Serum insulin-like growth factor-I level is independently associated with coronary artery disease progression in young male survivors of myocardial infarction: Beneficial effects of bezafibrate treatment

Onjectives. We investigated whether the effect of bezafibrate on progressio n of coronary atherosclerosis in the BEzafibrate Coronary Atherosclerosis I ntervention Trial (BECAIT) was related to insulin-like growth factor (IGF)- I and glucose-insulin homeostasis. Background. BECAIT, the first double-blind, placebo-controlled, randomized, serial angiographic trial of a fibrate compound, demonstrated that progres sion of focal coronary atherosclerosis in young patients after infarction c ould be retarded by bezafibrate treatment. Methods. The treatment effects on serum concentrations of IGF-I and insulin -like growth factor binding protein (IGFBP)-1, as well as on basal and post load glucose and insulin levels, were examined, and on-trial determinations were related to the angiographic outcome measurements. Results. Bezafibrate treatment resulted in a significant reduction of serum IGF-I levels, both at two and five years, and on-trial serum IGF-I levels were directly related to changes in both minimal lumen diameter (r = 0.25, p < 0.05) and mean segment diameter (r = 0.29, p < 0.05). In contrast, none of the available indexes of insulin resistance (homeostasis model assessme nt estimate, basal and postload plasma insulin concentrations and serum IGF BP-1 levels) were related to the angiographic changes, nor were they signif icantly affected by bezafibrate treatment. Multiple stepwise regression ana lysis showed that the relation between on-trial serum IGF-I level and coron ary artery disease (CAD) progression was independent of baseline angiograph ic score, age, body mass index, serum lipoprotein and plasma fibrinogen con centrations and measures of glucose-insulin: homeostasis. Conclusions. IGF-I, could be implicated in the progression of premature CAD , and a reduction of serum IGF-I concentration could account partly for the effect of bezafibrate on progression of focal coronary atherosclerosis. (C ) 2000 by the American College of Cardiology.