Resistance to insulin-mediated glucose disposal as a predictor of cardiovascular disease.
Resistance to insulin-mediated glucose disposal as a predictor of cardiovascular disease.
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DOI：
10.1210/jcem.83.8.5005
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发表时间：
1998-08
期刊：
影响因子：
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通讯作者：
J. Yip;F. Facchini;G. Reaven
中科院分区：
文献类型：
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作者：
J. Yip;F. Facchini;G. Reaven
对胰岛素介导的葡萄糖处置的抵抗已被假定为使个体易患已知增加心血管疾病（CVD）风险的一组相关异常（X综合征）。虽然X综合征的标题下包含的几个异常已被证明可以预测心血管疾病，一直没有前瞻性研究评估胰岛素抵抗的力量，在这种情况下，在综合征的假定的基本缺陷。因此，本研究旨在评估对胰岛素介导的葡萄糖处置的抵抗可预测健康志愿者CVD发生的假设。为了实现这一目标，在基线测量稳态血糖浓度（胰岛素介导的葡萄糖处置的估计值）以及其他CVD风险因素后，对147名正常、健康、非肥胖志愿者进行了评价[4.7 +/- 0.1年（平均值+/- SEM）]。在随访期间，13名受试者出现了临床终点;高血压5例，冠状动脉疾病4例，脑血管意外3例，外周血管疾病1例。SSPG和CVD之间存在显著的单变量关系（P < 0.002），大多数事件发生在具有最高SSPG浓度的三分之一受试者中，即最大程度的胰岛素抵抗。相比之下，在SSPG浓度最低的三分位数中未观察到CVD事件;胰岛素敏感性最高。SSPG还与舒张压、甘油三酯、低密度脂蛋白和高密度脂蛋白胆固醇浓度以及葡萄糖和胰岛素对口服葡萄糖的反应显著相关。所有这些关系都与年龄、性别、体重指数、体力活动估计值和吸烟史无关。当SSPG与一系列多元回归模型中的其他变量配对时，只有SSPG或胰岛素反应是CVD事件的独立预测因子。总之，在胰岛素抵抗最严重的三分位数中，大约每五个健康的非肥胖受试者中就有一个，随访大约5年，有严重的临床事件。这些数据突出了胰岛素抵抗作为CVD预测因子的重要性。
Resistance to insulin-mediated glucose disposal has been postulated to predispose individuals to a cluster of associated abnormalities (Syndrome X) known to increase risk of cardiovascular disease (CVD). Although several abnormalities subsumed under the rubric of Syndrome X have been shown to predict CVD, there has been no prospective study evaluating the power of insulin resistance, the putative fundamental defect in the syndrome, in this context. Therefore, this study was initiated to evaluate the hypothesis that resistance to insulin-mediated glucose disposal would predict the development of CVD in healthy volunteers. To accomplish this goal, 147 normal, healthy, nonobese, volunteers were evaluated [4.7 +/- 0.1 yr (mean +/- SEM)] after baseline measurements of steady state plasma glucose concentration (an estimate of insulin-mediated glucose disposal), as well as other CVD risk factors. Clinical end points developed in 13 subjects during the follow-up period; hypertension in 5, coronary artery disease in 4, cerebrovascular accident in 3, and peripheral vascular disease in 1. There was a significant univariate relationship between SSPG and CVD (P < 0.002), with the majority of the events taking place in the tertile of subjects with the highest SSPG concentration, i.e. the greatest degree of insulin resistance. In contrast, no CVD events were observed in the tertile with the lowest SSPG concentrations; the most insulin sensitive. SSPG was also related significantly to diastolic blood pressure, triglyceride, and low-density lipoprotein and high-density lipoprotein cholesterol concentrations, and the glucose and insulin responses to oral glucose. All of these relationships were independent of age, gender, body mass index, estimates of physical activity, and smoking history. When SSPG was paired with each of the other variables in a series of multiple regression models, only SSPG, or insulin response, were independent predictors of CVD events. In conclusion, approximately one of every five healthy, nonobese subjects in the most insulin-resistant tertile, followed for approximately 5 yr, had a serious clinical event. These data highlight the importance of insulin resistance as a predictor of CVD.