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Post-infarction patients: Insulin resistance predicts the risk for recurrent coronary events

Researchers have investigated the risk for recurrent coronary events associated with insulin resistance in post infarction patients from the Thrombogenic Factors and Recurrent Coronary Events ( THROMBO ) study.

The association between insulin resistance expressed by Homeostatic Model Assessment 2 for Insulin Resistance ( HOMA2-IR ) and the risk for recurrent coronary events was investigated in a cohort of 1,032 patients evaluated 2 months after myocardial infarction with a follow-up of 26 months.

The endpoint for the study was recurrent coronary event defined as cardiac death, nonfatal myocardial infarction, or unstable angina, whichever occurred first.

Researchers used time dependent survival analysis and Cox proportional hazards regression method to determine the association between HOMA2 categorized as high more than 75th percentile and endpoints after adjustment for relevant clinical covariates and series of thrombogenic and dyslipogenic factors.

High HOMA2-IR defined as in fourth quartile ( greater than or equal to 2.4 ) was associated with increased risk for recurrent coronary events ( hazard ratio, HR=1.44; [CI] 1.03-2.01; P=0.03 ) after adjustment for the clinical covariates: age, gender, diabetes, prior myocardial infarction, pulmonary congestion, CABG and PTCA.

The highest risk of cardiac events was observed in non-obese patients ( BMI less than or equal to 30 kg/m2 ) with high HOMA2-IR ( HR=1.5; [CI] 1.02-2.22; P=0.038 ).

The plasma level of plasminogen activator inhibitor-1 ( PAI-1 ) was associated with higher risk for recurrent coronary events in patients with insulin resistance ( HR=1.79; [CI] 1.05-3.03; P=0.03, interaction P=0.018 ).

In conclusion, insulin resistance predicts recurrence of coronary events in post-infarction population.
HOMA2-IR is better than BMI to stratify risk of recurrent coronary events. ( Xagena )

Szepietowska B et al, Cardiol J 2015; Epub ahead of print