Copyright © 1998 by the European Society of Cardiology.
Components of the insulin resistance syndrome are associated with progression of atherosclerosis in non-grafted arteries 5 years after coronary artery bypass surgery
a Department of Medicine, Turku University Hospital, Turku
b Department of Medicine, Division of Cardiology, Helsinki University Hospital, Helsinki
c Research and Development Centre of the Social Insurance Institution, Turku, Finland
accepted February 20, 1998
Aims
Risk factors for progression of atherosclerosis in non-grafted coronary arteries were examined in a prospective 5-year follow-up study of 228 consecutive coronary artery bypass surgery patients, with the main emphasis on insulin resistance syndrome.
Methods and Results
Serum lipids and lipoproteins were measured pre-operatively and 1, 2, 3 and 5 years after surgery; and a baseline oral glucose tolerance test with plasma insulin determinations was performed pre-operatively. Progression of atherosclerosis was assessed by means of computer-based quantitative coronary angiography. Compared to subjects without progression, the patients with progression of atherosclerotic lesions had a higher body mass index both at baseline (P=0·022) and at 5 years (P=0·007), were more often treated for hyper-tension at baseline (P=0·008) and at 5 years (P=0·012), used diuretics more often during the follow-up period (P=0·002), had a larger blood glucose area under the curve (P=0·015) and a lower insulin sensitivity index (P=0·006) in the baseline oral glucose tolerance test, had a higher serum total cholesterol concentration at baseline (P=0·044), and a higher serum triglyceride concentration (P=0·005) during the whole follow-up period. Clustering of the components of insulin resistance syndrome at baseline was more frequently found in patients with progression of atherosclerotic lesions than in patients without progression (P=0·025). For example, for patients with 
1 component, the risk of progression was 17%, while for patients with 
5 components the risk was 67%. As compared to the other patients, those with new atherosclerotic lesions had a lower insulin sensitivity index at baseline (P=0·033), and a lower serum high density lipoprotein cholesterol concentration during the follow-up period (P=0·033).
Conclusion
In addition to high serum cholesterol, the components of the insulin resistance syndrome are associated with progression of atherosclerosis in non-grafted coronary arteries 5 years after coronary artery bypass surgery
Key Words: Atherosclerosis • coronary bypass surgery • triglycerides • insulin resistance
f1 Correspondence: Kari Korpilahti, MD, Department of Medicine, Central Hospital of Vaasa, Hietalahdenkatu 2-4, FIN-65130 Vaasa, Finland.
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