The relationship between coronary artery severity and insulin resistance in patients with impaired glucose tolerance and metabolic syndrome

Abstract Background The relation between metabolic syndrome (MS) and coronary artery disease (CAD) is multifactorial, and the well-known risk factors can explain only about 25% of the disease as the relation between insulin resistance (IR) on top of MS and severity of CAD still a subject of debate with conflicting data. Also, IR and glucose intolerance are included in the definition of metabolic syndrome only by some associations. So, the aim of this research was to analyze the the relation between CAD severity (measured by the modified Gensini score) and the different components of the metabolic syndrome including insulin resistance and glucose intolerance. Results Out of 70 patients enrolled, 71.4% represented impaired glucose tolerance group (IGT group; n = 50) and 28.6% represented normal glucose tolerance group (NGT group; n = 20). The following variables were significantly greater among the IGT group including BMI (30.19 ± 2.27 vs 23.62 ± 2.92; P < 0.001), waist circumference (105.09 ± 8.02 vs 92.89 ± 19.92; P < 0.001), frequency of hypertension (80% vs 50%; P = 0.012), 2 h post prandial glucose (164 ± 30 vs 110 ± 20; P < 0. 04), fasting insulin (9.2 ± 1.2 vs 5.1 ± 4.3; P = 0.003), HOMA-IR (3.03 ± 0.12% vs 1.9 ± 0.12, P < 0.001), serum uric acid (4.8 ± 1.3 vs 5.8 ± 2.6; P = 0.03), mean modified Gensini score (22.3 ± 9.2 vs 15.4 ± 6.8; P < 0.001), while the mean serum HDL was significantly higher among the NGT group (40.8 ± 10.1 vs 50.6 ± 10.2; P < 0.001). There was a positive correlation between HOMA–IR; hs-CRP; MS-related variables (including waist circumflex; BMI; serum uric acid; HDL; TG);and the modified Gensini score (for HOMA, r = 0.63; P < 0.001). Several predictors for high scores of modified Gensini were noted in multiple regression analysis; however, out of those several predictors, HOMA-IR was the strongest one (OR = 4.0, 95% CI = (2.04-7.08). Conclusion IR is an independent risk factor for CAD severity in patients with IGT and MS. In patients with IR; those with aggressive CAD (or with a positive family history of premature CAD), IGT should be managed aggressively even before any evidence of frank diabetes. IR workup should be recommended among the other standard workup for those patients, if documented, interventions targeted against IR should be considered among the other standard management.

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The positive association between serum uric acid, impaired fasting glucose, impaired glucose tolerance, and diabetes mellitus in the ELSA-Brasil study

Cadernos de Saúde Pública ◽

10.1590/0102-311x00255920 ◽

2021 ◽

Vol 37 (9) ◽

Author(s):

Aline Isabel Rodrigues Galvão ◽

Alline Maria R. Beleigoli ◽

Pedro Guatimosim Vidigal ◽

Bruce Bartholow Duncan ◽

Maria Inês Schmidt ◽

...

Keyword(s):

Diabetes Mellitus ◽

Insulin Resistance ◽

Uric Acid ◽

Glucose Tolerance ◽

Impaired Glucose Tolerance ◽

Serum Uric Acid ◽

Impaired Fasting Glucose ◽

Fasting Glucose ◽

Newly Diagnosed ◽

Glycemic Status

Abstract: There is a conflict in the literature regarding the association between serum uric acid (SUA) levels and glycemic status. Therefore, we evaluated the association between SUA level and glycemic status - impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and diabetes mellitus - and insulin resistance, in a large Brazilian study. This is a cross-sectional, observational study with 13,207 participants aged 35-74 years, at baseline (2008-2010) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). A multinomial regression analysis was performed to test the association between SUA and glycemic status (IFG, IGT, and newly diagnosed type 2 diabetes at the cohort baseline) after adjustments by age, sex, skin color, body mass index, physical activity, smoking, alcohol consumption, comorbidities, and medicines use. Logistic regression model was used to evaluate the association between SUA and insulin resistance by HOMA-IR. Stratified analyses by sex were performed. The mean age (standard deviation) was 51.4 (8.9) years, 55.2% of participants were women. There were 1,439 newly diagnosed diabetes. After all adjustments, higher SUA was associated with IFG, IGT, and diabetes, with odds ratio (OR) = 1.15 (95%CI: 1.06; 1.25), 1.23 (95%CI: 1.14; 1.33), and 1.37 (95%CI: 1.24; 1.51), respectively. There was association between SUA levels and insulin resistance with OR = 1.24 (95%CI: 1.13; 1.36). In analysis stratified by sex, higher SUA persisted independently associated with impaired glycemic status. Our results suggest that a higher SUA levels were significantly associated with glycemic status in a large Latin American population, mainly among women.

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Serum Uric Acid as a Harbinger of Metabolic Outcome in Subjects With Impaired Glucose Tolerance: The Finnish Diabetes Prevention Study

Diabetes Care ◽

10.2337/diacare.29.03.06.dc05-1465 ◽

2006 ◽

Vol 29 (3) ◽

pp. 709-711 ◽

Cited By ~ 60

Author(s):

L. Niskanen ◽

D. E. Laaksonen ◽

J. Lindstrom ◽

J. G. Eriksson ◽

S. Keinanen-Kiukaanniemi ◽

...

Keyword(s):

Uric Acid ◽

Glucose Tolerance ◽

Impaired Glucose Tolerance ◽

Serum Uric Acid ◽

Diabetes Prevention ◽

Prevention Study ◽

Diabetes Prevention Study ◽

Metabolic Outcome

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Serum Uric Acid and Its Association with Coronary Artery Disease

Cardiovascular Journal ◽

10.3329/cardio.v5i1.12206 ◽

2012 ◽

Vol 5 (1) ◽

pp. 12-17 ◽

Cited By ~ 1

Author(s):

MAK Akanda ◽

KN Choudhury ◽

MZ Ali ◽

S Naher ◽

ASME Islam ◽

...

Keyword(s):

Uric Acid ◽

Coronary Artery ◽

Serum Uric Acid ◽

Uric Acid Level ◽

Acid Level ◽

Serum Uric Acid Level ◽

Gensini Score ◽

Significant Difference ◽

Artery Disease ◽

High Uric Acid

Background: Few studies have assessed the relation of uric acid level with the severity of coronary artery disease (CAD). This study investigated the association between high uric acid levels with the presence and severity of CAD.Materials and Methods: This study was designed as an observational cohort study. The study was composed of 180 patients admitted at our institution due to symptoms related to CAD. Patients having angiographic evidence of stenosis in coronary artery were as case group and without stenosis control group. Patients with high uric acid (hyperuricemia) were defined as serum uric acid concentration ?7.0mg/dl or ?420 ?mol/L in men and ?6mg/dl or ?360 ? mol/L in women. The presence of CAD has been defined as the Gensini score being ?1. Results: There was a statistically significant difference between the mean uric acid levels of patients with and without CAD (358.23±71.11 ?mol/l vs251.32±54.92 ?mol/l respectively, p<0.001). There was a statistically significant difference between ejection fraction of patients with and without CAD (54.50±9.25 vs. 63.16±6.56 respectively, p?0.001). Spearman correlation analysis demonstrated a positive correlation between the serum uric acid level and the severity of CAD (p=?0.001, r=0.39). When patients were classified into four groups according to their Gensini score, mean serum uric acid level was found to be significantly increased across the tertiles, and a statistically significant difference was detected between the tertiles (p= ?0.001). Conclusion: In conclusion, a significant association has been found between serum uric acid level and the presence and severity of CAD. In addition to the evaluation of conventional risk factors in daily clinical practice, the measurement of uric acid level might provide significant prognostic benefits in terms of global cardiovascular risk and management of the patients. DOI: http://dx.doi.org/10.3329/cardio.v5i1.12206 Cardiovasc. j. 2012; 5(1): 12-17

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A study of angiographic severity in patients with coronary artery disease and hyperuricemia

Asian Journal of Medical Sciences ◽

10.3126/ajms.v7i2.12717 ◽

2015 ◽

Vol 7 (2) ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Subhraprakash Pramanik ◽

Koushik Mondal ◽

Arpan Kumar Dey ◽

Pijush Kanti Mandal ◽

Shovan Kumar Das ◽

...

Keyword(s):

Coronary Artery Disease ◽

Uric Acid ◽

Coronary Artery ◽

Serum Uric Acid ◽

Uric Acid Level ◽

Acid Level ◽

Serum Uric Acid Level ◽

P Value ◽

Gensini Score ◽

Artery Disease

Backgrounds: Hyperuricemia has not yet been established as cardiovascular risk factor. We aimed to study the angiographic severity in patients with coronary artery disease (CAD) and hyperuricemia.Materials and Methods: In this observational cross-sectional study we measured serum uric acid level in 82 patients of CAD who underwent coronary angiography in catheterisation laboratory of our Institution. Severity of CAD was determined on the basis of Gensini score, number of diseased vessels, critical lesions and total occlusions.Results: The prevalence of hyperuricemia in patients with CAD was 42.68% in our study. Hyperuricemia was associated with higher Gensini score (33.33±10.64 vs. 22.90±6.75, p value <0.001), number of critical lesions (1.03±0.84 vs. 0.63±0.72, p value 0.031), total occlusions (0.67±0.47 vs. 0.37±0.48, p value 0.007) and dyslipidemia (63.6% vs. 30.6%, p value 0.003) more frequently compared to normouricemic patients. And also the higher serum uric acid level was correlated with higher Gensini score (beta 0.418, t 4.430, p value <0.001, 95% CI 0.036 and 0.094) and frequent number of total occlusion (beta 0.338, t 3.589, p value 0.001, 95% CI 0.462 and 1.613).Conclusion: Hyperuricemia was associated with higher Gensini score, frequent total occlusions and critical lesions in patients with Coronary Artery Disease compared to patients with normal uric acid level and also it was significantly correlated with higher Gensini score and frequent total occlusions.Asian Journal of Medical Sciences Vol.7(2) 2015 1-4

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Effect of the rs997509 Polymorphism on the Association between Ectonucleotide Pyrophosphatase Phosphodiesterase 1 and Metabolic Syndrome and Impaired Glucose Tolerance in Childhood Obesity

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2008-1659 ◽

2009 ◽

Vol 94 (1) ◽

pp. 300-305 ◽

Cited By ~ 15

Author(s):

Nicola Santoro ◽

Grazia Cirillo ◽

Maria Grazia Lepore ◽

Alfonsina Palma ◽

Alessandra Amato ◽

...

Keyword(s):

Insulin Resistance ◽

Metabolic Syndrome ◽

Insulin Sensitivity ◽

Confidence Interval ◽

Glucose Tolerance ◽

Impaired Glucose Tolerance ◽

Odds Ratio ◽

Rare Allele ◽

Common Allele ◽

Obese Children

Abstract Context: Variants on the nucleotide pyrophosphatase/phosphodiesterase-1 (ENPP-1) gene have been associated with obesity and insulin resistance. Because insulin resistance is a pivotal factor in the development of metabolic syndrome (MS) and impaired glucose tolerance (IGT), we aimed to test the association between the K121Q and rs997509 ENPP-1 variants with obesity, MS and IGT in obese children and adolescents. Methods: We screened 809 children, 409 obese and 400 lean controls. Obese subjects underwent a standard oral glucose tolerance test, whole body insulin sensitivity index (WBISI) and homeostasis model assessment (HOMA) were calculated. Results: No difference in prevalence for K121Q and rs997509 polymorphisms between obese and controls (P > 0.05) were observed. Obese children carrying the rs997509 rare allele showed higher insulin (P = 0.001), HOMA (P < .001) and lower WBISI values (P = 0.04) compared with common allele homozygous. A similar observation was done for K121Q variant, with 121Q allele carriers showing higher insulin (P = 0.03) and HOMA (P = 0.04) values than 121K homozygotes. Moreover, subjects carrying the rs997509 rare allele had higher risk of MS (odds ratio 2.4, 95% confidence interval: 1.3–4.3) and IGT (odds ratio 4.7, 95% confidence interval: 1.9–11.4) than common allele homozygotes. Evaluating combined effects of both polymorphisms, which are in strong linkage disequilibrium, we showed that the effect on insulin sensitivity was due to the rs997509 T variant. Conclusion: We conclude that the ENPP1 rs997509T allele can predispose obese children to MS and IGT and that this variant might drive the association between the ENPP1 121Q allele and insulin resistance.

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Insulin resistance, serum uric acid and metabolic syndrome are linked to cardiovascular dysfunction in pediatric obesity

International Journal of Cardiology ◽

10.1016/j.ijcard.2017.09.031 ◽

2017 ◽

Vol 249 ◽

pp. 366-371 ◽

Cited By ~ 17

Author(s):

Giulia Genoni ◽

Veronica Menegon ◽

Gioel Gabrio Secco ◽

Michela Sonzini ◽

Massimiliano Martelli ◽

...

Keyword(s):

Insulin Resistance ◽

Metabolic Syndrome ◽

Uric Acid ◽

Serum Uric Acid ◽

Pediatric Obesity ◽

Cardiovascular Dysfunction

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Uric acid as a future biomarker in diagnosing metabolic syndrome patients.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.11.3191 ◽

2019 ◽

Vol 26 (11) ◽

pp. 1911-1915

Author(s):

Shameela Majeed ◽

Brig. Rizwan Hashim

Keyword(s):

Insulin Resistance ◽

Metabolic Syndrome ◽

Uric Acid ◽

Waist Circumference ◽

Serum Uric Acid ◽

Serum Triglyceride ◽

Military Hospital ◽

P Value ◽

Model Assessment ◽

R Value

Objectives: To determine the possible correlation between raised serum uric acid and various components of metabolic syndrome (Waist circumference, serum triglyceride, plasma HDL-C). Study Design: Descriptive case control. Setting: Army Medical College laboratory, Military Hospital, Rawalpindi. Period: One year (November 2014 to October 2015). Material and Methods: Total of 100 subjects were enrolled in this study. WHO criteria were applied for identifying the patients of metabolic syndrome. Fasting plasma glucose, lipid profile and serum uric acid levels were measured by using colorimetric enzymatic method. The formula of Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) was applied to calculate Insulin resistance. Collected data was analyzed by using SPSS- Window version-17 for statistical analysis. Results: Serum uric acid levels were turned out to be high in metabolic syndrome patients (cases= 6.1±1.3mg/dL) when compared with controls (having no symptoms of MetS=3.6±1.2; p<0.001). Uric acid showed a statistically significant positive association with waist circumference (WC=r-value:0.250; p-value:0.000) and serum triglyceride (TG=r-value:0.341; p-value:0.000). Negative correlation had been found between plasma high-density lipoprotein-cholesterol (HDL-C=r-value: -0.173; p-value:<0.01) with uric acid levels. Conclusion: Serum uric acid levels show a significant association with components of metabolic syndrome making it a powerful biomarker of metabolic syndrome and its various cardiometabolic complications.

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