Anti-Inflammatory and Profibrinolytic Effect of Insulin in Acute ST-Segment-Elevation Myocardial Infarction

Ajay Chaudhuri, David Janicke, Michael F. Wilson, Devjit Tripathy, Rajesh Garg, Arindam Bandyopadhyay, Janeen Calieri, Debbie Hoffmeyer, Tufail Syed, Husam Ghanim, Ahmad Aljada, Paresh Dandona

Research output: Contribution to journalArticlepeer-review

245 Scopus citations

Abstract

Background - The clinical benefits of insulin previously observed in acute ST-segment-elevation myocardial infarction (STEMI) may be partially explained by an anti-inflammatory effect. We assessed this potential effect of insulin in STEMI patients treated with fibrinolytics. Methods and Results - Thirty-two patients receiving reteplase were randomly assigned infusions of either insulin at 2.5 U/h, dextrose, and potassium (GIK) or normal saline and potassium (C) for 48 hours. Plasma concentrations of high-sensitivity C-reactive protein (CRP), serum amyloid A (SAA), plasminogen activator inhibitor-1 (PAI-1), creatine kinase (CK), and CK-MB were measured at baseline and sequentially for 48 hours. Total p47 phox protein in mononuclear cells was measured in a subgroup of 13 subjects. Baseline CRP and SAA were significantly increased (2- to 4-fold) at 24 and 48 hours in each group (P<0.01). However, in the insulin group, there was a significant (P<0.05) attenuation of the absolute rise in concentration of CRP and SAA from baseline. The absolute increase of CRP and SAA was reduced by 40% (CRP) and 50% (SAA) at 24 hours and at 48 hours compared with the control group. The absolute increase in PAI-1 from baseline and the percentage increase in p47 phox over 48 hours were significantly (P<0.05) lower in the insulin-treated group. CK-MB peaked earlier and tended to be lower in insulin-treated subjects, especially in patients with inferior MI. Conclusions - Insulin has an anti-inflammatory and profibrinolytic effect in patients with acute MI. These effects may contribute to the clinical benefits of insulin in STEMI.

Original languageEnglish (US)
Pages (from-to)849-854
Number of pages6
JournalCirculation
Volume109
Issue number7
DOIs
StatePublished - Feb 24 2004

Keywords

  • Atherosclerosis
  • Inflammation
  • Insulin
  • Myocardial infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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