Insulin resistance (IR) is associated with coronary artery disease (CAD) severity. However, its underlying mechanisms are not fully understood. Therefore, our study aimed to explore the relationship between IR and coronary inflammation and investigate the synergistic and mediating effects of coronary inflammation on the association between IR and CAD severity. Consecutive patients with CAD who underwent coronary angiography and coronary computed tomography angiography between April 2018 and March 2023 were enrolled. The triglyceride–glucose index (TyG index) and peri-coronary adipose tissue (PCAT) attenuation around the proximal right coronary artery (RCA) were used to evaluate IR and coronary inflammation, respectively. The correlation between the TyG index and PCAT attenuation was analyzed using linear regression models. Logistic regression models were further used for investigating the correlation of the TyG index and PCAT attenuation with CAD severity. A mediation analysis assessed the correlation between IR and CAD severity mediated by coronary inflammation. A total of 569 participants (mean age, 62 ± 11 years; 67.8% men) were included in the study. PCAT attenuation was positively associated with the TyG index (r = 0.166; P < 0.001). After adjusting for potential confounders, the per standard deviation increment in the TyG index was associated with a 1.791 Hounsfield unit (HU) increase (95% confidence interval [CI], 0.920–2.662 HU; P < 0.001) in the PCAT attenuation. In total, 382 (67.1%) patients had multivessel CAD. The patients in the high-TyG index/high PCAT attenuation group had approximately 3.2 times the odds of multivessel CAD compared with those in the low-TyG index/low PCAT attenuation group (odds ratio, 3.199; 95%CI, 1.826–5.607; P < 0.001). Mediation analysis indicated that PCAT attenuation mediated 31.66% of the correlation between the TyG index and multivessel CAD. The TyG index positively correlated with PCAT attenuation in patients with CAD. The TyG index and PCAT attenuation showed a synergistic correlation with multivessel CAD. Furthermore, PCAT attenuation partially mediated the relationship between the TyG index and CAD severity. Controlling inflammation in patients with high IR and coronary inflammation may provide additional benefits.

中文翻译：

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冠状动脉疾病患者的胰岛素抵抗和冠状动脉炎症：一项横断面研究

胰岛素抵抗 (IR) 与冠状动脉疾病 (CAD) 的严重程度相关。然而，其基本机制尚不完全清楚。因此，我们的研究旨在探讨IR和冠状动脉炎症之间的关系，并研究冠状动脉炎症对IR和CAD严重程度之间关系的协同和中介作用。2018 年 4 月至 2023 年 3 月期间连续接受冠状动脉造影和冠状动脉计算机断层扫描血管造影的 CAD 患者入组。甘油三酯-葡萄糖指数（TyG 指数）和近端右冠状动脉（RCA）周围冠状动脉周围脂肪组织（PCAT）衰减分别用于评估 IR 和冠状动脉炎症。使用线性回归模型分析 TyG 指数和 PCAT 衰减之间的相关性。Logistic 回归模型进一步用于研究 TyG 指数和 PCAT 衰减与 CAD 严重程度的相关性。中介分析评估了冠状动脉炎症介导的 IR 和 CAD 严重程度之间的相关性。该研究共有 569 名参与者（平均年龄 62 ± 11 岁；67.8% 为男性）。PCAT 衰减与 TyG 指数呈正相关（r = 0.166；P < 0.001）。调整潜在的混杂因素后，TyG 指数的每标准差增量与 PCAT 衰减的 1.791 Hounsfield 单位 (HU) 增加相关（95% 置信区间 [CI]，0.920–2.662 HU；P < 0.001）。总共有 382 名 (67.1%) 患者患有多支血管 CAD。与低 TyG 指数/低 PCAT 衰减组患者相比，高 TyG 指数/高 PCAT 衰减组患者发生多支 CAD 的几率约为 3.2 倍（比值比，3.199；95% CI，1.826-5.607； P < 0.001）。中介分析表明，PCAT 衰减介导了 TyG 指数与多支血管 CAD 之间 31.66% 的相关性。CAD 患者的 TyG 指数与 PCAT 衰减呈正相关。TyG 指数和 PCAT 衰减与多血管 CAD 呈协同相关性。此外，PCAT 衰减部分介导了 TyG 指数和 CAD 严重程度之间的关系。控制高 IR 和冠状动脉炎症患者的炎症可能会带来额外的好处。