Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
JACC Cardiovasc Imaging. 2011 Apr;4(4):392-401. doi: 10.1016/j.jcmg.2011.02.004.
We sought to assess whether hyperinsulinemia is associated with percentage lipid and coronary plaque burden in nondiabetic patients with acute coronary syndromes (ACS).
Hyperinsulinemia carries an increased risk of cardiovascular disease even in pre-diabetic patients, but the precise mechanisms of its effects remain unclear.
Nonculprit coronary lesions associated with mild-to-moderate stenosis in 82 nondiabetic patients with ACS were examined by integrated backscatter intravascular ultrasound (IB-IVUS), using a 40-MHz intravascular catheter. Conventional IVUS and IB-IVUS measurements from the worst 10-mm segment (1-mm intervals) were calculated. All patients underwent a 75-g oral glucose tolerance test (OGTT) to calculate the area under the insulin concentration-time curve (AUC insulin) from 0 to 120 min.
Patients in the high tertile of AUC insulin had a significantly greater percentage lipid area and absolute lipid volume than did patients in the intermediate and low tertiles (tertile 3 vs. tertile 2 vs. tertile 1; 37.6 ± 16.6% vs. 25.8 ± 11.9% vs. 27.5 ± 14.7%, p < 0.01 by analysis of variance [ANOVA], and 29.9 ± 22.6 mm(3) vs. 15.3 ± 12.6 mm(3) vs. 17.7 ± 12.7 mm(3), p < 0.01 by ANOVA, respectively) and a smaller percentage fibrosis area (55.0 ± 11.5% vs. 61.7 ± 9.4% vs. 60.7 ± 9.4%, p = 0.03 by ANOVA). Multiple regression analysis showed that the high tertile of AUC insulin was independently associated with an increased percentage lipid area (p < 0.05). On conventional IVUS analysis, external elastic membrane cross-sectional area was significantly increased with greater plaque volume in patients in the high tertile of AUC insulin (both p < 0.05 by ANOVA).
Hyperinsulinemia is associated with an increased lipid content and a greater plaque volume of nonculprit intermediate lesions in nondiabetic patients with ACS, suggesting that plaque vulnerability is increased in this subgroup of patients.
我们旨在评估非糖尿病急性冠脉综合征（ACS）患者的高胰岛素血症是否与脂类百分比和冠状动脉斑块负担相关。
即使在糖尿病前期患者中，高胰岛素血症也会增加心血管疾病的风险，但确切的作用机制仍不清楚。
通过使用 40MHz 血管内导管的背向散射积分血管内超声（IB-IVUS）检查 82 例非糖尿病 ACS 患者与轻度至中度狭窄相关的非罪犯性冠状动脉病变。计算最差 10mm 节段（1mm 间隔）的常规 IVUS 和 IB-IVUS 测量值。所有患者均接受 75g 口服葡萄糖耐量试验（OGTT），以计算 0 至 120 分钟时胰岛素浓度时间曲线下面积（AUCinsulin）。
AUCinsulin 高三分位组的脂类百分比面积和绝对脂类体积明显大于中三分位组和低三分位组（三分位 3 比三分位 2 比三分位 1；37.6±16.6%比 25.8±11.9%比 27.5±14.7%，方差分析 [ANOVA]，p<0.01；29.9±22.6mm3 比 15.3±12.6mm3 比 17.7±12.7mm3，ANOVA，p<0.01），而纤维化百分比面积较小（55.0±11.5%比 61.7±9.4%比 60.7±9.4%，ANOVA，p=0.03）。多元回归分析显示，AUCinsulin 高三分位与脂类百分比面积增加独立相关（p<0.05）。在常规 IVUS 分析中，AUCinsulin 高三分位患者的斑块体积越大，外膜弹性膜横截面积显著增加（均 p<0.05，ANOVA）。
在非糖尿病 ACS 患者中，高胰岛素血症与非罪犯性中等病变的脂类含量增加和斑块体积增大相关，这表明该亚组患者的斑块易损性增加。
