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The Relationship of Insulin Resistance and Systemic Inflammation with Cardiovascular Outcomes in Non-Diabetic Patients Undergoing Coronary Artery Bypass Grafting

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Titel: The Relationship of Insulin Resistance and Systemic Inflammation with Cardiovascular Outcomes in Non-Diabetic Patients Undergoing Coronary Artery Bypass Grafting
Autoren: Yingying Xie, Hao Chen, Yanxiang Gao, Haoming He, Zhe Wang, Yaru Zhang, Qiaochu Zhou, Ling Liu, Jingang Zheng
Quelle: J Inflamm Res
Journal of Inflammation Research, Vol Volume 18, Iss Issue 1, Pp 9031-9043 (2025)
Verlagsinformationen: Informa UK Limited, 2025.
Publikationsjahr: 2025
Schlagwörter: systemic inflammation, insulin resistance, coronary artery bypass grafting, Pathology, RB1-214, Therapeutics. Pharmacology, RM1-950, non-diabetic, Original Research
Beschreibung: BACKGROUND: Insulin resistance (IR) is linked to adverse cardiovascular outcomes, but its mechanisms are not fully understood. This study investigates the relationship between IR and systemic inflammation and evaluates how systemic inflammation affects the correlation between IR and prognosis in non-diabetic patients undergoing coronary artery bypass grafting (CABG). METHODS: This study enrolled 1,658 patients post-CABG. IR was assessed via the estimated glucose disposal rate (eGDR), and systemic inflammation was measured by C-reactive protein (CRP) levels. The correlation between eGDR and CRP was analyzed using linear regression. Associations of eGDR and CRP with major adverse cardiovascular and cerebrovascular events (MACCEs) were evaluated through the Kaplan–Meier method, restricted cubic splines (RCS), and adjusted Cox regression analyses. A novel two-stage regression method for survival data was used in the mediation analysis. RESULTS: Over a median follow-up period of 60.9 months, 414 MACCEs cases were documented. The RCS analysis revealed an L-shaped association between eGDR and MACCEs with an approximate threshold of 8 mg/kg/min, whereas CRP exhibited a linear positive dose-response relationship with MACCEs. Compared with individuals in the high eGDR and low CRP group (eGDR > 8 and CRP < 3), those in the low eGDR and high CRP group (eGDR ≤ 8 and CRP ≥ 3) showed the highest risk for MACCEs (hazard ratio [HR] = 2.282, 95% confidence interval [CI] 1.749–2.978). Mediation analysis indicated that CRP levels mediated 12.3% of the correlation between eGDR and MACCEs. CONCLUSION: eGDR showed a negative correlation with CRP levels, and their synergistic relationship enhanced the prediction of MACCEs in non-diabetic patients undergoing CABG. Additionally, CRP levels partially mediated the association between eGDR and MACCEs. Anti-inflammatory treatment for non-diabetic individuals with high IR who underwent CABG may offer further benefits.
Publikationsart: Article
Other literature type
Sprache: English
ISSN: 1178-7031
DOI: 10.2147/jir.s514852
Zugangs-URL: https://doaj.org/article/da7193cfbd0449e6878659627c4db96c
Rights: CC BY NC
URL: http://creativecommons.org/licenses/by-nc/4.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at http://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v4.0) License (http://creativecommons.org/licenses/by-nc/4.0/ (http://creativecommons.org/licenses/by-nc/4.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (http://www.dovepress.com/terms.php).
Dokumentencode: edsair.doi.dedup.....ea5c833c923c065bafd784442d8d9be3
Datenbank: OpenAIRE
Beschreibung
Abstract:BACKGROUND: Insulin resistance (IR) is linked to adverse cardiovascular outcomes, but its mechanisms are not fully understood. This study investigates the relationship between IR and systemic inflammation and evaluates how systemic inflammation affects the correlation between IR and prognosis in non-diabetic patients undergoing coronary artery bypass grafting (CABG). METHODS: This study enrolled 1,658 patients post-CABG. IR was assessed via the estimated glucose disposal rate (eGDR), and systemic inflammation was measured by C-reactive protein (CRP) levels. The correlation between eGDR and CRP was analyzed using linear regression. Associations of eGDR and CRP with major adverse cardiovascular and cerebrovascular events (MACCEs) were evaluated through the Kaplan–Meier method, restricted cubic splines (RCS), and adjusted Cox regression analyses. A novel two-stage regression method for survival data was used in the mediation analysis. RESULTS: Over a median follow-up period of 60.9 months, 414 MACCEs cases were documented. The RCS analysis revealed an L-shaped association between eGDR and MACCEs with an approximate threshold of 8 mg/kg/min, whereas CRP exhibited a linear positive dose-response relationship with MACCEs. Compared with individuals in the high eGDR and low CRP group (eGDR > 8 and CRP < 3), those in the low eGDR and high CRP group (eGDR ≤ 8 and CRP ≥ 3) showed the highest risk for MACCEs (hazard ratio [HR] = 2.282, 95% confidence interval [CI] 1.749–2.978). Mediation analysis indicated that CRP levels mediated 12.3% of the correlation between eGDR and MACCEs. CONCLUSION: eGDR showed a negative correlation with CRP levels, and their synergistic relationship enhanced the prediction of MACCEs in non-diabetic patients undergoing CABG. Additionally, CRP levels partially mediated the association between eGDR and MACCEs. Anti-inflammatory treatment for non-diabetic individuals with high IR who underwent CABG may offer further benefits.
ISSN:11787031
DOI:10.2147/jir.s514852