Acute-phase HOMA2-IR and in-hospital cardiovascular complications in patients with acute coronary syndrome without known diabetes.

Q: What are the key findings of this study?

Acute-phase insulin resistance (HOMA2-IR ≥1.35) was associated with higher odds of in-hospital composite MACE in non-diabetic ACS patients (28.5% vs 15.7%; adjusted OR 3.08, 95% CI 1.55-6.14, P=0.001).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute coronary syndrome without known diabetes (n=252). Intervention: Acute-phase insulin resistance (HOMA2-IR ≥1.35 measured 24-48 hours after admission) vs. No insulin resistance (HOMA2-IR <1.35). Primary outcome: In-hospital composite MACE (cardiac death; acute heart failure, cardiogenic shock, or pulmonary edema; acute mechanical complication; severe ventricular arrhythmia or cardiac arrest; and recurrent ischemia, reinfarction, or unplanned coronary revascularization) (OR 3.08, 95% CI 1.55-6.14, p=0.001).

Q: What does this research mean for the field?

Acute-phase HOMA2-IR-defined insulin resistance is associated with an increased risk of in-hospital cardiovascular complications, predominantly heart failure-related events, in acute coronary syndrome patients without known diabetes. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Nguyen Ngoc Minh Thu; Bui The Dung; Lâm Vĩnh Niên; Vu Hoang Vu; Vu Hoang Vu; Nguyen Chi Thanh

doi:10.7417/ct.2026.2164

November 1, 2026LinhasOpen Access

Acute-phase HOMA2-IR and in-hospital cardiovascular complications in patients with acute coronary syndrome without known diabetes.

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Key result

Acute-phase insulin resistance is linked to ~3.1-fold higher odds of in-hospital MACE in non-diabetic ACS.

OR 3.08
95% CI 1.55-6.14
P=0.001
n=252

Why the study?

Insulin resistance during ACS may reflect pre-existing metabolic vulnerability and the response to acute illness, motivating an evaluation of its association with in-hospital cardiovascular complications in patients without known diabetes.

Is acute-phase HOMA2-IR-defined insulin resistance (HOMA2-IR ≥1.35) associated with in-hospital cardiovascular complications (composite MACE) in patients with acute coronary syndrome without known diabetes?

Key Points

To examine whether acute-phase insulin resistance measured by HOMA2-IR is associated with in-hospital cardiovascular complications in acute coronary syndrome patients without known diabetes.
Prospective single-center cohort of 252 patients with acute coronary syndrome and admission HbA1c <6.5%, evaluating fasting glucose and insulin 24 to 48 hours post-admission.
Insulin resistance was defined using a prespecified HOMA2-IR cutoff of ≥1.35 derived from healthy controls.
Primary outcome was a composite in-hospital MACE evaluated via logistic and modified Poisson regression adjusted for age, sex, BMI, smoking, and hypertension.
Insulin resistance occurred in 54.4% (137/252) of patients, and composite MACE developed in 28.5% (39/137) of insulin-resistant versus 15.7% (18/115) of non-resistant patients (risk difference 12.8 percentage points, 95% CI 2.5–22.6).
Insulin resistance was independently associated with composite MACE (adjusted OR 3.08, 95% CI 1.55–6.14; adjusted RR 2.29, 95% CI 1.39–3.75), with each doubling of HOMA2-IR conferring higher risk (adjusted OR 1.47, 95% CI 1.09–1.99).
Complications were predominantly heart-failure-related, accounting for 53 of 57 events, and the association was attenuated after adjusting for left ventricular ejection fraction (adjusted OR 2.25, 95% CI 0.97–5.22).

Study Design

Type

Cohort (n=252)

Multicenter

No

Structured PICO

Is acute-phase HOMA2-IR-defined insulin resistance (HOMA2-IR ≥1.35) associated with in-hospital cardiovascular complications (composite MACE) in patients with acute coronary syndrome without known diabetes?

P

Population

252 adult patients (33.7% female) in Vietnam with acute coronary syndrome without known diabetes (admission HbA1c <6.5%), evaluated for cardiovascular complications during the index hospitalization.

E

Exposure

Acute-phase insulin resistance defined as HOMA2-IR ≥1.35, calculated from paired fasting glucose and insulin concentrations measured after at least an 8-hour fast at 24–48 hours after hospital admission (n=137, 54.4%).

C

Comparator

No insulin resistance defined as HOMA2-IR <1.35 measured 24–48 hours after hospital admission (n=115, 45.6%).

O

Outcome

In-hospital major adverse cardiovascular events (MACE) occurring between HOMA2-IR sampling (24-48 hours after admission) and hospital discharge or in-hospital death, adjudicated from medical records as a composite of: (1) cardiac death; (2) acute heart failure–related events (acute heart failure, cardiogenic shock, or pulmonary edema); (3) acute mechanical complication; (4) severe ventricular arrhythmia or cardiac arrest; and (5) recurrent ischemia, reinfarction, or unplanned coronary revascularization.composite

Main Result

Odds Ratio: 3.08 (95% CI 1.55–6.14)

Absolute Event Rate: 28.5% vs 15.7%

p-value: p=0.001

Limitations

HOMA2-IR was measured only once during the acute phase and may reflect both pre-existing insulin resistance and the metabolic response to ACS.
The composite MACE was dominated by heart-failure-related complications (53 of 57 events).
Single-center analysis restricted to patients who survived and remained stable enough to undergo fasting metabolic sampling, limiting generalizability to the whole spectrum of ACS.
Exact event times were not recorded, so time-to-event analyses were not performed.
Reverse causation cannot be excluded because heart failure, shock, and myocardial injury can alter glucose and insulin concentrations.
Single-center analysis restricted to patients who survived and remained stable enough to undergo fasting metabolic sampling, limiting generalizability.
Exact event times were not recorded, precluding time-to-event analyses.
Reverse causation cannot be excluded as heart failure, shock, and myocardial injury can alter glucose and insulin concentrations.

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Implication

In patients with ACS without known diabetes, acute-phase insulin resistance (HOMA2-IR ≥1.35) is independently associated with a more than two-fold higher risk of in-hospital cardiovascular complications, predominantly driven by acute heart failure and hemodynamic instability.

Abstract

Background: Insulin resistance measured during acute coronary syndrome (ACS) may reflect pre-existing metabolic vulnerability as well as the response to acute illness. We examined its association with cardiovascular complications arising during the index hospitalization in patients with ACS and no known diabetes. Methods: In this single-center prospective cohort, 252 patients with ACS and an admission HbA1c <6.5% had fasting glucose and insulin measured 24-48 hours after admission. Insulin resistance was defined by a HOMA2-IR threshold of ≥1.35 prespecified from independent healthy controls. The composite MACE outcome comprised five prespecified complications occurring between sampling and discharge or death. Logistic and modified Poisson regression were adjusted for age, sex, body mass index, smoking, and hypertension. Results: Insulin resistance was present in 137 patients (54.4%), and the composite MACE occurred in 57 (22.6%): 28.5% with versus 15.7% without insulin resistance; risk difference 12.8 percentage points (95% CI 2.5-22.6). Insulin resistance was associated with the composite (adjusted OR 3.08, 95% CI 1.55-6.14; adjusted RR 2.29, 95% CI 1.39-3.75); each doubling of HOMA2-IR was associated with higher odds (adjusted OR 1.47, 95% CI 1.09-1.99). The association persisted after GRACE adjustment (adjusted OR 2.83, 95% CI 1.32-6.06) and was attenuated after adding left ventricular ejection fraction, a possible mediator (adjusted OR 2.25, 95% CI 0.97-5.22). Acute heart failure, cardiogenic shock, or pulmonary edema accounted for 53 of the 57 events. Conclusions: Acute-phase HOMA2-IR-defined insulin resistance was associated with cardiovascular complications during the index hospitalization, mainly heart-failure-related events. These findings are associational and require confirmation in multicenter cohorts.

Discussion

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Cite This Study

Thu et al. (2026) conducted a cohort in Acute coronary syndrome without known diabetes (n=252). Acute-phase insulin resistance (HOMA2-IR ≥1.35 measured 24-48 hours after admission) vs. No insulin resistance (HOMA2-IR <1.35) was evaluated on In-hospital composite MACE (cardiac death; acute heart failure, cardiogenic shock, or pulmonary edema; acute mechanical complication; severe ventricular arrhythmia or cardiac arrest; and recurrent ischemia, reinfarction, or unplanned coronary revascularization) (OR 3.08, 95% CI 1.55-6.14, p=0.001). Acute-phase insulin resistance (HOMA2-IR ≥1.35) was associated with higher odds of in-hospital composite MACE in non-diabetic ACS patients (28.5% vs 15.7%; adjusted OR 3.08, 95% CI 1.55-6.14, P=0.001).

synapsesocial.com/papers/6ae978e834f3420dc6e6eb4e https://doi.org/10.7417/ct.2026.2164

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Acute-phase HOMA2-IR and in-hospital cardiovascular complications in patients with acute coronary syndrome without known diabetes.

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Acute-phase HOMA2-IR and in-hospital cardiovascular complications in patients with acute coronary syndrome without known diabetes.

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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