Prospective associations of fasting insulin, body fat distribution, and diabetes with risk of ischemic stroke
Prospective associations of fasting insulin, body fat distribution, and diabetes with risk of ischemic stroke
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DOI：
10.2337/diacare.22.7.1077
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发表时间：
1999-07-01
期刊：
影响因子：
16.2
通讯作者：
Heiss, G
中科院分区：
文献类型：
--
作者：
Folsom, AR;Rasmussen, ML;Heiss, G
目的：我们检验了糖尿病、体脂分布和研究设计和方法-作为社区动脉粥样硬化风险（ARIC）研究的一部分，我们通过使用空腹血糖标准、腰围和臀围，以及在>12岁，000名年龄在45-64岁的成年人，基线时无心血管疾病。我们对191例患者进行了6-8年的缺血性卒中发生率的随访，结果-在调整了年龄、性别、种族、ARIC社区、吸烟和教育水平后，缺血性卒中的相对危险度为3.70（95%CI 2.7-5.1），腰臀比增加0.11为1.74（1.4-2.2），非糖尿病受试者空腹胰岛素增加50 pmol/l为1.19（1.1-1.3）。缺血性卒中的发生率与BMI无统计学显著相关性（BMI校正的相对危险度= 1.15，95%CI 0.97-1.36）。调整其他中风风险因素后（其中一些可能介导糖尿病、脂肪分布和高胰岛素血症的影响），糖尿病、腰臀比和空腹胰岛素水平的相对危险度为2.22（95%CI 1.5-3.2）、1.08（0.8-1.4）和1.14（1.01-1.3）。结论-糖尿病是缺血性卒中的一个强危险因素。胰岛素抵抗的各个方面，如腰臀比升高和空腹胰岛素水平升高所反映的，也可能导致缺血性卒中的风险增加。
OBJECTIVE - We tested the hypothesis that diabetes, body fat distribution, and (in nondiabetic subjects) fasting insulin levels are positively associated with ischemic stroke incidence in the general population RESEARCHDESIGN AND METHODS - As part of the Atherosclerosis Risk in Communities (ARIC) Study we measured diabetes by using fasting glucose criteria, waist and hip circumferences, and fasting insulin levels with a radioimmunoassay in >12,000 adults aged 45-64 years who had no cardiovascular disease at baseline. We followed them for 6-8 years for ischemic stroke occurrence (n = 191).RESULTS - After adjustment for age, sex, race, ARIC community, smoking, and education level, the relative risk of ischemic stroke was 3.70 (95% CI 2.7-5.1) for diabetes, 1.74 (1.4-2.2) for a 0.11 increment of waist-to-hip ratio, and 1.19 (1.1-1.3) for a 50-pmol/l increment of fasting insulin among nondiabetic subjects. Ischemic stroke incidence was nor statistically significantly associated with BMI (comparably adjusted relative risk = 1.15, 95% CI 0.97-1.36). With adjustment for other stroke risk factors (some of which may mediate the effects of diabetes, fat distribution, and hyperinsulinemia), the relative risks for diabetes, waist-to-hip ratio, and fasting insulin level were 2.22 (95% CI 1.5-3.2), 1.08 (0.8-1.4), and 1.14 (1.01-1.3), respectivelyCONCLUSION - Diabetes is a strong risk factor for ischemic stroke. Aspects of insulin resistance, as reflected by elevated waist-to-hip ratios and elevated fasting insulin levels, may also contribute to a greater risk of ischemic stroke.