Association of microalbuminuria and fasting insulin levels with presence and severity of coronary artery disease in non-diabetic cases

Abstract

Objective: In this study we aimed to determine the relation of presence and severity of coronary artery disease with microalbuminuria, fasting insulin levels and the classical risk factors in non-diabetic patients.

Methods: We enrolled 100 non-diabetic patients that had an indication for coronary angiography. Group I consisted of 55 patients with coronary artery disease, and 45 patients without coronary artery disease were included in Group 2. The study was cross-sectional and case-controlled. In all patients 24-hour microalbuminuria, serum total, high density lipoprotein (HDL), low density lipoprotein (LDL) cholesterol and lipoprotein a, triglyceride, fasting blood sugar levels were obtained. Fasting insulin levels were determined and routine urinary tests were performed. Gensini scoring was done for determination of the severity of coronary artery disease. Statistical analysis was performed using unpaired t test, Mann-Whitney U test, Chi-square test, ROC analysis and multiple logistic regression analysis.

Results: Microalbuminuria levels (p<0.001), fasting insulin levels (p<0.001), mean age (p=0.01), pulse pressure (p=0.014), LDL cholesterol levels (p=0.004), lipoprotein a levels (p<0.001) were significantly higher and HDL cholesterol levels were significantly lower (p=0.015) in Group 1 compared to the Group 2. Male gender was more frequent in Group 1 (p<0.001). With cut-off values defined by ROC analysis microalbuminuria (118 mu gr/min, sensitivity: 91 %, specificity: 45%, area under the curve: 0.790, 95% Cl 2.43-15.96, p<0.001) increased probability of coronary artery disease by 6.2-fold and fasting insulin level higher than 10 mu IU/ml by 11 folds at multivariate logistic regression analysis. When the cases were evaluated according to the Gensini scoring there was a significant association of coronary artery disease and microalbuminuria (r=0.52, P<0.001).

Conclusion: We concluded that in non-diabetic cases microalbuminuria and increased fasting insulin levels were predictors of presence and the severity of coronary artery disease and can be suggested as risk factors.