Key result
High HbA1c linked to ~276% greater coronary endothelial dysfunction risk in NOCA, alongside high WHR.
Why the study?
In humans, detailed investigations on the relationship between metabolic parameters and coronary endothelial dysfunction were lacking.
Are metabolic parameters such as HbA1c and waist-to-hip ratio independent markers for coronary endothelial dysfunction in patients with nonobstructive coronary arteries?
Cross-Sectional (n=108)
No
Are metabolic parameters such as HbA1c and waist-to-hip ratio independent markers for coronary endothelial dysfunction in patients with nonobstructive coronary arteries?
Higher HbA1c and waist-to-hip ratio are independent markers of coronary endothelial dysfunction in patients with nonobstructive coronary arteries, suggesting that long-term metabolic abnormalities impair endothelial function.
Should not yet change practice in NOCA; hypothesis-generating for metabolic markers of endothelial dysfunction, needing prospective validation.
Background and Objectives:Reciprocal relationships between endothelial dysfunction and insulin resistance have been suggested by previous experimental studies.In humans, there has been no detailed investigation on the relationship between metabolic parameters and coronary endothelial dysfunction.In this study, we hypothesized an independent relationship between metabolic parameters and coronary endothelial function in patients with nonobstructive coronary artery (NOCA).Methods: The participants underwent an intracoronary acetylcholine provocation test in the left anterior descending coronary artery.Cardiovascular risk factors and metabolic parameters including insulin resistance, adipocytokines, and inflammatory markers were measured.Results: A total of 108 patients were enrolled in this study (age: 48.511.4years; male: n=73, 68%).The endothelial dysfunction group (n=52, 48%) showed a higher incidence of diabetes mellitus (11.5% vs. 1.8%, p=0.04), and a higher waist-to-hip ratio (WHR) (0.950.08 vs. 0.920.06,p=0.04) and glycated hemoglobin (HbA1c) (5.820.94% vs. 5.540.42%;p=0.05) compared with the no endothelial dysfunction group.In multivariate analysis adjusted for traditional cardiovascular risk factors, HbA1c (adjusted hazard ratio [HR], 3.755; 95% confidence interval [CI], 1.266-11.141;p=0.017) and WHR (HR, 8.765; 95% CI, 0.010-7,349.690;p=0.049) were independent factors for endothelial dysfunction.Interestingly, HbA1c (r=-0.247,p=0.011) and serum insulin (r=0.217,p=0.03) levels were closely correlated with the changes in coronary artery diameter after acetylcholine infusion.Conclusions: High HbA1c and WHR reflect the long-term status of metabolic conditions are independent factors for coronary endothelial dysfunction in patients with NOCA.Our results suggest that longer exposure to abnormal metabolic conditions induces coronary endothelial dysfunction.
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Han et al. (2023) conducted a cross-sectional in Non-obstructive coronary artery (NOCA) (n=108). Glycated hemoglobin (HbA1c) and waist-to-hip ratio (WHR) was evaluated on Coronary endothelial dysfunction (>20% diameter reduction in response to maximum dose of acetylcholine) (HR 3.755, 95% CI 1.266-11.141, p=0.017). High glycated hemoglobin (HbA1c) and waist-to-hip ratio (WHR) were independent risk factors for coronary endothelial dysfunction (HR 3.755 and HR 8.765, respectively) in patients with NOCA.
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