Key result
The product of HOMA-IR and TG/HDLc index > 28 was significantly associated with the presence of angiographic coronary artery disease (RR 1.64).
Why the study?
Do elevated HOMA-IR and TG/HDLc index predict the presence of angiographic coronary artery disease in patients referred for coronary angiography?
Cross-Sectional (n=131)
No
Do elevated HOMA-IR and TG/HDLc index predict the presence of angiographic coronary artery disease in patients referred for coronary angiography?
Relative Risk: 1.64 (95% CI 1.28–2.09)
p-value: p=<0.001
Elevated HOMA-IR and TG/HDLc index are independently associated with angiographic coronary artery disease, suggesting their potential utility in cardiovascular risk stratification.
Should not yet change risk stratification in angiography referrals; leaves open whether the combined index adds predictive value beyond standard factors.
BACKGROUND: Insulin-resistance is associated with cardiovascular disease but it is not used as a marker for disease in clinical practice. AIMS: To study the association between the homeostatic model assessment (HOMA-IR) and triglyceride/HDLc ratio (TG/HDLc) with the presence of coronary artery disease in patients submitted to cardiac catheterization. METHODS: In a cross-sectional study, 131 patients (57.0 +/- 10 years-old, 51.5% men) underwent clinical, laboratory and angiographic evaluation and were classified as No CAD (absence of coronary artery disease) or CAD (stenosis of more than 30% in at least one major coronary artery). RESULTS: Prevalence of coronary artery disease was 56.7%. HOMA-IR and TG/HDLc index were higher in the CAD vs No CAD group, respectively: HOMA-IR: 3.19 (1.70-5.62) vs. 2.33 (1.44-4.06), p = 0.015 and TG/HDLc: 3.20 (2.38-5.59) vs. 2.80 (1.98-4.59) p = 0.045) - median (p25-75). After a ROC curve analysis, cut-off values were selected based on the best positive predictive value for each variable: HOMA-IR = 6.0, TG/HDLc = 8.5 and [HOMA-IRxTG/HDLc] = 28. Positive predictive value for coronary artery disease for HOMA-IR>6.0 was 82.6%, for TG/HDLc>8.5 was 85.7% and for [HOMA-IRxTG/HDLc]>28 was 88.0%. Adjusted relative risk (age, gender, diabetes, body mass index, systolic blood pressure) for the presence of coronary artery disease was: for HOMA-IR>6.0, 1.47 (95.CI: 1.06-2.04, p = 0.027), for TG/HDLc>8.5, 1.46 (95% CI:1.07-1.98), p = 0.015) and for [HOMA-IR x TG/HDLc] >28, 1.64 (95%CI: 1.28-2.09), p < 0.001). CONCLUSIONS: Increased HOMA-IR, TG/HDLc and their product are positively associated with angiographic coronary artery disease, and may be useful for risk stratification as a high-specificity test for coronary artery disease.
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Bertoluci et al. (2010) conducted a cross-sectional in Coronary artery disease (n=131). [HOMA-IR × TG/HDLc] > 28 vs. [HOMA-IR × TG/HDLc] ≤ 28 was evaluated on Presence of coronary artery disease (stenosis of more than 30% in at least one major coronary artery) (RR 1.64, 95% CI 1.28-2.09, p=<0.001). The product of HOMA-IR and TG/HDLc index > 28 was significantly associated with the presence of angiographic coronary artery disease (RR 1.64).
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