Insulin resistance, cardiovascular risk factors and cardiac remodeling in non diabetic patients

Background: Insulin resistance (IR) is considered an important risk factor for cardiovascular disease and a key determinant of cardiovascular risk factors, including obesity, hyperlipidemia and hypertension, clustering alltogether within the metabolic syndrome. However, it is not well known the impact of IR on cardiac remodeling. Purpose: To examine the relationship between IR and cardiac structure in non diabetic patients (pts) and the association with traditional cardiovascular risk factors in these pts. Methods:We evaluated 393 non-diabetic, asymptomatic pts that underwent our Preventive Cardiology Department for a comprehensive risk factors screening. All pts were free of overt coronary artery disease. A comprehensive echocardiography was performed in all pts. The left ventricular and atrial measurements were indexed by height2.7. Pts with valve disease more than mild were excluded. Insulin resistance was measured from plasma fasting insulin and glucose levels using Homeostasis Model Assessment (HOMA-IR). Results: The mean age was 54+14 yrs (37% males). Men had significantly higher HOMA-IR values than women (p=.006). We found a positive correlation between HOMA-IR and BMI (p,.001), heart rate (p=.006), glucose levels (p,.001), triglycerides (p,.001) anddiastolic blood pressure (p=.001).HOMA-IRwasnegatively correlated with HDL-cholesterol (p=.001). HOMA-IR was positively correlated with left ventricular (LV) mass index (p,.001), LVend-diastolic and end-systolic volumes index (p,.001, respectively p=.002) and left atrial volume index (p=.003). In a multivariate regression model, we found thatHOMA-IRwasa significant predictor of LVmassindex, independent of age,BMI and hypertension (p=.008). Conclusions:Ourdatashowedthat insulin resistance, assessedusingHOMA-IR, is associated with a worse impact on subclinical cardiac remodeling in non diabetic pts. HOMA-IR may be an important marker for identifying pts who may be at risk for development of cardiac disease.