Insulin resistance, metabolic syndrome, and subclinical atherosclerosis: the multi-ethnic study of atherosclerosis (MESA)
Insulin resistance, metabolic syndrome, and subclinical atherosclerosis: the multi-ethnic study of atherosclerosis (MESA)
复制标题
DOI：
10.2337/dc07-1042
复制
发表时间：
2007-11-01
期刊：
影响因子：
16.2
通讯作者：
Szklo, Moyses
中科院分区：
文献类型：
--
作者：
Bertoni, Alain G.;Wong, Nathan D.;Szklo, Moyses
目的-探讨胰岛素抵抗和临床定义的代谢综合征(METS)与亚临床动脉粥样硬化的关系，并检验这些关系是否因种族/民族或性别而异。研究设计和方法-在动脉粥样硬化多种族研究中，5810名无糖尿病的参与者通过冠状动脉钙化(CAC)和颈动脉内中膜厚度(IMT)评估亚临床动脉粥样硬化，这是一组年龄在45-84岁之间、既往无心血管疾病(CVD)的成年人。采用稳态模型胰岛素抵抗指数(HOMA-IR)评估空腹胰岛素和血糖来评估胰岛素抵抗，并使用修订的国家胆固醇教育计划对蛋氨酸的定义。采用多变量线性或相对风险回归分析HOMA-IR与亚临床动脉粥样硬化的关系，并评估其与Mets成分的独立性。结果在调整人口统计学因素(年龄、地点和教育程度)、吸烟、教育程度和低密度脂蛋白后，HOMA-IR与除西班牙裔受试者外的每个民族以及男性和女性的IMT增加相关。在进一步调整非葡萄糖蛋氨酸成分后，HOMA-IR与IMT增加无关。在对人口统计学、吸烟和低密度脂蛋白进行调整后，HOMA-IR中最高五分之一的受试者在每个种族和性别中CAC的患病率都有所增加，但在进一步调整非葡萄糖蛋氨酸成分后没有增加。在可检测到CAC的患者中，HOMA-IR与CAC的数量没有显著关系。结论：尽管HOMA-IR与亚临床动脉粥样硬化的增加有关，但这种关联并不独立于构成蛋氨酸的危险因素。德特米-
OBJECTIVE - To investigate the association of insulin resistance and clinically defined metabolic syndrome (MetS) with subclinical atherosclerosis and examine whether these relationships vary by race/ethnicity or sex.RESEARCH DESIGN AND METHODS - Subclinical atherosclerosis was assessed by coronary artery calcium (CAC) and carotid intima-medial thickness (IMT) in 5,810 participants without diabetes in the Multi-Ethnic Study of Atherosclerosis, a cohort of adults aged 45-84 years without prior cardiovascular disease (CVD). Fasting insulin and glucose were utilized to estimate insulin resistance by the homeostasis model assessment of insulin resistance (HOMA-IR) index, and the revised National Cholesterol Education Program definition of MetS was utilized. Multivariable linear or relative risk regression was used to analyze the association between HOMA-IR and subclinical atherosclerosis and assess its independence from MetS components.RESULTS- HOMA-IR was associated with increased IMT after adjustment for demographics (age, site, and education), smoking, education, and LDL cholesterol in each ethnic group, except Hispanic subjects, and in both men and women. After further adjusting for nonglucose MetS components, HOMA-IR was not associated with increased IMT. Subjects in the highest quintile of HOMA-IR had an elevated prevalence of CAC in each ethnic group and both sexes, after adjustment for demographics, smoking, and LDL but not after further adjustment for nonglucose MetS components. Among those with detectable CAC, there was no significant relationship between HOMA-IR and the amount of CAC.CONCLUSIONS - Although HOMA-IR was associated with increased subclinical atherosclerosis, the association was not independent of the risk factors that comprise MetS. Determi-