Insulin resistance and incident peripheral artery disease in the Cardiovascular Health Study.
Insulin resistance and incident peripheral artery disease in the Cardiovascular Health Study.
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DOI：
10.1177/1358863x11436195
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发表时间：
2012-04
期刊：
影响因子：
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通讯作者：
Djoussé L
中科院分区：
文献类型：
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作者：
Britton KA;Mukamal KJ;Ix JH;Siscovick DS;Newman AB;de Boer IH;Thacker EL;Biggs ML;Gaziano JM;Djoussé L
2型糖尿病是PAD的一个危险因素，而胰岛素抵抗是糖尿病和糖尿病前期的一个关键特征。没有纵向流行病学研究检查胰岛素抵抗和PAD之间的关系。我们的研究分析了胰岛素抵抗稳态模型（HOMA-IR）的四分位数与两种方法定义的PAD发展的关系。PAD最初被定义为在6年随访后出现异常踝肱指数（ABI）（二分类结果）。PAD也可被定义为临床PAD的发展（事件时间分析）。研究样本包括65岁以上的成年人，他们参加了心血管健康研究，有空腹胰岛素和葡萄糖测量，有ABI测量，没有接受糖尿病治疗。对多变量模型进行校正，排除潜在的混杂因素，包括年龄、性别、现场中心和队列、BMI、吸烟状况、饮酒和运动强度。额外的模型调整了潜在的介质，包括血压、血脂、肾功能和流行的血管疾病。在ABI分析（n=2108）中，多变量调整模型显示HOMA-IR与PAD事件呈正相关（HOMA-IR第4和第1四分位数的比值比为1.80,95%置信区间为1.20-2.71）。在临床PAD分析（n=4208）中，我们发现了类似的关系（HOMA-IR第4和第1四分位数的风险比=2.30,95%置信区间为1.15-4.58）。正如预期的那样，对潜在介质的进一步调整导致了效应估计的一些衰减。总之，胰岛素抵抗与老年人患PAD的高风险相关。
Type 2 diabetes is a risk factor for PAD, and insulin resistance is a key feature of diabetes and pre-diabetes. No longitudinal epidemiological study has examined the relation between insulin resistance and PAD. Our study analyzed the association of quartiles of the homeostatic model of insulin resistance (HOMA-IR) and the development of PAD defined by 2 methods. PAD was first defined as the development of an abnormal ankle brachial index (ABI) (dichotomous outcome) after six years of follow-up. PAD was alternatively defined as the development of clinical PAD (time to event analysis). The study samples included adults over the age of 65 who were enrolled in the Cardiovascular Health Study, had fasting measurements of insulin and glucose, had ABI measurements, and were not receiving treatment for diabetes. Multivariable models were adjusted for potential confounders, including age, sex, field center and cohort, BMI, smoking status, alcohol use, and exercise intensity. Additional models adjusted for potential mediators, including blood pressure, lipids, kidney function, and prevalent vascular disease. In the ABI analysis (n=2108), multivariable adjusted models demonstrated a positive relation between HOMA-IR and incident PAD (Odds Ratio=1.80 comparing the 4th versus 1st quartile of HOMA-IR, 95% confidence interval 1.20-2.71). In the clinical PAD analysis (n=4208), we found a similar relation (Hazard ratio=2.30 comparing the 4th versus 1st quartile of HOMA-IR, 95% confidence interval 1.15-4.58). As expected, further adjustment for potential mediators led to some attenuation of effect estimates. In conclusion, insulin resistance is associated with a higher risk of PAD in older adults.