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Effects of insulin resistance on cardiovascular risk factors in obese and non-obese patients

Yıl 2024, Cilt: 10 Sayı: 1 - January 2024, 105 - 117, 04.01.2024
https://doi.org/10.18621/eurj.1363228

Öz

Objectives: It is known that insulin resistance increases cardiovardiovascular risk. But it could not obviously be understood whether insulin resistance itself or the metabolic syndrome parameters, like obesity, that already exist in most of them, are responsible for this increased risk. Our aim is to determine cardiovascular risks in obese and non-obese insulin-resistant patients.

Methods: One hundred thirty-nine patients were included in the study. They were divided into 4 groups: Group 1 (having obesity and insulin resistance), Group 2 (having only insulin resistance but not obesity), Group 3 (having obesity but not insulin resistance), and Group 4 (having neither obesity nor insulin resistance). Patients having any systemic disease were excluded. Insulin resistance is calculated via Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) formula. Electrocardiographic, echocardiographic and lipid parameters of these patients were compared.

Results: High-density lipoprotein (HDL) levels of Group-4 were higher than Group 1 and Group 2. There was no statistical difference in HDL cholesterol levels between Group 3 and the others. Triglyceride and very low-density lipoprotein levels were higher in Group 1. There was no difference in P wave dispersion between the groups. In echocardigraphy, epicardial fat tissue thickness of Group 1 was significantly higher. Prevalance of diastolic dysfunction was higher in Group 1 compared to Group 4.

Conclusions: Insulin resistance itself is a risk factor for low HDL levels independent of obesity. When obesity is added to insulin resistance, other cardiovascular risk factors appear, like high triglyceride levels, increase in epicardial fat tissue thickness and presence of diastolic dysfunction. Early detection of insulin resistance may alert us to the risks of cardiovascular diseases.

Kaynakça

  • 1. Katsuki A, Sumida Y, Gabazza EC, et al. Homeostasis model assessment is a reliable indicator of insulin resistance during follow-up of patients with type 2 diabetes. Diabetes Care. 2001;24(2):362-365. doi: 10.2337/diacare.24.2.362.
  • 2. Krishnamurthy H, Siriwardhane T, Krishna K, et al. Insulin resistance in thyroid disorders: association between anti-TPO and HOMA-IR. medRxiv 2023. doi: 10.1101/2023.06.06.23291013.
  • 3. Roberts CK, Hevener AL, Barnard RJ. Metabolic syndrome and insulin resistance: underlying causes and modification by exercise training. Compr Physiol. 2013;3(1):1-58. doi: 10.1002/cphy.c110062.
  • 4. Silveira Rossi JL, Barbalho SM, Reverete de Araujo R, Bechara MD, Sloan KP, Sloan LA. Metabolic syndrome and cardiovascular diseases: going beyond traditional risk factors. Diabetes Metab Res Rev. 2022;38(3):e3502. doi: 10.1002/dmrr.3502.
  • 5. Novo G, Pugliesi M, Visconti C, et al. Early subclinical ventricular dysfunction in patients with insulin resistance. J Cardiovasc Med (Hagerstown). 2014;15(2):110-114. doi: 10.2459/JCM.0b013e3283638164.
  • 6. Hwang YC, Jee JH, Kang M, Rhee EJ, Sung J, Lee MK. Metabolic syndrome and insulin resistance are associated with abnormal left ventricular diastolic function and structure independent of blood pressure and fasting plasma glucose level. Int J Cardiol. 2012;159(2):107-111. doi: 10.1016/j.ijcard.2011.02.039.
  • 7. Safar ME, Balkau B, Lange C, et al. Hypertension and vascular dynamics in men and women with metabolic syndrome. J Am Coll Cardiol. 2013;61(1):12-9. doi: 10.1016/j.jacc.2012.01.088.
  • 8. Cadeddu C, Nocco S, Piano D, et al. Early impairment of contractility reserve in patients with insulin resistance in comparison with healthy subjects. Cardiovasc Diabetol. 2013;12:66. doi: 10.1186/1475-2840-12-66.
  • 9. Onuchina EL, Solov'ev OV, Mochalova OV, Kononov SK, Onuchin SG. [Metabolic syndrome and chronic persistent atrial fibrillation]. Klin Med (Mosk). 2011;89(1):26-31. [Article in Russian]
  • 10. Hung CL, Chao TF, Lai YH, et al. The relationship among atrium electromechanical interval, insulin resistance, and metabolic syndrome. Can J Cardiol. 2013;29(10):1263-1268. doi: 10.1016/j.cjca.2013.01.001.
  • 11. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1-39.e14. doi: 10.1016/j.echo.2014.10.003.
  • 12. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385(9963):117-171. doi: 10.1016/S0140-6736(14)61682-2.
  • 13. Roth GA, Huffman MD, Moran AE, et al. Global and regional patterns in cardiovascular mortality from 1990 to 2013. Circulation. 2015;132(17):1667-1678. doi: 10.1161/CIRCULATIONAHA.114.008720.
  • 14. Patel SA, Winkel M, Ali MK, Narayan KM, Mehta NK. Cardiovascular mortality associated with 5 leading risk factors: national and state preventable fractions estimated from survey data. Ann Intern Med. 2015;163(4):245-53. doi: 10.7326/M14-1753.
  • 15. Vasan RS, Sullivan LM, Wilson PW, et al. Relative importance of borderline and elevated levels of coronary heart disease risk factors. Ann Intern Med. 2005;142(6):393-402. doi: 10.7326/0003-4819-142-6-200503150-00005.
  • 16. Lowe LP, Greenland P, Ruth KJ, Dyer AR, Stamler R, Stamler J. Impact of major cardiovascular disease risk factors, particularly in combination, on 22-year mortality in women and men. Arch Intern Med. 1998;158(18):2007-2014. doi: 10.1001/archinte.158.18.2007.
  • 17. Adeva-Andany MM, Martínez-Rodríguez J, González-Lucán M, Fernández-Fernández C, Castro-Quintela E. Insulin resistance is a cardiovascular risk factor in humans. Diabetes Metab Syndr. 2019;13(2):1449-1455. doi: 10.1016/j.dsx.2019.02.023.
  • 18. Ginsberg HN. Insulin resistance and cardiovascular disease. J Clin Invest. 2000;106(4):453-458. doi: 10.1172/JCI10762.
  • 19. Kissebah AH, Freedman DS, Peiris AN. Health risks of obesity. Med Clin North Am. 1989;73(1):111-138. doi: 10.1016/s0025-7125(16)30695-2.
  • 20. Piché ME, Weisnagel SJ, Corneau L, Nadeau A, Bergeron J, Lemieux S. Contribution of abdominal visceral obesity and insulin resistance to the cardiovascular risk profile of postmenopausal women. Diabetes. 2005;54(3):770-777. doi: 10.2337/diabetes.54.3.770.
  • 21. Julius U. Influence of plasma free fatty acids on lipoprotein synthesis and diabetic dyslipidemia. Exp Clin Endocrinol Diabetes. 2003;111(5):246-250. doi: 10.1055/s-2003-41284.
  • 22. Petersen KF, Dufour S, Befroy D, Garcia R, Shulman GI. Impaired mitochondrial activity in the insulin-resistant offspring of patients with type 2 diabetes. N Engl J Med. 2004;350(7):664-671. doi: 10.1056/NEJMoa031314.
  • 23. Nieves DJ, Cnop M, Retzlaff B, et al. The atherogenic lipoprotein profile associated with obesity and insulin resistance is largely attributable to intra-abdominal fat. Diabetes. 2003;52(1):172-179. doi: 10.2337/diabetes.52.1.172.
  • 24. Fontes-Carvalho R, Ladeiras-Lopes R, Bettencourt P, Leite-Moreira A, Azevedo A. Diastolic dysfunction in the diabetic continuum: association with insulin resistance, metabolic syndrome and type 2 diabetes. Cardiovasc Diabetol. 2015;14:4. doi: 10.1186/s12933-014-0168-x.
  • 25. Dinh W, Lankisch M, Nickl W, et al. Insulin resistance and glycemic abnormalities are associated with deterioration of left ventricular diastolic function: a cross-sectional study. Cardiovasc Diabetol. 2010;9:63. doi: 10.1186/1475-2840-9-63.
  • 26. Russo C, Jin Z, Homma S, et al. Effect of obesity and overweight on left ventricular diastolic function: a community-based study in an elderly cohort. J Am Coll Cardiol. 2011;57(12):1368-1374. doi: 10.1016/j.jacc.2010.10.042.
  • 27. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128(16):1810-1852. doi: 10.1161/CIR.0b013e31829e8807.
  • 28. Bajraktari G, Koltai MS, Ademaj F, et al. Relationship between insulin resistance and left ventricular diastolic dysfunction in patients with impaired glucose tolerance and type 2 diabetes. Int J Cardiol. 2006;110(2):206-211. doi: 10.1016/j.ijcard.2005.08.033.
  • 29. de las Fuentes L, Brown AL, Mathews SJ, et al. Metabolic syndrome is associated with abnormal left ventricular diastolic function independent of left ventricular mass. Eur Heart J. 2007;28(5):553-559. doi: 10.1093/eurheartj/ehl526.
  • 30. Iacobellis G, Leonetti F. Epicardial adipose tissue and insulin resistance in obese subjects. J Clin Endocrinol Metab. 2005;90(11):6300-6302. doi: 10.1210/jc.2005-1087.
  • 31. Ahn SG, Lim HS, Joe DY, et al. Relationship of epicardial adipose tissue by echocardiography to coronary artery disease. Heart. 2008;94(3):e7. doi: 10.1136/hrt.2007.118471.
  • 32. Iacobellis G, Barbaro G. The double role of epicardial adipose tissue as pro- and anti-inflammatory organ. Horm Metab Res. 2008;40(7):442-445. doi: 10.1055/s-2008-1062724.
  • 33. Mazurek T, Zhang L, Zalewski A, et al. Human epicardial adipose tissue is a source of inflammatory mediators. Circulation. 2003;108(20):2460-2466. doi: 10.1161/01.CIR.0000099542.57313.C5.
  • 34. Picard FA, Gueret P, Laissy JP, et al. Epicardial adipose tissue thickness correlates with the presence and severity of angiographic coronary artery disease in stable patients with chest pain. PLoS One. 2014;9(10):e110005. doi: 10.1371/journal.pone.0110005.
Yıl 2024, Cilt: 10 Sayı: 1 - January 2024, 105 - 117, 04.01.2024
https://doi.org/10.18621/eurj.1363228

Öz

Kaynakça

  • 1. Katsuki A, Sumida Y, Gabazza EC, et al. Homeostasis model assessment is a reliable indicator of insulin resistance during follow-up of patients with type 2 diabetes. Diabetes Care. 2001;24(2):362-365. doi: 10.2337/diacare.24.2.362.
  • 2. Krishnamurthy H, Siriwardhane T, Krishna K, et al. Insulin resistance in thyroid disorders: association between anti-TPO and HOMA-IR. medRxiv 2023. doi: 10.1101/2023.06.06.23291013.
  • 3. Roberts CK, Hevener AL, Barnard RJ. Metabolic syndrome and insulin resistance: underlying causes and modification by exercise training. Compr Physiol. 2013;3(1):1-58. doi: 10.1002/cphy.c110062.
  • 4. Silveira Rossi JL, Barbalho SM, Reverete de Araujo R, Bechara MD, Sloan KP, Sloan LA. Metabolic syndrome and cardiovascular diseases: going beyond traditional risk factors. Diabetes Metab Res Rev. 2022;38(3):e3502. doi: 10.1002/dmrr.3502.
  • 5. Novo G, Pugliesi M, Visconti C, et al. Early subclinical ventricular dysfunction in patients with insulin resistance. J Cardiovasc Med (Hagerstown). 2014;15(2):110-114. doi: 10.2459/JCM.0b013e3283638164.
  • 6. Hwang YC, Jee JH, Kang M, Rhee EJ, Sung J, Lee MK. Metabolic syndrome and insulin resistance are associated with abnormal left ventricular diastolic function and structure independent of blood pressure and fasting plasma glucose level. Int J Cardiol. 2012;159(2):107-111. doi: 10.1016/j.ijcard.2011.02.039.
  • 7. Safar ME, Balkau B, Lange C, et al. Hypertension and vascular dynamics in men and women with metabolic syndrome. J Am Coll Cardiol. 2013;61(1):12-9. doi: 10.1016/j.jacc.2012.01.088.
  • 8. Cadeddu C, Nocco S, Piano D, et al. Early impairment of contractility reserve in patients with insulin resistance in comparison with healthy subjects. Cardiovasc Diabetol. 2013;12:66. doi: 10.1186/1475-2840-12-66.
  • 9. Onuchina EL, Solov'ev OV, Mochalova OV, Kononov SK, Onuchin SG. [Metabolic syndrome and chronic persistent atrial fibrillation]. Klin Med (Mosk). 2011;89(1):26-31. [Article in Russian]
  • 10. Hung CL, Chao TF, Lai YH, et al. The relationship among atrium electromechanical interval, insulin resistance, and metabolic syndrome. Can J Cardiol. 2013;29(10):1263-1268. doi: 10.1016/j.cjca.2013.01.001.
  • 11. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1-39.e14. doi: 10.1016/j.echo.2014.10.003.
  • 12. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385(9963):117-171. doi: 10.1016/S0140-6736(14)61682-2.
  • 13. Roth GA, Huffman MD, Moran AE, et al. Global and regional patterns in cardiovascular mortality from 1990 to 2013. Circulation. 2015;132(17):1667-1678. doi: 10.1161/CIRCULATIONAHA.114.008720.
  • 14. Patel SA, Winkel M, Ali MK, Narayan KM, Mehta NK. Cardiovascular mortality associated with 5 leading risk factors: national and state preventable fractions estimated from survey data. Ann Intern Med. 2015;163(4):245-53. doi: 10.7326/M14-1753.
  • 15. Vasan RS, Sullivan LM, Wilson PW, et al. Relative importance of borderline and elevated levels of coronary heart disease risk factors. Ann Intern Med. 2005;142(6):393-402. doi: 10.7326/0003-4819-142-6-200503150-00005.
  • 16. Lowe LP, Greenland P, Ruth KJ, Dyer AR, Stamler R, Stamler J. Impact of major cardiovascular disease risk factors, particularly in combination, on 22-year mortality in women and men. Arch Intern Med. 1998;158(18):2007-2014. doi: 10.1001/archinte.158.18.2007.
  • 17. Adeva-Andany MM, Martínez-Rodríguez J, González-Lucán M, Fernández-Fernández C, Castro-Quintela E. Insulin resistance is a cardiovascular risk factor in humans. Diabetes Metab Syndr. 2019;13(2):1449-1455. doi: 10.1016/j.dsx.2019.02.023.
  • 18. Ginsberg HN. Insulin resistance and cardiovascular disease. J Clin Invest. 2000;106(4):453-458. doi: 10.1172/JCI10762.
  • 19. Kissebah AH, Freedman DS, Peiris AN. Health risks of obesity. Med Clin North Am. 1989;73(1):111-138. doi: 10.1016/s0025-7125(16)30695-2.
  • 20. Piché ME, Weisnagel SJ, Corneau L, Nadeau A, Bergeron J, Lemieux S. Contribution of abdominal visceral obesity and insulin resistance to the cardiovascular risk profile of postmenopausal women. Diabetes. 2005;54(3):770-777. doi: 10.2337/diabetes.54.3.770.
  • 21. Julius U. Influence of plasma free fatty acids on lipoprotein synthesis and diabetic dyslipidemia. Exp Clin Endocrinol Diabetes. 2003;111(5):246-250. doi: 10.1055/s-2003-41284.
  • 22. Petersen KF, Dufour S, Befroy D, Garcia R, Shulman GI. Impaired mitochondrial activity in the insulin-resistant offspring of patients with type 2 diabetes. N Engl J Med. 2004;350(7):664-671. doi: 10.1056/NEJMoa031314.
  • 23. Nieves DJ, Cnop M, Retzlaff B, et al. The atherogenic lipoprotein profile associated with obesity and insulin resistance is largely attributable to intra-abdominal fat. Diabetes. 2003;52(1):172-179. doi: 10.2337/diabetes.52.1.172.
  • 24. Fontes-Carvalho R, Ladeiras-Lopes R, Bettencourt P, Leite-Moreira A, Azevedo A. Diastolic dysfunction in the diabetic continuum: association with insulin resistance, metabolic syndrome and type 2 diabetes. Cardiovasc Diabetol. 2015;14:4. doi: 10.1186/s12933-014-0168-x.
  • 25. Dinh W, Lankisch M, Nickl W, et al. Insulin resistance and glycemic abnormalities are associated with deterioration of left ventricular diastolic function: a cross-sectional study. Cardiovasc Diabetol. 2010;9:63. doi: 10.1186/1475-2840-9-63.
  • 26. Russo C, Jin Z, Homma S, et al. Effect of obesity and overweight on left ventricular diastolic function: a community-based study in an elderly cohort. J Am Coll Cardiol. 2011;57(12):1368-1374. doi: 10.1016/j.jacc.2010.10.042.
  • 27. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128(16):1810-1852. doi: 10.1161/CIR.0b013e31829e8807.
  • 28. Bajraktari G, Koltai MS, Ademaj F, et al. Relationship between insulin resistance and left ventricular diastolic dysfunction in patients with impaired glucose tolerance and type 2 diabetes. Int J Cardiol. 2006;110(2):206-211. doi: 10.1016/j.ijcard.2005.08.033.
  • 29. de las Fuentes L, Brown AL, Mathews SJ, et al. Metabolic syndrome is associated with abnormal left ventricular diastolic function independent of left ventricular mass. Eur Heart J. 2007;28(5):553-559. doi: 10.1093/eurheartj/ehl526.
  • 30. Iacobellis G, Leonetti F. Epicardial adipose tissue and insulin resistance in obese subjects. J Clin Endocrinol Metab. 2005;90(11):6300-6302. doi: 10.1210/jc.2005-1087.
  • 31. Ahn SG, Lim HS, Joe DY, et al. Relationship of epicardial adipose tissue by echocardiography to coronary artery disease. Heart. 2008;94(3):e7. doi: 10.1136/hrt.2007.118471.
  • 32. Iacobellis G, Barbaro G. The double role of epicardial adipose tissue as pro- and anti-inflammatory organ. Horm Metab Res. 2008;40(7):442-445. doi: 10.1055/s-2008-1062724.
  • 33. Mazurek T, Zhang L, Zalewski A, et al. Human epicardial adipose tissue is a source of inflammatory mediators. Circulation. 2003;108(20):2460-2466. doi: 10.1161/01.CIR.0000099542.57313.C5.
  • 34. Picard FA, Gueret P, Laissy JP, et al. Epicardial adipose tissue thickness correlates with the presence and severity of angiographic coronary artery disease in stable patients with chest pain. PLoS One. 2014;9(10):e110005. doi: 10.1371/journal.pone.0110005.

Ayrıntılar

Birincil Dil İngilizce
Konular İç Hastalıkları
Bölüm Original Article
Yazarlar

Bahar ARICAN TARIM 0000-0002-6017-3259

Nurdan PAPİLA TOPAL 0000-0001-9745-6845

Özcan KESKİN 0000-0002-9562-6967

Gokhan FAİKOGLU 0000-0002-8980-4499

Kübra SAYGISEVER-FAİKOĞLU Bu kişi benim 0000-0002-4723-8580

Tuğçe USKUR Bu kişi benim 0000-0001-6626-4859

Erken Görünüm Tarihi 18 Aralık 2023
Yayımlanma Tarihi 4 Ocak 2024
Gönderilme Tarihi 20 Eylül 2023
Kabul Tarihi 12 Aralık 2023
Yayımlandığı Sayı Yıl 2024 Cilt: 10 Sayı: 1 - January 2024

Kaynak Göster

AMA ARICAN TARIM B, PAPİLA TOPAL N, KESKİN Ö, FAİKOGLU G, SAYGISEVER-FAİKOĞLU K, USKUR T. Effects of insulin resistance on cardiovascular risk factors in obese and non-obese patients. Eur Res J. Ocak 2024;10(1):105-117. doi:10.18621/eurj.1363228

e-ISSN: 2149-3189 


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