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Heart. Oct 1999; 82(4): 443–447.
PMCID: PMC1760262

Significance of an index of insulin resistance on admission in non-diabetic patients with acute coronary syndromes


BACKGROUND—Insulin resistance is associated with ischaemic heart disease and has been proposed as a risk factor for subsequent myocardial infarction.
AIM—To investigate the potential use of a recently proposed insulin resistance index in identifying insulin resistance in patients admitted with an acute coronary syndrome.
METHODS—Single centre study of 441 non-diabetic patients admitted with chest pain to a coronary care unit and followed prospectively for a median of three years for outcome. Admission glucose and insulin concentrations were measured and from these values an admission index of insulin resistance (AIRI) calculated. Its association with other known factors in the insulin resistance syndrome, and subsequent outcome, was examined.
RESULTS—The AIRI was greater in patients with myocardial infarction than in a control group without myocardial infarction (p < 0.0001). A Cox regression model for subsequent cardiac death identified previous myocardial infarction (p < 0.0001), infarct size (p < 0.0001), and AIRI (p = 0.0033) as positive risk predictors. Patients of Indian subcontinent ethnic origin had greater AIRI values than white patients: mean (SD) 7.5 (1.3) v 4.6 (0.2), p < 0.001.
CONCLUSIONS—A simple index of insulin resistance measured on patients admitted with myocardial infarction provides an important predictive measure of poor outcome and is superior to admission glucose measurement. It may be useful in identifying patients admitted with myocardial infarction who could benefit from alternative early management strategies.

Keywords: myocardial infarction; unstable angina; insulin resistance; glucose

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Selected References

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  • DeFronzo RA, Tobin JD, Andres R. Glucose clamp technique: a method for quantifying insulin secretion and resistance. Am J Physiol. 1979 Sep;237(3):E214–E223. [PubMed]
  • DeFronzo RA, Ferrannini E. Insulin resistance. A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care. 1991 Mar;14(3):173–194. [PubMed]
  • McKeigue PM, Shah B, Marmot MG. Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet. 1991 Feb 16;337(8738):382–386. [PubMed]
  • Caro JF. Clinical review 26: Insulin resistance in obese and nonobese man. J Clin Endocrinol Metab. 1991 Oct;73(4):691–695. [PubMed]
  • Oswald GA, Smith CC, Betteridge DJ, Yudkin JS. Determinants and importance of stress hyperglycaemia in non-diabetic patients with myocardial infarction. Br Med J (Clin Res Ed) 1986 Oct 11;293(6552):917–922. [PMC free article] [PubMed]
  • Duncan MH, Singh BM, Wise PH, Carter G, Alaghband-Zadeh J. A simple measure of insulin resistance. Lancet. 1995 Jul 8;346(8967):120–121. [PubMed]
  • Cleland SJ, Petrie JR, Morris AD, Ueda S, Dorrian CA, Connell JM. FIRI: a fair insulin resistance index? Lancet. 1996 Mar 16;347(9003):770–770. [PubMed]
  • Oliver MF, Opie LH. Effects of glucose and fatty acids on myocardial ischaemia and arrhythmias. Lancet. 1994 Jan 15;343(8890):155–158. [PubMed]
  • Collinson PO, Moseley D, Stubbs PJ, Carter GD. Troponin T for the differential diagnosis of ischaemic myocardial damage. Ann Clin Biochem. 1993 Jan;30(Pt 1):11–16. [PubMed]
  • Hamm CW, Ravkilde J, Gerhardt W, Jørgensen P, Peheim E, Ljungdahl L, Goldmann B, Katus HA. The prognostic value of serum troponin T in unstable angina. N Engl J Med. 1992 Jul 16;327(3):146–150. [PubMed]
  • Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985 Jul;28(7):412–419. [PubMed]
  • Bergman RN, Prager R, Volund A, Olefsky JM. Equivalence of the insulin sensitivity index in man derived by the minimal model method and the euglycemic glucose clamp. J Clin Invest. 1987 Mar;79(3):790–800. [PMC free article] [PubMed]
  • Yarnell JW, Patterson CC, Sweetnam PM. Simple measure of insulin resistance. Lancet. 1995 Oct 21;346(8982):1108–1109. [PubMed]
  • Del Prato S, Pozzilli P. FIRI: fasting or false insulin resistance index? Lancet. 1996 Jan 13;347(8994):132–132. [PubMed]
  • Reaven GM. Role of insulin resistance in human disease (syndrome X): an expanded definition. Annu Rev Med. 1993;44:121–131. [PubMed]
  • Malmberg K, Rydén L, Efendic S, Herlitz J, Nicol P, Waldenström A, Wedel H, Welin L. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. J Am Coll Cardiol. 1995 Jul;26(1):57–65. [PubMed]
  • Opie LH. Glucose and the metabolism of ischaemic myocardium. Lancet. 1995 Jun 17;345(8964):1520–1521. [PubMed]
  • Neely JR, Grotyohann LW. Role of glycolytic products in damage to ischemic myocardium. Dissociation of adenosine triphosphate levels and recovery of function of reperfused ischemic hearts. Circ Res. 1984 Dec;55(6):816–824. [PubMed]

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