U-shaped and J-shaped relationships between serum insulin and coronary heart disease in the general population - The Bruneck study
U-shaped and J-shaped relationships between serum insulin and coronary heart disease in the general population - The Bruneck study
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DOI：
10.2337/diacare.21.2.221
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发表时间：
1998-02-01
期刊：
影响因子：
16.2
通讯作者：
Muggeo, M
中科院分区：
文献类型：
--
作者：
Bonora, E;Willeit, J;Muggeo, M
研究设计和方法-在动脉粥样硬化及其危险因素的横断面调查中，从意大利布鲁内克的人群中随机选择了500名男性和500名女性，年龄在40-79岁之间。对936名参与研究的受试者进行了动脉粥样硬化的行为危险因素评估。在空腹（n = 888）和口服葡萄糖负荷后2 h（n = 811，排除已知的糖尿病受试者）测量血清胰岛素。CHD被确定为异常心电图和/或心绞痛或心肌梗塞的历史。结果-受试者进行分层，根据血清胰岛素五分位数在空腹或2小时后，葡萄糖负荷。在调整性别、年龄、BMI、吸烟、体力活动、饮酒和社会经济状况（协方差分析）后，心血管危险因素聚集在胰岛素水平最高的五分位数受试者中。多元logistic回归分析，包括模型1中的性别和年龄，模型2中的性别、年龄、BMI、葡萄糖耐量、社会经济状况和行为变量，或模型3中的这组变量连同甘油三酯和载脂蛋白α 1和B、纤维蛋白原和血压状况，显示当将中位胰岛素五分位数用作参考类别时，高血清胰岛素与CHD之间存在显著关联。此外，低血清胰岛素水平，如在最低的五分之一的受试者中发现的那些，与CHD独立相关。这些结果是在调整几个协变量之前（模型1）或之后（模型2和3）发现的。一致的结果被发现在男性和女性，以及在年轻和老年subjects.CONCLUSIONS -本研究的结果表明，高胰岛素血症和“hypoinsulinemia”是冠心病的独立指标。冠心病与空腹胰岛素呈U型关系，与糖后胰岛素呈J型关系。
OBJECTIVE - To evaluate the relationship existing between serum insulin and coronary heart disease (CHD) in the general population.RESEARCH DESIGN AND METHODS - In a cross-sectional survey on atherosclerosis and its risk factors, 500 men and 500 women aged 40-79 years were randomly selected from the population of Bruneck, Italy Clinical, biochemical, and behavioral risk factors of atherosclerosis were assessed in the 936 subjects who participated in the study. Serum insulin was measured at fasting (n = 888) and 2 h (n = 811, known diabetic subjects were excluded) after an oral glucose load. CHD was ascertained by an abnormal electrocardiogram and/or a history of angina or myocardial infarction.RESULTS - Subjects were stratified according to serum insulin quintiles at fasting or 2 h after glucose loading. After adjustment for sex, age, BMI, smoking, physical activity, alcohol intake, and socioeconomic status (analysis of covariance), cardiovascular risk factors clustered in subjects of the top insulin quintile. Multiple logistic regression analysis, including sex and age in model 1, sex, age, BMI, glucose tolerance, socioeconomic status, and behavioral variables in model 2, or this set of variables together with triglycerides and apoproteins al and B, fibrinogen, and blood pressure status in model 3, revealed a significant association between high serum insulin and CHD when median insulin quintile was used as the reference class. Moreover, low serum insulin levels, such as those found in subjects of the lowest quintile, were independently related to CHD. These results were found either before (model 1) or after (models 2 and 3) adjusting for several covariates. Consistent results were found in men and women, as well as in younger and older subjects.CONCLUSIONS - Results of the present study suggest that both hyperinsulinemia and "hypoinsulinemia" are independent indicators of CHD. Furthermore, it is proposed that the relationship between CHD and fasting insulin is U-shaped, whereas that between CHD and postglucose insulin may be J-shaped.