The association between insulin sensitivity indices, ECG findings and mortality: a 40-year cohort study.
The association between insulin sensitivity indices, ECG findings and mortality: a 40-year cohort study.
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DOI：
10.1186/s12933-021-01284-9
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发表时间：
2021-05-06
影响因子：
9.3
通讯作者：
Dankner R
中科院分区：
文献类型：
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作者：
Moshkovits Y;Rott D;Chetrit A;Dankner R
2 型糖尿病是心血管 (CV) 死亡的主要危险因素。胰岛素抵抗可以通过胰岛素敏感性指数（ISI）（例如麦考利指数（MCAi））进行无创评估，该指数是空腹胰岛素和甘油三酯的函数。目前，在大规模和异质人群中，ISI 和心电图结果与全因死亡率和心血管死亡率之间的关联尚未建立。在一项针对以色列葡萄糖不耐受、肥胖和高血压 (GOH) 第二阶段（1979-1982）队列的前瞻性研究中，对 1830 名男性和女性进行了随访，直至 2016 年 12 月的心血管死亡率和 2019 年 12 月的全因死亡率。在基线期间记录心电图并进行 OGTT。 ISI 被分为四分位数，并根据心电图结果以及全因死亡率和心血管死亡率进行评估。基线时的平均年龄为 52.0±8.1 岁，MCAi 上四分位数 (Q2-4) 和下四分位数 (Q1) 的参与者分别有 75 名 (15.2%) 和 47 名 (25.3%) 参与者在心电图上出现缺血性变化 (p = 0.02)。多变量分析显示，与 Q2-4-MCAi 中的个体相比，Q1-MCAi 中的个体（调整后 OR = 1.7，95% CI 1.02–2.8）心电图缺血性变化的几率更高，排除糖尿病个体后，Q2-4-MCAi 中的个体发生心电图缺血性变化的几率会减弱（调整后 OR = 1.6，95% CI 0.9–2.7， p = 0.09）。全因死亡率和心血管死亡率的中位随访时间分别为 31 年和 37 年。 Cox 比例风险回归显示，与 Q2-4-MCAi 相比，Q1-MCAi 中个体的全因死亡风险增加（HR = 1.2，95% CI 1.02–1.3），并且 CV 死亡率风险增加（HR = 1.4，95% CI 1.1–1.8）。 Q4-Ln稳态模型评估-胰岛素抵抗（HOMA-IR）和Q1-定量胰岛素敏感性检查指数（QUICKI）中的个体也表现出全因死亡风险增加（HR = 1.2，95%CI 1.04–1.4；HR = 1.2，95%CI 1.04–1.4，分别）。其他 ISI 并未表现出与心血管死亡率显着相关。根据 MCAi 的说法，较高的胰岛素抵抗与心电图变化相关，并且在 40 年的随访中全因死亡率和心血管死亡率风险更高。 MCAi 可被视为成人心血管发病率和死亡率的早期预测和预后生物标志物。在线版本包含可在 10.1186/s12933-021-01284-9 获取的补充材料。
Type 2 Diabetes is a major risk factor for cardiovascular (CV) mortality. Insulin resistance can be evaluated non-invasively by insulin sensitivity indices (ISI) such as the Mcauley index (MCAi), which is a function of the fasting insulin and triglycerides. Currently, the association between ISIs and ECG findings and all-cause and CV mortality is still not established in a large scale and heterogeneous population. In a prospective study of the Israel cohort on Glucose Intolerance, Obesity and Hypertension (GOH) second phase (1979–1982) 1830 men and women were followed until December-2016 for CV-mortality and December-2019 for all-cause mortality. ECGs were recorded and OGTTs performed during baseline. ISIs were categorized into quartiles and evaluated against ECG findings and all-cause and CV-mortality. Mean age at baseline was 52.0 ± 8.1 years, and 75 (15.2%) and 47 (25.3%) participants in the upper quartiles (Q2-4) and the lower quartile (Q1) of the MCAi, presented with Ischemic changes on ECG respectively (p = 0.02). Multivariable analysis showed higher odds for ECG ischemic changes, for individuals in Q1-MCAi (adjusted-OR = 1.7, 95% CI 1.02–2.8), compared with Q2-4-MCAi, which attenuated when excluding individuals with diabetes (adjusted-OR = 1.6, 95% CI 0.9–2.7, p = 0.09). Median follow up for all-cause and for cardiovascular mortality was 31 years and 37 years, respectively. Cox proportional-hazards regression showed an increased risk for all-cause mortality for individuals in Q1-MCAi (HR = 1.2, 95% CI 1.02–1.3) as well as an increased risk for CV-mortality (HR = 1.4, 95%CI 1.1–1.8) compared with Q2-4-MCAi. Individuals in Q4-Ln Homeostatic model assessment- Insulin Resistance (HOMA-IR) and Q1- Quantitative Insulin Sensitivity Check Index (QUICKI) also presented with increased risk for all-cause-mortality (HR = 1.2, 95%CI 1.04–1.4; and HR = 1.2, 95% CI 1.04–1.4, respectively). Other ISIs did not show significant associations with CV-mortality. Higher insulin-resistance, according to the MCAi, associated with ECG-changes, and with greater risk for all-cause and CV-mortality over a 40-year follow-up. The MCAi may be considered as an early predictive and prognostic biomarker for CV-morbidity and mortality in adults. The online version contains supplementary material available at 10.1186/s12933-021-01284-9.
DOI：
10.1002/dmrr.2794
发表时间：
2016-10
期刊：
Diabetes/metabolism research and reviews
影响因子：
--
作者：
Bhatt AB;Mulvey CK;Qasim AN;Nair JV;Rickels MR;Prenner SB;Iqbal N;Reilly MP
通讯作者：
Reilly MP