Insulin resistance, the metabolic syndrome, and risk of incident cardiovascular disease in nondiabetic American Indians - The Strong Heart Study
Insulin resistance, the metabolic syndrome, and risk of incident cardiovascular disease in nondiabetic American Indians - The Strong Heart Study
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DOI：
10.2337/diacare.26.3.861
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发表时间：
2003-03-01
期刊：
影响因子：
16.2
通讯作者：
Howard, BV
中科院分区：
文献类型：
--
作者：
Resnick, HE;Jones, K;Howard, BV
胰岛素抵抗（IR）和代谢综合征（MS）与2型糖尿病和不良心血管疾病（CVD）危险因素相关。IR和MS是否独立于糖尿病和其他CVD危险因素预测CVD尚不清楚。本研究探讨IR和/或MS的存在是否与非糖尿病美洲印第安人（AI）的CVD独立相关。研究设计和方法-我们在强心脏研究（SHS）的基线检查中检查了2,283例无心血管疾病的非糖尿病AI。测量心血管疾病的危险因素，使用稳态模型评估（HOMA）对IR进行量化，并根据国家胆固醇教育计划成人治疗小组（ATP III）的定义对每个参与者进行MS评估。在随访中确定心血管疾病和糖尿病的发生率。结果：798人（35%）出现MS， 181人（7.9%）在7.6 +/- 1.8年的随访中出现CVD。在HOMA-IR中，年龄、BMI、腰围和甘油三酯水平升高，高密度脂蛋白胆固醇降低。糖尿病风险随着基线HOMA-IR（6.3%、14.6%和30.1%;P < 0.001）和MS（12.8%对24.5%）的增加而增加。在校正了心血管疾病危险因素的Cox模型中，心血管疾病的风险没有随着基线HOMA-IR或MS的变化而增加，但个体心血管疾病危险因素预测了随后的心血管疾病。结论：在SHS的非糖尿病AI中，HOMA-IR和MS都能预测糖尿病，但都不能独立于其他已知的CVD危险因素预测CVD。
OBJECTIVE - Insulin resistance (IR) and the metabolic syndrome (MS) are associated with type 2 diabetes and adverse cardiovascular disease (CVD) risk factor profiles. Whether IR and MS predict CVD independently of diabetes and other CVD risk factors is not known. This study examines whether IR and/or presence of MS are independently associated with CVD in nondiabetic American Indians (AI).RESEARCH DESIGN AND METHODS - We examined 2,283 nondiabetic AI who were free of CVD at the baseline examination of the Strong Heart Study (SHS). CVD risk factors were measured, IR was quantified using the homeostasis model assessment (HOMA), and MS as defined by the National Cholesterol Education Program Adult Treatment Panel (ATP III) was assessed for each participant. Incident CVD and diabetes were ascertained during follow-up.RESULTS - MS was present in 798 individuals (35%), and 181 participants (7.9%) developed CVD over 7.6 +/- 1.8 years of follow-up. Age, BMI, waist circumference, and triglyceride levels increased and HDL cholesterol decreased across tertiles of HOMA-IR. Risk of diabetes increased as a function of baseline HOMA-IR (6.3, 14.6, and 30.1%; P < 0.001) and MS (12.8 vs. 24.5%). In Cox models adjusted for CVD risk factors, risk of CVD did not increase either as a function of baseline HOMA-IR or MS, but individual CVD risk factors predicted subsequent CVD.CONCLUSIONS - Among nondiabetic AI in the SHS, HOMA-IR and MS both predict diabetes, but neither predicts CVD independently of other established CVD risk factors.