Abstract 15653: Insulin Resistance is Associated With Low Systemic Vascular Resistance in Non-Diabetic Individuals After Cardiac Surgery

• Published in: Circulation (New York, N.Y.) Vol. 138; no. Suppl_1 Suppl 1; p. A15653
• Main Authors: Carew, David, Tiong, Jonathan, Reid, David, Duve, Karen, Mack, Jane, Baradi, Arul, Newcomb, Andrew, Wilson, Andrew
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 06.11.2018
• ISSN: 0009-7322

BackgroundPost-operative decreases in systemic vascular resistance (SVR) are associated with prolonged ICU stay and increased morbidity. Insulin resistance (IR) has been described as a component of systemic inflammation and endothelial dysfunction which may lead to low SVR. We hypothesised that IR in non-diabetic individuals undergoing cardiac surgery would be associated with clinically significant low post-operative SVR.MethodsWe analysed data from a prospective cohort study of 699 non-diabetic individuals who underwent cardiac surgery at a large tertiary hospital between 2012 and 2017. All participants had post-operative SVR recorded during ICU stay. Patients with a recorded SVR ≤ 800 dyn·s·cm were considered low SVR (n = 399). Fasting insulin and glucose were collected. Patients above median homeostatic model assessment of IR (HOMA-IR) were considered insulin resistant.ResultsHOMA-IR, as well as increasing age, male sex, total cholesterol, high-density lipoprotein (HDL), BMI, and history of coronary disease were significantly associated with low SVR on bivariate analysis (p < 0.05). Exercise capacity and dysglycemia were similar between groups. Using a multivariate logistic regression model, we found HOMA-IR (OR = 1.7, CI 95%1.2-2.4; p = 0.001) independently predicted low SVR in non-diabetic patients when adjusted for age, sex, and other risk factors but not BMI. Male sex (OR = 3.9, CI 95%2.6-5.9; p < 0.001) had the strongest independent association with low SVR.ConclusionsIR is independently associated with clinically significant low post-operative SVR in non-diabetic individuals who underwent cardiac surgery. This data supports pathophysiological hypotheses that suggest IR as a component of vascular dysfunction resulting in low SVR. This novel, preliminary finding warrants further research of IR as a clinical tool for predicting low SVR in other non-cardiac surgical patients.