Association between HOMA-IR, fasting insulin and fasting glucose with coronary heart disease mortality in nondiabetic men: a 20-year observational study
Association between HOMA-IR, fasting insulin and fasting glucose with coronary heart disease mortality in nondiabetic men: a 20-year observational study
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DOI：
10.1007/s00592-014-0615-x
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发表时间：
2015-02-01
影响因子：
3.8
通讯作者：
Laukkanen, Jari A.
中科院分区：
文献类型：
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作者：
Kurl, Sudhir;Zaccardi, Francesco;Laukkanen, Jari A.
目前尚不清楚葡萄糖和胰岛素与冠心病(CHD)死亡率的风险是否存在不同的关联。在一项包括中年非糖尿病芬兰男性的前瞻性研究中，我们旨在评估胰岛素抵抗(通过胰岛素抵抗的稳态模型评估，HOMA-IR评估)、空腹血清胰岛素(FI)和空腹血糖(FPG)与冠心病死亡率之间的关系。在平均20年的随访中，发生了273例(11%)冠心病死亡。在对年龄、体重指数、收缩压、血清低密度脂蛋白-胆固醇、吸烟、冠心病病史、饮酒、血白细胞和血浆纤维蛋白原进行校正的多变量COX回归分析中，冠心病死亡率的风险比(HR)为：HOMA-IR的1.69(95%CI：1.15-2.48；p=0.008)；FI的1.59(1.09-2.32；p=0.016)；空腹血糖的1.26(0.90-1.76；p=0.173)。这些发现表明IR和FI，而不是空腹血糖，是CHD死亡率的独立危险因素。进一步的研究可以在筛查和风险分层、关联的因果关系和治疗含义方面帮助澄清这些结果。
Whether glucose and insulin are differently associated with the risk of coronary heart disease (CHD) mortality is unclear. We aimed to estimate the association between insulin resistance (estimated by the homeostasis model assessment for insulin resistance, HOMA-IR), fasting serum insulin (FI) and fasting plasma glucose (FPG) with incident CHD mortality in a prospective study including middle-aged nondiabetic Finnish men. During an average follow-up of 20 years, 273 (11 %) CHD deaths occurred. In a multivariable Cox regression analysis adjusted for age, body mass index, systolic blood pressure, serum LDL-cholesterol, cigarette smoking, history of CHD, alcohol consumption, blood leukocytes and plasma fibrinogen, the hazard ratios (HRs) for CHD mortality comparing top versus bottom quartiles were as follows: 1.69 (95 % CI: 1.15-2.48; p = 0.008) for HOMA-IR; 1.59 (1.09-2.32; p = 0.016) for FI; and 1.26 (0.90-1.76; p = 0.173) for FPG. These findings suggest that IR and FI, but not FPG, are independent risk factors for CHD mortality. Further studies could help clarify these results in terms of screening and risk stratification, causality of the associations, and therapeutical implications.