Cardiac insulin resistance may predict risk of metabolic syndrome and atherosclerosis in apparently healthy individuals

Experimental evidence suggests that metabolic syndrome (MetS) is associated with changes in cardiac metabolism. Whether this association occurs in humans is unknown.

821 asymptomatic individuals from the Progression of Early Subclinical Atherosclerosis (PESA) study (50.6 [46.9–53.6] years, 83.7% male) underwent two whole-body 18F-fluorodeoxyglucose positron emission tomography-magnetic resonance (18F-FDG PET-MR) 4.8 ± 0.6 years apart. Presence of myocardial 18F-FDG uptake was evaluated qualitatively and quantitatively. No myocardial uptake was grade 0, while positive uptake was classified in grades 1–3 according to target-to-background ratio tertiles.

RESULTS

One hundred fifty-six participants (19.0%) showed no myocardial 18F-FDG uptake, and this was significantly associated with higher prevalence of MetS (29.0% vs. 13.9%, P < 0.001), hypertension (29.0% vs. 18.0%, P = 0.002), and diabetes (11.0% vs. 3.2%, P < 0.001), and with higher insulin resistance index (HOMA-IR, 1.64% vs. 1.23%, P < 0.001). Absence of myocardial uptake was associated with higher prevalence of early atherosclerosis (i.e., arterial 18F-FDG uptake, P = 0.004). On follow-up, the associations between myocardial 18F-FDG uptake and risk factors were replicated, and MetS was more frequent in the group without myocardial uptake. The increase in HOMA-IR was associated with a progressive decrease in myocardial uptake (P < 0.001). In 82% of subjects, the categorization according to presence/absence of myocardial 18F-FDG uptake did not change between baseline and follow-up. MetS regression on follow-up was associated with a significant (P < 0.001) increase in myocardial uptake.

Apparently healthy individuals without cardiac 18F-FDG uptake have higher HOMA-IR and higher prevalence of MetS traits, cardiovascular risk factors, and early atherosclerosis. An improvement in cardiometabolic profile is associated with the recovery of myocardial 18F-FDG uptake at follow-up

Reference:

Ana Devesa, Valentin Fuster, Ravi Vazirani, Inés García-Lunar, Belén Oliva, Samuel España, Andrea Moreno-Arciniegas, Javier Sanz, Cristina Perez-Herreras, Héctor Bueno, Enrique Lara-Pezzi, Ana García-Alvarez, Vicente Martínez de Vega, Leticia Fernández-Friera, Maria G. Trivieri, Antonio Fernández-Ortiz, Xavier Rossello, Javier Sanchez-Gonzalez, Borja Ibanez; Cardiac Insulin Resistance in Subjects With Metabolic Syndrome Traits and Early Subclinical Atherosclerosis. Diabetes Care 1 November 2023; 46 (11): 2050–2057.

Keywords:

Cardiac, insulin, resistance, linked, higher, incident, metabolic, syndrome, early, atherosclerosis, apparently, healthy individuals, Ana Devesa, Valentin Fuster, Ravi Vazirani, Inés García-Lunar, Belén Oliva, Samuel España, Andrea Moreno-Arciniegas, Javier Sanz, Cristina Perez-Herreras, Héctor Bueno, Enrique Lara-Pezzi, Ana García-Alvarez, Vicente Martínez de Vega, Leticia Fernández-Friera, Maria G. Trivieri, Antonio Fernández-Ortiz, Xavier Rossello, Javier Sanchez-Gonzalez, Borja Ibanez