A systematic evaluation of the insulin resistance syndrome as an independent risk factor for cardiovascular disease mortality and derivation of a clinical index
A systematic evaluation of the insulin resistance syndrome as an independent risk factor for cardiovascular disease mortality and derivation of a clinical index
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DOI：
10.1016/j.metabol.2011.02.012
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发表时间：
2011-10-01
影响因子：
9.8
通讯作者：
Johnston, Desmond G.
中科院分区：
文献类型：
--
作者：
Godsland, Ian F.;Lecamwasam, Kamalini;Johnston, Desmond G.
胰岛素抵抗相关的危险因素聚类（胰岛素抵抗综合征或IRS）可能是心血管疾病（CVD）的危险因素，但要令人信服地证明这一点，需要严格推导出的参考指标，并对该指标得出的指标和指标进行系统评估。利用已建立的IRS特征，对832名基线时总体健康的白人男性进行因素分析，先验地产生了IRS参考测量值。IRS诊断是通过评估参考测量的CVD死亡率风险的百分位数来选择的。IRS临床指标通过(1)通过多元线性回归确定IRS参考指标的可测量的独立预测因子；(2)分配给每个预测器的最佳切割点，以区分被诊断为IRS的参与者；(3)选择二分类预测因子组合，进一步优化IRS判别。参考IRS诊断由IRS参考指标的前16.7%定义，并在Cox比例风险模型中预测CVD死亡率（风险比为2.7；95%置信区间为1.5-5.2;P = 0.002）。优化的IRS指标定义为甘油三酯至少1.6 mmol/L，尿酸至少400 mu mol/L，加上空腹血糖至少5.4 mmol/L，舒张压至少90 mm Hg，或体重指数至少27.0 kg/m(2)，并预测CVD死亡率（风险比2.14 [1.08-4.24];P = 0.02）。预测与高血压、高胆固醇血症和吸烟无关。常规衍生的血糖调节性胰岛素抵抗和代谢综合征不具有预测性。IRS是心血管疾病死亡率的独立危险因素；一个有效的、临床可用的指标可以从容易测量的变量中得出。(C) 2011爱思唯尔公司版权所有。
Insulin resistance-related risk factor clustering (the insulin resistance syndrome or IRS) may be a cardiovascular disease (CVD) risk factor, but a convincing demonstration of this requires a rigorously derived reference measure and a systematic evaluation of measures and indices that derive from that measure. Using established IRS characteristics, factor analysis in 832 white men, generally healthy at baseline, generated a priori an IRS reference measure. An IRS diagnostic was chosen by evaluating CVD mortality risk in percentiles of the reference measure. An IRS clinical index was derived by (1) identification of readily measured, independent predictors of the IRS reference measure by multiple linear regression; (2) assignment to each predictor of a cut point optimal for discrimination of participants diagnosed with IRS; and (3) selection of a combination of the dichotomized predictors that further optimized IRS discrimination. The reference IRS diagnostic was defined by the top 16.7% of the IRS reference measure and predicted CVD mortality in Cox proportional hazards modeling (hazard ratio, 2.7; 95% confidence interval, 1.5-5.2; P = .002). An optimized IRS index was defined by triglycerides of at least 1.6 mmol/L and uric acid of at least 400 mu mol/L plus any one of fasting plasma glucose of at least 5.4 mmol/L, diastolic blood pressure of at least 90 mm Hg, or body mass index of at least 27.0 kg/m(2) and predicted CVD mortality (hazard ratio, 2.14 [1.08-4.24]; P = .02). Prediction was independent of hypertension, hypercholesterolemia, and smoking. Conventionally derived glucoregulatory insulin resistance and metabolic syndrome were not predictive. The IRS is an independent risk factor for CVD mortality; and an effective, clinically usable index can be derived from readily measured variables. (C) 2011 Elsevier Inc. All rights reserved.