The metabolic syndrome, insulin resistance, and cardiovascular risk in diabetic and nondiabetic patients
The metabolic syndrome, insulin resistance, and cardiovascular risk in diabetic and nondiabetic patients
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DOI：
10.1210/jc.2005-0799
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发表时间：
2005-10-01
影响因子：
5.8
通讯作者：
Drexel, H
中科院分区：
文献类型：
--
作者：
Saely, CH;Aczel, S;Drexel, H
内容：胰岛素抵抗本身对代谢综合征（MetS）引起的血管风险的贡献尚不清楚;相反，胰岛素抵抗是否引起MetS以外的血管风险尚不确定。目的：本研究的目的是调查代谢综合征的影响（成人治疗组III标准）和胰岛素抵抗（如通过稳态模型评估指数估计的）对血管事件的发生率的影响。这是一项前瞻性队列研究，纳入了750名连续接受冠状动脉造影术的患者，以评估冠状动脉疾病。设置：该研究在三级临床研究中心进行。主要结局指标：主要结局指标是2.3年以上血管事件的发生率。结果：在控制了非MetS危险因素后，MetS和胰岛素抵抗均能预测血管事件[风险比（HR）分别为2.74（95%置信区间，1.71-4.39; P < 0.001）和1.51（1.24-1.84; P < 0.001）]。在对胰岛素抵抗进行额外调整后，MetS仍然显著预测血管事件[ HR，2.69（1.57 - 4.64）; P < 0.001]，相反，尽管对MetS进行了调整，胰岛素抵抗仍然显著预测血管事件[标准化HR，1.41（1.14-1.75）; P = 0.002]。对2型糖尿病的进一步校正显示，MetS [校正的HR，2.57（1.47-4.51）; P < 0.001]和稳态模型评估胰岛素抵抗[标准化校正HR，1.37（1.09-1.73）; P = 0.007]显著预测独立于糖尿病状态的血管事件。代谢综合征和胰岛素抵抗都是血管造影患者血管风险的强有力且相互独立的预测因子。
Context: The contribution of insulin resistance per se to the vascular risk conferred by the metabolic syndrome (MetS) is not known; conversely, it is uncertain whether insulin resistance confers vascular risk beyond the entity of the MetS.Objective: The objective of this study was to investigate the impact of the MetS ( Adult Treatment Panel III criteria) and insulin resistance ( as estimated by the homeostasis model assessment index) on the incidence of vascular events.Design and Patients: This was a prospective cohort study enrolling 750 consecutive patients undergoing coronary angiography for the evaluation of coronary artery disease.Setting: The study was performed at a tertiary care clinical research center.Main Outcome Measure: The main outcome measure was the incidence of vascular events over 2.3 yr.Results: Both the MetS and insulin resistance predicted vascular events after controlling for non-MetS risk factors [ hazard ratio (HR), 2.74 (95% confidence interval, 1.71-4.39; P < 0.001) and 1.51 (1.24-1.84; P < 0.001), respectively]. After additional adjustment for insulin resistance, the MetS remained significantly predictive of vascular events [ HR, 2.69 (1.57 - 4.64); P < 0.001], and conversely, insulin resistance remained significantly predictive of vascular events despite adjustment for the MetS [ standardized HR, 1.41 (1.14-1.75); P = 0.002]. Additional adjustment for the presence of type 2 diabetes revealed that both the MetS [ adjusted HR, 2.57 (1.47-4.51); P < 0.001] and homeostasis model assessment of insulin resistance [ standardized adjusted HR, 1.37 (1.09-1.73); P = 0.007] significantly predicted vascular events independent from diabetes status.Conclusions: Both the MetS and insulin resistance are strong and mutually independent predictors of vascular risk among angio-graphed coronary patients.