Insulin-sensitizing therapy suppresses CV risk markers
MedWire News: An insulin-sensitizing (IS) strategy for glycemic control leads to lower concentrations of biomarkers for cardiovascular (CV) risk than an insulin-providing (IP) strategy, report US researchers.
The IS strategy caused a change in biomarker profiles indicative of decreased insulin resistance, constrained fibrinolysis, and reduced systemic inflammation in diabetic patients with coronary artery disease (CAD), say the authors.
As reported in the journal Circulation, Burton Sobel (University of Vermont, Burlington, US) and team assessed biomarker profiles of 2368 patients with Type 2 diabetes and CAD. The patients had been randomized to either an IS or an IP strategy during the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial.
The authors found that, although the IS and IP strategies had a comparable impact on CV events, they had different effects on biomarker profile.
An IS strategy compared with an IP strategy led to significantly lower concentrations of plasma insulin, tissue plasminogen activator antigen, plasminogen activator inhibitor type 1 antigen and activity, CRP, and fibrinogen over a 5-year follow-up period.
Interestingly, the IS strategy was associated with a 1.57-ng/ml lower concentration of tissue plasminogen activator (known to track with plasminogen activator inhibitor type 1), as well as a 15% lower concentration of plasminogen activator inhibitor type 1 antigen.
"Thus, the IS, compared with the IP strategy, was associated with a marked and directionally different change in the biomarker profile indicative of a shift in the balance between fibrinolysis and thrombosis favoring fibrinolysis," explain the authors.
They add that the same was true with respect to reduction of intensity of inflammation, as reflected by CRP levels in patients receiving IS treatment.
"However, the possibility that the biomarker profiles portend clinical outcomes will require comparisons of large numbers of patients over prolonged intervals stratified with respect to changes in biomarker profiles induced by specific treatment strategies," they conclude.
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By Sally Robertson