Association of Insulin Resistance, Hyperleptinemia, and Impaired Nitric Oxide Release With In-Stent Restenosis in Patients Undergoing Coronary Stenting

PierMarco Piatti, Carlo Di Mario, Lucilla D. Monti, Gabriele Fragasso, Fabio Sgura, Andrea Caumo, Emanuela Setola, Pietro Lucotti, Elena Galluccio, Cristina Ronchi, Anna Origgi, Ivana Zavaroni, Alberto Margonato, Antonio Colombo

Research output: Contribution to journalArticle

164 Citations (Scopus)

Abstract

Background - Previously undiagnosed diabetes, impaired glucose tolerance, and insulin resistance are common in patients with acute myocardial infarction and coronary heart disease (CHD) and might be involved in early restenosis after stent implantation. To evaluate whether markers of insulin resistance syndrome, including leptin, and endothelial dysfunction are related to increased rate of early restenosis, we studied nondiabetic patients with CHD after successful coronary stenting. Methods and Results - Both patients with CHD undergoing coronary stenting (120 patients) and control subjects (58 patients) were submitted to an oral glucose tolerance test (OGTT). Fasting leptin levels and fasting and postglucose load insulin sensitivity were assessed. Endothelial function was measured by nitrite and nitrate release (NOx) during OGTT. More than 50% of patients treated with stent implantation presented impaired glucose tolerance or type 2 diabetes, which was previously undiagnosed. These patients also had higher glucose, insulin, and leptin levels than control subjects. Among the stented patients, insulin and leptin levels were higher in patients with restenosis than in patients without restenosis. A significant increase in NOx levels was found during OGTT both in patients without restenosis and in control subjects. On the contrary, NOx profiles were blunted in patients with restenosis. At multiple regression analysis, only ΔAUC-NOx areas and insulin sensitivity index showed an independent correlation with the minimal lumen diameter at follow-up. Conclusions - We demonstrated that insulin resistance and endothelial dysfunction are independent predictors of early restenosis after coronary stenting.

Original languageEnglish
Pages (from-to)2074-2081
Number of pages8
JournalCirculation
Volume108
Issue number17
DOIs
Publication statusPublished - Oct 28 2003

Fingerprint

Stents
Insulin Resistance
Nitric Oxide
Leptin
Glucose Tolerance Test
Coronary Disease
Glucose Intolerance
Fasting
Coronary Restenosis
Insulin
Nitrites
Nitrates
Type 2 Diabetes Mellitus
Area Under Curve
Myocardial Infarction
Regression Analysis
Glucose

Keywords

  • Coronary disease
  • Diabetes mellitus
  • Metabolism
  • Nitric oxide
  • Restenosis

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Association of Insulin Resistance, Hyperleptinemia, and Impaired Nitric Oxide Release With In-Stent Restenosis in Patients Undergoing Coronary Stenting. / Piatti, PierMarco; Di Mario, Carlo; Monti, Lucilla D.; Fragasso, Gabriele; Sgura, Fabio; Caumo, Andrea; Setola, Emanuela; Lucotti, Pietro; Galluccio, Elena; Ronchi, Cristina; Origgi, Anna; Zavaroni, Ivana; Margonato, Alberto; Colombo, Antonio.

In: Circulation, Vol. 108, No. 17, 28.10.2003, p. 2074-2081.

Research output: Contribution to journalArticle

Piatti, PierMarco ; Di Mario, Carlo ; Monti, Lucilla D. ; Fragasso, Gabriele ; Sgura, Fabio ; Caumo, Andrea ; Setola, Emanuela ; Lucotti, Pietro ; Galluccio, Elena ; Ronchi, Cristina ; Origgi, Anna ; Zavaroni, Ivana ; Margonato, Alberto ; Colombo, Antonio. / Association of Insulin Resistance, Hyperleptinemia, and Impaired Nitric Oxide Release With In-Stent Restenosis in Patients Undergoing Coronary Stenting. In: Circulation. 2003 ; Vol. 108, No. 17. pp. 2074-2081.
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T1 - Association of Insulin Resistance, Hyperleptinemia, and Impaired Nitric Oxide Release With In-Stent Restenosis in Patients Undergoing Coronary Stenting

AU - Piatti, PierMarco

AU - Di Mario, Carlo

AU - Monti, Lucilla D.

AU - Fragasso, Gabriele

AU - Sgura, Fabio

AU - Caumo, Andrea

AU - Setola, Emanuela

AU - Lucotti, Pietro

AU - Galluccio, Elena

AU - Ronchi, Cristina

AU - Origgi, Anna

AU - Zavaroni, Ivana

AU - Margonato, Alberto

AU - Colombo, Antonio

PY - 2003/10/28

Y1 - 2003/10/28

N2 - Background - Previously undiagnosed diabetes, impaired glucose tolerance, and insulin resistance are common in patients with acute myocardial infarction and coronary heart disease (CHD) and might be involved in early restenosis after stent implantation. To evaluate whether markers of insulin resistance syndrome, including leptin, and endothelial dysfunction are related to increased rate of early restenosis, we studied nondiabetic patients with CHD after successful coronary stenting. Methods and Results - Both patients with CHD undergoing coronary stenting (120 patients) and control subjects (58 patients) were submitted to an oral glucose tolerance test (OGTT). Fasting leptin levels and fasting and postglucose load insulin sensitivity were assessed. Endothelial function was measured by nitrite and nitrate release (NOx) during OGTT. More than 50% of patients treated with stent implantation presented impaired glucose tolerance or type 2 diabetes, which was previously undiagnosed. These patients also had higher glucose, insulin, and leptin levels than control subjects. Among the stented patients, insulin and leptin levels were higher in patients with restenosis than in patients without restenosis. A significant increase in NOx levels was found during OGTT both in patients without restenosis and in control subjects. On the contrary, NOx profiles were blunted in patients with restenosis. At multiple regression analysis, only ΔAUC-NOx areas and insulin sensitivity index showed an independent correlation with the minimal lumen diameter at follow-up. Conclusions - We demonstrated that insulin resistance and endothelial dysfunction are independent predictors of early restenosis after coronary stenting.

AB - Background - Previously undiagnosed diabetes, impaired glucose tolerance, and insulin resistance are common in patients with acute myocardial infarction and coronary heart disease (CHD) and might be involved in early restenosis after stent implantation. To evaluate whether markers of insulin resistance syndrome, including leptin, and endothelial dysfunction are related to increased rate of early restenosis, we studied nondiabetic patients with CHD after successful coronary stenting. Methods and Results - Both patients with CHD undergoing coronary stenting (120 patients) and control subjects (58 patients) were submitted to an oral glucose tolerance test (OGTT). Fasting leptin levels and fasting and postglucose load insulin sensitivity were assessed. Endothelial function was measured by nitrite and nitrate release (NOx) during OGTT. More than 50% of patients treated with stent implantation presented impaired glucose tolerance or type 2 diabetes, which was previously undiagnosed. These patients also had higher glucose, insulin, and leptin levels than control subjects. Among the stented patients, insulin and leptin levels were higher in patients with restenosis than in patients without restenosis. A significant increase in NOx levels was found during OGTT both in patients without restenosis and in control subjects. On the contrary, NOx profiles were blunted in patients with restenosis. At multiple regression analysis, only ΔAUC-NOx areas and insulin sensitivity index showed an independent correlation with the minimal lumen diameter at follow-up. Conclusions - We demonstrated that insulin resistance and endothelial dysfunction are independent predictors of early restenosis after coronary stenting.

KW - Coronary disease

KW - Diabetes mellitus

KW - Metabolism

KW - Nitric oxide

KW - Restenosis

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