Association of insulin resistance and inflammation with peripheral arterial disease - The National Health and Nutrition Examination Survey, 1999 to 2004
Association of insulin resistance and inflammation with peripheral arterial disease - The National Health and Nutrition Examination Survey, 1999 to 2004
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DOI：
10.1161/circulationaha.107.721878
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发表时间：
2008-07-01
期刊：
影响因子：
37.8
通讯作者：
Creager, Mark A.
中科院分区：
文献类型：
--
作者：
Pande, Reena L.;Perlstein, Todd S.;Creager, Mark A.
背景 - 尽管炎症在外周动脉疾病 (PAD) 病理生理学中的作用已得到充分证实，但胰岛素抵抗 (IR) 对 PAD 的影响尚不清楚。我们假设 IR 与 PAD 相关，并且 IR 的存在会影响 C 反应蛋白 (CRP) 和 PAD 之间的关联，这种关联主要在健康个体中建立。 方法和结果 - 我们分析了 1999 年至 2004 年国家健康和营养检查调查 (NHANES) 中 3242 名成年人的数据，他们接受了踝肱指数、CRP 以及空腹血糖和胰岛素的测量，从而能够计算 IR 的稳态模型（HOMA-IR）。通过逻辑回归估计优势比 (OR) 和 95% CI。 PAD 的平均患病率（定义为踝臂指数 3 mg/L）也与 PAD 密切相关（OR，2.2；95% CI，1.3 至 3.6；P = 0.003 对比 CRP < 1 mg/L）。根据中位 HOMA-IR 对受试者进行分层，我们发现在 IR 受试者中，CRP > 3 mg/L 不再与 PAD 显着相关（OR，1.3；95% CI，0.8 至 2.1；P = 0.3，交互作用 P = 0.08）。 结论 - 这些结果表明 IR 与 PAD 具有强烈且独立的相关性。此外，IR 改变了炎症与 PAD 的关联。这些数据确立了 IR 在 PAD 中的作用，并强调了炎症在患有和不患有 IR 的患者中的相对重要性。
Background - Although the role of inflammation in the pathophysiology of peripheral arterial disease ( PAD) is well established, the contribution of insulin resistance (IR) to PAD is less clear. We hypothesized that IR is associated with PAD and that the presence of IR would influence the association between C-reactive protein (CRP) and PAD, an association established predominantly in healthy individuals.Methods and Results - We analyzed data from 3242 adults in the National Health and Nutrition Examination Survey (NHANES) 1999 to 2004 who underwent measurement of ankle brachial index, CRP, and fasting glucose and insulin, enabling calculation of homeostasis model of IR (HOMA-IR). Odds ratios (ORs) and 95% CIs were estimated by logistic regression. The mean prevalence of PAD (defined as an ankle brachial index 3 mg/L) also was strongly associated with PAD (OR, 2.2; 95% CI, 1.3 to 3.6; P = 0.003 versus CRP < 1 mg/L). Stratifying subjects on the basis of median HOMA-IR, we found that CRP > 3 mg/L was no longer significantly associated with PAD in subjects with IR (OR, 1.3; 95% CI, 0.8 to 2.1; P = 0.3, P for interaction = 0.08).Conclusions - These findings demonstrate that IR is strongly and independently associated with PAD. Furthermore, IR modifies the association of inflammation with PAD. These data establish a role of IR in PAD and highlight the relative importance of inflammation in patients with and without IR.