In patients with coronary artery disease (CAD), homeostatic indexes of insulin resistance (HOMA-IR) increase over time, say researchers from Israel. That was one of the major findings in their two-year study of 2,504 patients taking placebo or bezafibrate (Bezalip, Roche). The other major finding: bezafibrate can significantly attenuate the process.
Bezafibrate is a fibric acid derivative, and its long-term use in patients with CAD has reduced the incidence of diabetes. It is a pharmacological ligand for peroxisome proliferator-activated receptor alpha (PPAR-a). PPAR-a controls primarily the expression of genes involved in lipid metabolism and plays a role in glucose homeostasis and the development of insulin resistance.
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HOMA-IRs were significantly correlated at baseline and during follow-up with glucose and triglycerides. During follow-up, the HOMA-IR rose only 6.6% among the patients taking bezafibrate, in contrast to 34% among the patients taking placebo. In a subgroup, patients with diabetes had a HOMA-IR that was 88% higher than those of counterparts without diabetes, and the HOMA-BCF (homeostatic index of percentage of beta-cell function) was 36% lower.
The researchers believe that this is the first large-scale report on the long-term effect of bezafibrate, but they caution that their study was a secondary analysis of a trial not designed to evaluate longitudinal changes in insulin resistance. Further studies are needed.