Yonsei Med J.  2018 Nov;59(9):1057-1063. 10.3349/ymj.2018.59.9.1057.

Impact of Insulin Resistance on Acetylcholine-Induced Coronary Artery Spasm in Non-Diabetic Patients

• Kang KW
• Choi BG
• Rha SW

• KMID: 2422490
• DOI: http://doi.org/10.3349/ymj.2018.59.9.1057

Abstract

PURPOSE
Coronary artery spasm (CAS) and diabetes mellitus (DM) are implicated in endothelial dysfunction, and insulin resistance (IR) is a major etiological cause of type 2 DM. However, the association between CAS and IR in non-diabetic individuals has not been elucidated. The aim of the present study was to evaluate the impact of IR on CAS in patients without DM.
MATERIALS AND METHODS
A total of 330 eligible patients without DM and coronary artery disease who underwent acetylcholine (Ach) provocation test were enrolled in this study. Inclusion criteria included both hemoglobin A1c < 6.0% and fasting glucose level < 110 mg/dL without type 2 DM. Patients were divided into quartile groups according the level of homeostasis model assessment of insulin resistance (HOMA-IR): 1Q (n=82; HOMA-IR < 1.35), 2Q (n=82; 1.35≤HOMA-IR < 1.93), 3Q (n=83; 1.93≤HOMA-IR < 2.73), and 4Q (n=83; HOMA-IR≥2.73).
RESULTS
In the present study, the higher HOMA-IR group (3Q and 4Q) was older and had higher body mass index, fasting blood glucose, serum insulin, hemoglobin A1c, total cholesterol, and triglyceride levels than the lower HOMA-IR group (1Q). Also, poor IR (3Q and 4Q) was considerably associated with frequent CAS. Compared with Q1, the hazard ratios for Q3 and Q4 were 3.55 (95% CI: 1.79-7.03, p < 0.001) and 2.12 (95% CI: 1.07-4.21, p=0.031), respectively, after adjustment of baseline risk confounders. Also, diffuse spasm and accompanying chest pain during Ach test were more strongly associated with IR patients with CAS.
CONCLUSION
HOMA-IR was significantly negatively correlated with reference diameter measured after nitroglycerin and significantly positively correlated with diffuse spasm and chest pain.

Keyword

Coronary artery spasm; insulin resistance; acetylcholine

MeSH Terms

Acetylcholine
Blood Glucose
Body Mass Index
Chest Pain
Cholesterol
Coronary Artery Disease
Coronary Vessels*
Diabetes Mellitus
Fasting
Glucose
Homeostasis
Humans
Insulin Resistance*
Insulin*
Nitroglycerin
Spasm*
Triglycerides
Acetylcholine
Blood Glucose
Cholesterol
Glucose
Insulin
Nitroglycerin

Figure

• 

  Fig. 1 Incidence of Ach-induced CAS. Adjusted Cox regression analysis model included age, sex (male), hypertension, dyslipidemia, current smokers, current alcohol drinkers, body mass index, and status of glycemic control (hemoglobin A1c). Ach, Acetylcholine; CAS, coronary artery spasm; HOMA-IR, homeostasis model assessment of insulin resistance; HR, hazard ratio.

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