Original Articles

Insulin resistance is associated with severe coronary artery stenosis in non-diabetic chronic coronary syndrome at Sanglah General Hospital, Bali

Ni Luh Eka Sriayu Wulandari , I Made Junior Rina Artha, Wira Gotera, I Gede Raka Widiana

Ni Luh Eka Sriayu Wulandari
Department Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia. Email: eka.wull@gmail.com

I Made Junior Rina Artha
Department Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia

Wira Gotera
Department of Internal Medicine, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia

I Gede Raka Widiana
Department of Internal Medicine, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia
Online First: December 20, 2020 | Cite this Article
Wulandari, N., Artha, I., Gotera, W., Widiana, I. 2020. Insulin resistance is associated with severe coronary artery stenosis in non-diabetic chronic coronary syndrome at Sanglah General Hospital, Bali. Indonesia Journal of Biomedical Science 15(1): 19-24. DOI:10.15562/ijbs.v15i1.252


Background: The prevalence of insulin resistance (IR) increases worldwide due to the increasing number of the elderly population, obesity, and physical inactivity. IR modifies insulin’s effect on blood vessel walls, with anti-atherogenic effects on insulin-sensitive and pro-atherogenic effects on IR conditions. However, the relationship between IR and the degree of atherosclerosis is still not conclusive. This study will examine the relationship between insulin resistance marker HOMA-IR and the degree of coronary artery stenosis using SYNTAX score measurements in non-diabetic subjects with the chronic coronary syndrome.

Methods: The study was conducted on 68 subjects with non-diabetic chronic coronary syndrome taken by consecutive sampling. The diagnosis of the chronic coronary syndrome (CCS) is defined as subjects with significant ≥50% stenosis findings on coronary angiography. The degree of insulin resistance was measured using HOMA-IR and subjects were divided according to the HOMA-IR quartile. Data were analyzed in bivariate and multivariable modeling by SPSS version 25 for Windows.

Results: The prevalence of severe coronary stenosis was 11.8%, 17.6%, 29.4% and 64.7% in quartiles 1, 2, 3 and 4, respectively. In multivariate analysis, it was found that quartile 4 subjects with cut-off value HOMA-IR ≥12.30 (OR 7.0; 95% CI=1.3-39.0; p=0.025) is an independent predictor of severe coronary stenosis, along with age ≥50 years (OR 13, 8; 95% CI=1.1-174.1; p=0.042), BMI ≥25 kg/m2 (OR 15.1; 95% CI=2.4-96.7; p=0.004), smoking (OR 18,0; 95% CI=2.0-160.5; p=0.010)  Also found that statin therapy ≥2 months (OR 0.11; 95% CI 0.02-0.59; p=0.010) is an independent protective factor against severe coronary stenosis in non-diabetic CCS subjects.

Conclusion: This study shows an independent association between IR and severe coronary stenosis in non-diabetic CCS subjects. This finding further strengthens clinical evidence of the direct pro-atherogenic effect of IR regardless of its glucose control effect and other metabolic syndrome components.

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