Sultanbeyli State Hospital, Department of Cardiology, Istanbul, Turkey (Dr Bulut).
Istanbul Medeniyet University School of Medicine, Department of Cardiology, Istanbul, Turkey (Drs Celik, Yilmaz, Kul and Caliskan).
J Clin Lipidol. 2024 Sep-Oct;18(5):e764-e772. doi: 10.1016/j.jacl.2024.04.135. Epub 2024 May 6.
Coronary microvascular dysfunction (CMD) is a common occurrence in individuals with insulin resistance (IR). Homeostatic model assessment for insulin resistance (HOMA-IR) is a widely used surrogate marker of IR, although recent studies suggest triglyceride-glucose (TyG) index is a superior marker of IR that had a better accuracy to predict type 2 diabetes or cardiovascular outcomes than HOMA-IR.
We aimed to assess the accuracy and usefulness of TyG index and HOMA-IR for predicting CMD as assessed with echocardiographic coronary flow reserve (CFR) measurement.
All cases included in the institutional CFR registry were retrospectively reviewed, and 656 cases without epicardial coronary artery disease and without major risk factors for atherosclerosis were included. A CFR ≤2.0 was defined as CMD.
TyG index was available in all cases, while HOMA-IR was available in 398 cases. Both TyG index and HOMA-IR were associated with CMD on univariate analyses, while after adjustment for potential confounders HOMA-IR (odds ratio [OR]:1.38, 95% confidence interval [CI]:1.14-1.67, p = 0.001) but not TyG index (OR:1.48, 95% CI:0.82-2.67, p = 0.19) was associated with CMD. The predictive accuracy of HOMA-IR (c-statistic:0.63, 95% CI:0.54-0.72, p = 0.003) was higher than TyG index(c-statistic:0.55, 95% CI:0.47-0.63, p = 0.13), although the difference was not statistically significant (DeLong p = 0.23). There was strong evidence favoring a true difference between CMD vs. non-CMD groups for HOMA-IR (BF:3507) but not for TyG index(BF:0.66).
HOMA-IR, but not TyG index, is closely associated with CMD.
冠状动脉微血管功能障碍（CMD）在胰岛素抵抗（IR）个体中很常见。稳态模型评估的胰岛素抵抗（HOMA-IR）是 IR 的广泛使用替代标志物，尽管最近的研究表明甘油三酯-葡萄糖（TyG）指数是 IR 的更好标志物，其对预测 2 型糖尿病或心血管结局的准确性优于 HOMA-IR。
我们旨在评估 TyG 指数和 HOMA-IR 预测超声心动图冠状动脉血流储备（CFR）测量评估的 CMD 的准确性和有用性。
回顾性审查了机构 CFR 登记处纳入的所有病例，并纳入了 656 例无外膜冠状动脉疾病且无动脉粥样硬化主要危险因素的病例。CFR≤2.0 定义为 CMD。
所有病例均有 TyG 指数，而 398 例有 HOMA-IR。TyG 指数和 HOMA-IR 在单因素分析中均与 CMD 相关，而在调整潜在混杂因素后，HOMA-IR（比值比 [OR]：1.38，95%置信区间 [CI]：1.14-1.67，p=0.001）但不是 TyG 指数（OR：1.48，95%CI：0.82-2.67，p=0.19）与 CMD 相关。HOMA-IR 的预测准确性（C 统计量：0.63，95%CI：0.54-0.72，p=0.003）高于 TyG 指数（C 统计量：0.55，95%CI：0.47-0.63，p=0.13），尽管差异无统计学意义（DeLong p=0.23）。有强有力的证据支持 HOMA-IR 与 CMD 组与非 CMD 组之间的真正差异（BF：3507），而 TyG 指数则不然（BF：0.66）。
HOMA-IR 与 CMD 密切相关，而 TyG 指数则不然。
