Published online before print October 6, 2003, doi: 10.1161/01.CIR.0000095272.67948.17
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(Circulation. 2003;108:2074.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Association of Insulin Resistance, Hyperleptinemia, and Impaired Nitric Oxide Release With In-Stent Restenosis in Patients Undergoing Coronary Stenting
From the Cardiovascular and Metabolic Rehabilitation Unit, Rehabilitation and Functional Reeducation Division, and Laboratory L20, Core Lab, Diabetology, Endocrinology, Metabolic Disease Unit, IRCCS H. San Raffaele (P.P., L.D.M., E.S., P.L., E.G., C.R., A.O.); Catheterization Laboratories, IRCCS H. San Raffaele (C.D.M., F.S., A.C.); Clinical Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS H. San Raffaele (G.F., A.M.), Milan; Nutrition and Metabolism Unit, Medicine Division, IRCCS H. San Raffaele (A.C.); and Department of Internal Medicine and Biochemical Science, Parma University (I.Z.), Parma, Italy.
Correspondence to PierMarco Piatti, MD, Cardiovascular and Metabolic Rehabilitation Unit, Medicine Division, Via Olgettina 60, 20132 Milano, Italy. E-mail piermarco.piatti{at}hsr.it
Received February 18, 2003; de novo received June 2, 2003; revision received July 29, 2003; accepted July 29, 2003.
Background— Previously undiagnosed diabetes, impaired glucose tolerance, and insulin resistance are common in patients with acute myocardial infarction and coronary heart disease (CHD) and might be involved in early restenosis after stent implantation. To evaluate whether markers of insulin resistance syndrome, including leptin, and endothelial dysfunction are related to increased rate of early restenosis, we studied nondiabetic patients with CHD after successful coronary stenting.
Methods and Results— Both patients with CHD undergoing coronary stenting (120 patients) and control subjects (58 patients) were submitted to an oral glucose tolerance test (OGTT). Fasting leptin levels and fasting and postglucose load insulin sensitivity were assessed. Endothelial function was measured by nitrite and nitrate release (NOx) during OGTT. More than 50% of patients treated with stent implantation presented impaired glucose tolerance or type 2 diabetes, which was previously undiagnosed. These patients also had higher glucose, insulin, and leptin levels than control subjects. Among the stented patients, insulin and leptin levels were higher in patients with restenosis than in patients without restenosis. A significant increase in NOx levels was found during OGTT both in patients without restenosis and in control subjects. On the contrary, NOx profiles were blunted in patients with restenosis. At multiple regression analysis, only 
AUC-NOx areas and insulin sensitivity index showed an independent correlation with the minimal lumen diameter at follow-up.
Conclusions— We demonstrated that insulin resistance and endothelial dysfunction are independent predictors of early restenosis after coronary stenting.
Key Words: restenosis • diabetes mellitus • coronary disease • metabolism • nitric oxide
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