Fasting serum C-peptide levels predict cardiovascular and overall death in nondiabetic adults.
Fasting serum C-peptide levels predict cardiovascular and overall death in nondiabetic adults.
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DOI：
10.1161/jaha.112.003152
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发表时间：
2012-12
影响因子：
5.4
通讯作者：
Wu WC
中科院分区：
文献类型：
--
作者：
Patel N;Taveira TH;Choudhary G;Whitlatch H;Wu WC
以高胰岛素血症和正常或升高的血清葡萄糖为特征的胰岛素抵抗是糖尿病和心血管疾病的既定前兆。尽管空腹血清C肽水平是糖尿病患者内源性胰岛素产生的准确和稳定的标志物，但C肽是否可以作为胰岛素抵抗的标志物并预测非糖尿病患者的结局尚不清楚。这是一项回顾性队列研究，使用NHANES-3（1988-1994）调查的数据，死亡率随访至2006年12月31日。参与者包括5153名受试者，年龄40至74岁，空腹血糖≥70 mg/dL，根据病史或实验室检查无糖尿病。受试者工作曲线分析比较了空腹C肽与已知的胰岛素抵抗指标，如空腹血糖、血清胰岛素、HOMA-IR、定量胰岛素敏感性检查指数和代谢综合征，以预测心血管和总体死亡。然后按C肽水平的四分位数对受试者进行分层。考克斯比例风险模型比较了C肽四分位数中心血管和总体死亡的风险，并对心血管和糖尿病风险的潜在混杂因素进行了调整。空腹血清C肽水平预测心血管和总体死亡优于其他研究指标（AUC分别为0.62和0.60 vs其余，AUC分别≤0.58和≤0.57，P<0.001）。与最低C肽四分位数相比，在控制混杂因素后，最高四分位数的受试者心血管死亡（HR=1.60，95%CI 1.07 - 2.39）和总死亡率（HR=1.72，95%CI 1.34 - 2.21）的校正风险比（HR）显著更高。C肽水平与非糖尿病成人的心血管危险和总体死亡显著相关，并且是比血清胰岛素和/或葡萄糖衍生指标更好的预测这些结局的指标。
Insulin resistance, characterized by hyperinsulinemia and normal or elevated serum glucose, is an established precursor to diabetes and cardiovascular disease. Despite fasting serum C‐peptide levels being an accurate and stable marker of endogenous insulin production used in patients with diabetes, it is unknown whether C‐peptide could serve as a marker of insulin resistance and predict outcomes in patients without diabetes. This is a retrospective cohort study using data from the NHANES‐3 (1988–1994) survey with mortality follow‐up through December 31, 2006. Participants included 5153 subjects, 40 to 74 years of age with fasting glucose ≥70 mg/dL, without diabetes by history or laboratory testing. Receiver‐operating‐curve analysis compared fasting C‐peptide against known insulin resistance measures such as fasting plasma glucose, serum insulin, HOMA‐IR, quantitative‐insulin‐sensitivity‐check‐index, and metabolic syndrome for the prediction of cardiovascular and overall death. Subjects were then stratified by quartiles of C‐peptide levels. Cox proportional‐hazards modeling compared hazards of cardiovascular and overall death amongst C‐peptide quartiles and adjusted for potential confounders of cardiovascular and diabetes risk. Fasting serum C‐peptide levels predicted cardiovascular and overall death better than other studied measures (AUC=0.62 and 0.60 respectively vs the rest, with AUC≤0.58 and ≤0.57 respectively, P<0.001). When compared with the lowest C‐peptide quartile, subjects in the highest quartile had significantly higher adjusted hazard ratios (HR) of cardiovascular death (HR=1.60, 95%CI 1.07 to 2.39) and overall mortality (HR=1.72, 95%CI 1.34 to 2.21) after controlling for confounders. C‐peptide levels significantly related to hazards of cardiovascular and overall death in nondiabetic adults and was a better predictor of these outcomes than serum insulin and/or glucose derived measures.