Background
Methods
Study population
Clinical, biochemical and echocardiographic assessments
Statistics
Results
Basic characteristics of the studied population
HOMA-IR tertiles | Low | Intermediate | High | P-value |
---|---|---|---|---|
n | 174 | 150 | 161 | |
Demographic characteristics | ||||
Age, years, mean (SD) | 65.24 (10.45) | 62.37 (11.23) | 59.93 (11.84) | < 0.001 |
Male, n (%) | 154 (88.51) | 132 (88.00) | 149 (92.55) | 0.342 |
Clinical measures, mean (SD) | ||||
BMI, kg/m2 | 23.09 (3.00) | 24.76 (2.93) | 25.95 (3.78) | < 0.001 |
SBP, mmHg | 121.07 (17.36) | 124.71 (17.87) | 125.37 (20.30) | 0.078 |
DBP, mmHg | 71.99 (11.45) | 75.57 (11.98) | 77.76 (12.02) | < 0.001 |
Current or former smoker, n (%) | 87 (50.00) | 72 (48.00) | 66 (40.99) | 0.228 |
Diseased vessels, n (%) | ||||
Single-vessel disease | 59 (33.91) | 46 (30.67) | 52 (32.30) | 0.768 |
Multi-vessel disease | 115 (66.09) | 104 (69.33) | 109 (67.70) | |
Medical history, n (%) | ||||
Hypertension | 90 (51.72) | 86 (57.33) | 101 (62.73) | 0.126 |
Atrial fibrillation or flutter | 6 (3.45) | 8 (5.33) | 8 (4.97) | 0.682 |
Chronic kidney disease | 8 (4.60) | 10 (6.67) | 13 (8.07) | 0.424 |
Cerebrovascular disease | 20 (11.49) | 8 (5.33) | 16 (9.94) | 0.140 |
Laboratory values, median (IQR) or mean (SD) | ||||
HbA1c, % | 5.60 (5.40–5.90) | 5.75 (5.40–6.10) | 5.70 (5.40–5.90) | 0.116 |
Fasting glucose, mmol/L | 5.04 (0.87) | 5.45 (0.76) | 6.17 (0.94) | < 0.001 |
Fasting insulin, μU/mL | 5.61 (2.12) | 10.32 (1.95) | 21.67 (10.83) | < 0.001 |
Triglyceride, mmol/L | 1.31 (0.99–1.73) | 1.51 (1.08–2.07) | 1.65 (1.18–2.30) | < 0.001 |
Total cholesterol, mmol/L | 4.50 (1.44) | 4.37 (0.83) | 4.77 (1.06) | 0.040 |
HDL cholesterol, mmol/L | 1.04 (0.26) | 1.02 (0.22) | 1.02 (0.23) | 0.855 |
LDL cholesterol, mmol/L | 2.85 (1.31) | 2.67 (0.68) | 3.02 (0.86) | 0.044 |
Apolipoprotein A–I, g/L | 1.10 (0.20) | 1.11 (0.19) | 1.14 (0.18) | 0.381 |
Apolipoprotein B, g/L | 0.89 (0.29) | 0.90 (0.21) | 0.94 (0.19) | 0.084 |
Alanine aminotransferase, IU/L | 40.96 (23.55) | 37.12 (18.47) | 61.98 (44.55) | < 0.001 |
Aspatate aminotransferase, IU/L | 140.90 (141.13) | 137.10 (123.68) | 238.58 (213.27) | < 0.001 |
Blood urea nitrogen, mmol/L | 5.20 (4.10–6.20) | 5.00 (4.20–6.00) | 5.10 (4.20–6.50) | 0.497 |
Serum creatinine, μmol/L | 78.00 (62.25–87.00) | 77.00 (67.00–87.00) | 80.00 (68.00–92.00) | 0.166 |
eGFR, mL/min/1.73 m2 | 83.42 (20.70) | 88.11 (21.65) | 85.38 (19.15) | 0.178 |
hsCRP, mg/L | 5.84 (2.31–13.74) | 4.50 (2.06–11.47) | 3.96 (1.81–12.85) | 0.151 |
NT-proBNP, pg/mL | 1049.00 (718.10–2668.00) | 859.55 (309.30–1843.00) | 466.60 (278.70–1344.75) | < 0.001 |
cTnI (ng/mL) | 6.19 (0.35–29.86) | 9.94 (0.32–36.47) | 24.40 (1.78–75.45) | < 0.001 |
Medication use, n (%) | ||||
ACEI or ARBs | 125 (71.84) | 114 (76.00) | 133 (82.61) | 0.064 |
Beta-blockers | 146 (83.91) | 122 (81.33) | 135 (83.85) | 0.787 |
Statins | 170 (97.70) | 142 (94.67) | 157 (97.52) | 0.243 |
Spirolactone | 10 (5.75) | 12 (8.00) | 20 (12.42) | 0.089 |
Changes in LV geometric and functional properties
HOMA-IR tertiles | Low | Intermediate | High | P-value |
---|---|---|---|---|
LVEDD, mm | ||||
B | 50.09 (4.35) | 50.77 (5.00) | 51.60 (5.23) | < 0.001 |
F | 50.60 (4.99) | 51.68 (5.49) | 53.04 (5.33) | |
Δ | 0.52 (2.47) | 0.91 (3.08) | 1.44 (3.96) | |
LVESD, mm | ||||
B | 34.04 (5.09) | 34.93 (5.35) | 35.55 (5.40) | < 0.001 |
F | 33.89 (5.43) | 34.93 (6.14) | 36.60 (6.37) | |
Δ | − 0.15 (3.351) | 0.00 (2.94) | 1.05 (4.11) | |
LVEDVI, mL/m2 | ||||
B | 70.17 (12.65) | 69.61 (13.88) | 70.28 (16.67) | < 0.001 |
F | 72.09 (14.60) | 72.66 (16.56) | 75.00 (17.84) | |
Δ | 1.91 (7.96) | 3.06 (10.63) | 4.66 (13.20) | |
LVESVI, mL/m2 | ||||
B | 29.11 (9.97) | 29.46 (10.55) | 30.32 (11.55) | < 0.001 |
F | 28.65 (11.00) | 29.86 (12.95) | 32.28 (14.21) | |
Δ | − 0.46 (6.68) | 0.40 (6.38) | 1.96 (9.13) | |
LVMI, g/m2 | ||||
B | 93.55 (17.15) | 96.39 (21.13) | 96.21 (21.67) | 0.130 |
F | 94.47 (18.35) | 95.32 (16.69) | 93.66 (17.95) | |
Δ | 0.91 (15.84) | − 1.07 (17.75) | − 2.73 (15.24) | |
IVST, mm | ||||
B | 9.27 (1.04) | 9.55 (1.15) | 9.60 (1.10) | 0.003 |
F | 9.14 (1.11) | 9.36 (1.04) | 9.01 (1.16) | |
Δ | − 0.13 (1.21) | − 0.19 (1.22) | − 0.59 (1.48) | |
LVPWT, mm | ||||
B | 8.92 (0.92) | 9.20 (1.07) | 9.19 (0.97) | 0.006 |
F | 8.93 (0.91) | 8.92 (0.85) | 8.83 (0.75) | |
Δ | 0.01 (1.03) | − 0.28 (1.09) | − 0.37 (1.25) | |
RWT | ||||
B | 0.36 (0.04) | 0.37 (0.05) | 0.37 (0.05) | 0.001 |
F | 0.36 (0.04) | 0.36 (0.05) | 0.34 (0.05) | |
Δ | − 0.01 (0.05) | − 0.01 (0.04) | − 0.03 (0.06) | |
LVEF, % | ||||
B | 59.04 (8.03) | 58.20 (7.85) | 57.76 (7.35) | 0.089 |
F | 60.89 (7.63) | 59.99 (7.53) | 58.22 (8.36) | |
Δ | 1.85 (6.76) | 1.79 (5.40) | 0.47 (6.80) |
Relation of insulin resistance parameters to LV dilation
∆ Geometric/functional parameters | Log-transformed HOMA-IR | |||
---|---|---|---|---|
Unadjusted | Adjusteda | |||
r | P-value | r | P-value | |
LVEDD | 0.172 | < 0.001 | 0.149 | 0.001 |
LVESD | 0.164 | < 0.001 | 0.163 | < 0.001 |
LVEDVI | 0.154 | 0.001 | 0.129 | 0.005 |
LVESVI | 0.167 | < 0.001 | 0.171 | < 0.001 |
LVMI | − 0.047 | 0.303 | − 0.106 | 0.022 |
IVST | − 0.129 | 0.004 | − 0.152 | 0.001 |
LVPWT | − 0.144 | 0.001 | − 0.203 | < 0.001 |
RWT | − 0.193 | < 0.001 | − 0.219 | < 0.001 |
LVEF | − 0.092 | 0.043 | − 0.126 | 0.006 |
Multivariate linear regression analysis for HOMA-IR and LV dilation
Covariates | Model 1 | Model 2 | ||||
---|---|---|---|---|---|---|
Coefficient (95% CI) | Sβ | P-value | Coefficient (95% CI) | Sβ | P-value | |
Male gender | − 0.009 (− 1.044 to 1.025) | − 0.001 | 0.986 | 0.028 (− 1.004 to 1.061) | 0.003 | 0.957 |
Age | − 0.190 (− 0.453 to 0.073) | − 0.066 | 0.157 | − 0.125 (− 0.385 to 0.135) | − 0.043 | 0.345 |
Smoking | 0.446 (− 0.138 to 1.030) | 0.067 | 0.134 | 0.366 (− 0.218 to 0.949) | 0.055 | 0.219 |
Hypertension | 0.351 (− 0.220 to 0.923) | 0.052 | 0.228 | 0.339 (− 0.226 to 0.905) | 0.050 | 0.239 |
CKD | 0.886 (− 0.220 to 1.991) | 0.066 | 0.116 | 0.855 (− 0.230 to 1.939) | 0.063 | 0.122 |
Lymphocytes | − 1.028 (− 1.563 to − 0.492) | − 0.166 | < 0.001 | − 1.049 (− 1.581 to − 0.517) | − 0.169 | < 0.001 |
HDL cholesterol | − 3.118 (− 4.722 to − 1.515) | − 0.163 | < 0.001 | − 3.265 (− 4.878 to − 1.651) | − 0.170 | < 0.001 |
TIMI flow ≤ 2 | 1.215 (− 0.460 to 2.890) | 0.059 | 0.155 | 1.489 (− 0.182 to 3.161) | 0.072 | 0.081 |
Log cTnI | 0.109 (0.007 to 0.211) | 0.092 | 0.036 | 0.114 (0.012 to 0.216) | 0.096 | 0.029 |
Basal LVEDD | − 0.293 (− 0.359 to − 0.227) | − 0.435 | < 0.001 | − 0.317 (− 0.384 to − 0.251) | − 0.471 | < 0.001 |
Basal LVEF | − 0.145 (− 0.187 to − 0.103) | − 0.344 | < 0.001 | − 0.145 (− 0.186 to − 0.104) | − 0.343 | < 0.001 |
HOMA-IR | < 0.001* | 0.088* | ||||
Tertile 2 vs. 1 | 1.196 (0.541 to 1.851) | 0.170 | < 0.001 | − 0.361 (− 1.360 to 0.638) | − 0.051 | 0.478 |
Tertile 3 vs. 1 | 1.926 (1.237 to 2.614) | 0.272 | < 0.001 | 1.224 (0.095 to 2.353) | 0.173 | 0.034 |
IGT | – | – | – | − 1.337 (− 2.311 to − 0.363) | − 0.185 | 0.007 |
IGT × HOMA-IR | – | – | – | 0.001† | ||
βint (tertile 2 vs. 1) | – | – | – | 2.453 (1.162 to 3.744) | 0.260 | < 0.001 |
βint (tertile 3 vs. 1) | – | – | – | 1.925 (0.561 to 3.288) | 0.197 | 0.006 |
BMI | – | – | – | 0.760 (− 0.249 to 1.769) | 0.113 | 0.140 |
BMI × HOMA-IR | – | – | – | 0.212† | ||
βint (tertile 2 vs. 1) | – | – | – | 0.775 (− 0.566 to 2.117) | 0.088 | 0.257 |
βint (tertile 3 vs. 1) | – | – | – | − 0.405 (− 1.796 to 0.985) | − 0.049 | 0.567 |