HYPERINSULINEMIA AS A PREDICTING BIOMARKER OF CORONARY ARTERY DISEASE IN METABOLIC SYNDROME

Background: Insulin resistance and its metabolic consequences are increasingly being recognized as risk factors for Coronary Artery Disease (CAD). Being obese and the further accumulation of CAD risk factors related to insulin resistance, creates a state of high risk for diabetes mellitus and coronary artery diseases. Objectives: To find out the prevalence of hyperinsulinemia in individuals with metabolic syndrome, both in patients with and without coronary artery disease (CAD). To assess the role of hyperinsulinemia as predictor of CAD risk in metabolic syndrome patients Materials and Methods: In this comparative, cross-sectional study, 200 patients with clinically diagnosed metabolic syndrome according to the NCEP ATP III criterion were selected out of which 100 were diagnosed cases of CAD (cases) selected from the CCU of Cardiology department and 100 without CAD (controls) were selected from the OPD of Endocrinology department of our tertiary care NIMS Hospital. For estimation of fasting serum insulin & lipid profile, fasting blood sample was collected and were performed in the Central Biochemistry Laboratory, NIMS Hospital. Results: Our study investigated the relationship between Metabolic Syndrome (MetS) and Coronary Artery Disease (CAD). We found that MetS patients with CAD were significantly older than those without CAD. Furthermore, CAD patients exhibited elevated fasting insulin levels, with a median value of 10.42 μIU/ml (6.49-19.55), compared to 9.47 μIU/ml (6.28-13.28) in non-CAD patients. Hyperinsulinemia was also more prevalent in CAD patients, affecting 17% of this group versus 6% of non-CAD patients. Additionally, median HOMA-IR values were higher in CAD patients (2.61 [1.898-5.07]) than in non-CAD patients (2.38 [1.45-3.42]). Although LDL and TAG levels were comparable between groups, HDL levels were significantly lower in CAD patients (p < 0.001).  Logistic regression analysis revealed that MetS with CAD patients who had high fasting insulin levels had a 3.4-fold increased risk of developing CAD compared to MetS patients without CAD. Conclusion: Our research suggests that Hyperinsulinemia (elevated insulin levels) serves as a reliable predictive biomarker for CAD in patients with Metabolic Syndrome (MetS), making it a valuable tool for diagnostic monitoring and follow-up care, ultimately enhancing the prevention and management of CAD in this patient population