel BE, Schneider DJ. Induction of hyperinsulinemia combined with hyperglycemia and hypertriglyceridemia increases plasminogen activator inhibitor 1 in blood in normal human subjects. Diabetes 1998; 47(2): 290-3.
  10. Preis SR, Hwang SJ, Coady S, Pencina MJ, D'Agostino RB, Savage PJ, et al. Trends in all-cause and cardiovascular disease mortality among women and men with and without diabetes mellitus in the Framingham Heart Study, 1950 to 2005. Circulation 2009; 119(13): 1728-35.
  11. Orasanu G, Plutzky J. The pathologic continuum of diabetic vascular disease. J Am Coll Cardiol 2009; 53(5 Suppl): S35-S42.
  12. Moller DE, Flier JS. Insulin resistance--mechanisms, syndromes, and implications. N Engl J Med 1991; 325(13): 938-48.
  13. Vafaeimanesh J, Parham M, Norouzi S, Hamednasimi P, Bagherzadeh M. Insulin resistance and coronary artery disease in non-diabetic patients: Is there any correlation? Caspian J Intern Med 2018; 9(2): 121-6.
  14. Mossmann M, Wainstein MV, Goncalves SC, Wainstein RV, Gravina GL, Sangalli M, et al. HOMA-IR is associated with significant angiographic coronary artery disease in non-diabetic, non-obese individuals: a cross-sectional study. Diabetol Metab Syndr 2015; 7: 100.
  15. Folsom AR, Rasmussen ML, Chambless LE, Howard G, Cooper LS, Schmidt MI, et al. Prospective associations of fasting insulin, body fat distribution, and diabetes with risk of ischemic stroke. The Atherosclerosis Risk in Communities (ARIC) Study Investigators. Diabetes Care 1999; 22(7): 1077-83.
  16. Ruige JB, Assendelft WJ, Dekker JM, Kostense PJ, Heine RJ, Bouter LM. Insulin and risk of cardiovascular disease: a meta-analysis. Circulation 1998; 97(10): 996-1001.
  17. Lamarche B, Tchernof A, Mauriege P, Cantin B, Dagenais GR, Lupien PJ, et al. Fasting insulin and apolipoprotein B levels and low-density lipoprotein particle size as risk factors for ischemic heart disease. JAMA 1998; 279(24): 1955-61.
  18. Okura T, Nakamura R, Fujioka Y, Kawamoto-Kitao S, Ito Y, Matsumoto K, et al. Body mass index >/=23 is a risk factor for insulin resistance and diabetes in Japanese people: A brief report. PLoS One 2018; 13(7): e0201052.
  19. Won KB, Kim YS, Lee BK, Heo R, Han D, Lee JH, et al. The relationship of insulin resistance estimated by triglyceride glucose index and coronary plaque characteristics. Medicine (Baltimore ) 2018; 97(21): e10726.
  20. Freitas RS, Fonseca MJMD, Schmidt MI, Molina MDCB, Almeida MDCC. Hypertriglyceridemic waist phenotype: associated factors and comparison with other cardiovascular and metabolic risk indicators in the ELSA-Brasil study. Cad Saude Publica 2018; 34(4): e00067617. [In Portuguese].
  21. Ware AL, Young PC, Weng C, Presson AP, Minich LL, Menon SC. Prevalence of Coronary Artery Disease Risk Factors and Metabolic Syndrome in Children with Heart Disease. Pediatr Cardiol 2018; 39(2): 261-7.
  22. Tack CJ, Smits P, Willemsen JJ, Lenders JW, Thien T, Lutterman JA. Effects of insulin on vascular tone and sympathetic nervous system in NIDDM. Diabetes 1996; 45(1): 15-22.
  23. Pandey AK, Pandey D, Pandit A. Obesity and lipid profile study in type 2 diabetes patients with auditory and reaction time deficits and non-diabetic control subjects. Advances in Diabetes and Metabolism 2017; 5(1): 1-5.
  24. Lakka HM, Lakka TA, Tuomilehto J, Sivenius J, Salonen JT. Hyperinsulinemia and the risk of cardiovascular death and acute coronary and cerebrovascular events in men: the Kuopio Ischaemic Heart Disease Risk Factor Study. Arch Intern Med 2000; 160(8): 1160-8.
  25. Golshahi J, Validi E, Akbari M. The association between fasting serum insulin, apo-lipoproteins level, and severity of coronary artery involvement in non-diabetic patients. Adv Biomed Res 2014; 3: 192.