Insulin resistance, the metabolic syndrome, and risk of incident cardiovascular disease - A population-based study
Insulin resistance, the metabolic syndrome, and risk of incident cardiovascular disease - A population-based study
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DOI：
10.1016/j.jacc.2007.01.088
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发表时间：
2007-05-29
影响因子：
24
通讯作者：
Madsbad, Sten
中科院分区：
文献类型：
--
作者：
Jeppesen, Jorgen;Hansen, Tine W.;Madsbad, Sten
目的本研究的目的是阐明胰岛素抵抗（IR）是否能独立于代谢综合征（MetSyn）预测心血管疾病（CVD）。背景虽然MetSyn的病因尚未明确，但IR已被认为是一个重要的病因。只有少数以人群为基础的研究试图澄清，如果IR预测CVD独立MetSyn.Methods这是一个前瞻性的丹麦人口为基础的研究2,493名男性和女性，年龄41至72岁，没有重大心血管疾病在基线。我们根据国际糖尿病基金会（IDF）和国家胆固醇教育计划（NCEP）标准定义MetSyn，并通过稳态模型评估（HOMA-IR）量化IR。根据IDF标准，MetSyn的患病率为21%，根据NCEP标准，MetSyn的患病率为16%。因此，我们定义的IDF-HOMA-IR属于最高的HOMA-IR distribution的21%，和NCEP-HOMA-IR属于最高的：16%的HOMA-IR distribution.Results超过一个中位数为9.4年的随访，CV终点（CV死亡，非致命性缺血性心脏病，非致命性中风）的发病率为233例。在比例风险模型中，校正年龄、性别、吸烟和低密度脂蛋白胆固醇，并将IDF-HOMA-IR和IDF-MetSyn纳入同一模型，IDF-HOMA-IR和IDF-MetSyn终点的相对风险分别为1.67（95%置信区间[CI] 1.22至2.29）和1.16（95% CI 0.84至1.60）。NCEP-HOMA-IR和NCEP-MetSyn在同一模型中的相应数值分别为1.49（95%CI 1.07 ~ 2.07）和1.56（95%CI 1.12 ~ 2.17）。
Objectives The goal was to clarify if insulin resistance (IR) would predict cardiovascular disease (CVD) independent of the metabolic syndrome (MetSyn).Background Although the cause of MetSyn is not well defined, IR has been proposed to be an important cause. Only a small number of population-based studies have sought to clarify if IR predicts CVD independent of MetSyn.Methods This was a prospective Danish population-based study of 2,493 men and women, age 41 to 72 years, without major CVD at baseline. We defined MetSyn according to both the International Diabetes Foundation (IDF) and the National Cholesterol Education Program (NCEP) criteria, and we quantified IR by the homeostasis model assessment (HOMA-IR). Prevalence of MetSyn was 21% according to IDF criteria and :16% according to NCEP criteria. Accordingly, we defined IDF-HOMA-IR as belonging to the highest 21% of the HOMA-IR distribution, and NCEP-HOMA-IR as belonging to the highest :16% of the HOMA-IR distribution.Results Over a median follow-up of 9.4 years, the incidence of CV end points (CV death, nonfatal ischemic heart disease, and nonfatal stroke) amounted to 233 cases. In proportional hazard models, adjusting for age, gender, smoking, and low-density lipoprotein cholesterol, and with IDF-HOMA-IR and IDF-MetSyn included in the same model, the relative risk of an end point was 1.67 (95% confidence interval [CI] 1.22 to 2.29) for IDF-HOMA-IR and 1.16 (95% Cl 0.84 to 1.60) for IDF-MetSyn. The corresponding figures for NCEP-HOMA-IR and NCEP-MetSyn included in the same model were 1.49 (95% Cl 1.07 to 2.07) and 1.56 (95% Cl 1.12 to 2.17).Conclusions In this Danish study, both HOMA-IR and NCEP-MetSyn were independent predictors of incident CVD.