| Title: |
Homeostasis model assessment of insulin resistance and survival in patients with diabetes and acute coronary syndrome |
| Authors: |
Stähli, BE; Nozza, A; Schrieks, IC; Buse, JB; Malmberg, K; Mellbin, L; Neal, B; Nicholls, SJ; Rydén, L; Svensson, A; Wedel, H; Weichert, A; Lincoff, AM; Grobbee, DE; Tardif, JC; Schwartz, GG |
| Source: |
urn:ISSN:0021-972X ; urn:ISSN:1945-7197 ; Journal of Clinical Endocrinology and Metabolism, 103, 7, 2522-2533 |
| Publisher Information: |
The Endocrine Society |
| Publication Year: |
2018 |
| Collection: |
UNSW Sydney (The University of New South Wales): UNSWorks |
| Subject Terms: |
32 Biomedical and Clinical Sciences; 3202 Clinical Sciences; Heart Disease - Coronary Heart Disease; Aging; Clinical Research; Diabetes; Cardiovascular; Heart Disease; Clinical Trials and Supportive Activities; Atherosclerosis; Patient Safety; 6.1 Pharmaceuticals; Metabolic and endocrine; Acute Coronary Syndrome; Aged; Diabetes Mellitus; Type 2; Female; Homeostasis; Humans; Hypoglycemic Agents; Insulin; Insulin Resistance; Male; Middle Aged; Natriuretic Peptide; Brain; Oxazoles; Peptide Fragments; Proportional Hazards Models |
| Description: |
Objective Insulin resistance has been linked to development and progression of atherosclerosis and is present in most patients with type 2 diabetes. Whether the degree of insulin resistance predicts adverse outcomes in patients with type 2 diabetes and acute coronary syndrome (ACS) is uncertain. Design The Effect of Aleglitazar on Cardiovascular Outcomes after Acute Coronary Syndrome in Patients with Type 2 Diabetes Mellitus trial compared the peroxisome proliferator-activated receptor-α/ 3 agonist aleglitazar with placebo in patients with type 2 diabetes 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 (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, twofold higher baseline HOMA-IR was associated with lower risk of death [hazard ratio (HR): 0.79, 95% CI: 0.68 to 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 to 1.19, P = 0.94). Baseline HOMA-IR was not associated with major adverse cardiovascular events, nor was the change in HOMA-IR on study treatment associated with death or major adverse cardiovascular events. Conclusions After accounting for levels of NT-proBNP, insulin resistance assessed by HOMA-IR is not related to the risk of death or major adverse cardiovascular events in patients with type 2 diabetes and ACS. |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf |
| Language: |
unknown |
| Relation: |
https://hdl.handle.net/1959.4/unsworks_70393 |
| DOI: |
10.1210/jc.2017-02772 |
| Availability: |
https://hdl.handle.net/1959.4/unsworks_70393; https://unsworks.unsw.edu.au/bitstreams/49145885-ac76-4357-85d3-604307a804de/download; https://doi.org/10.1210/jc.2017-02772 |
| Rights: |
open access ; https://purl.org/coar/access_right/c_abf2 ; CC-BY-NC-ND ; https://creativecommons.org/licenses/by-nc-nd/4.0/ ; free_to_read |
| Accession Number: |
edsbas.3E25E7A6 |
| Database: |
BASE |