INSULIN RESISTANCE HYPERGLYCEMIA AND ATHEROSCLEROSIS

Kaiser Permanente Medical Care研究部（DOR） 计划（毕马威会计师事务所）北方加州与部门合作 医学部、斯坦福大学医学院和劳伦斯 加州大学伯克利实验室提出研究 胰岛素抵抗与心血管疾病的关系及其 随机样本中葡萄糖耐量谱的危险因素 从21，000多名40-69岁的KPMCP成员中选出的400名成年人 在上一年接受多项健康检查的年龄。 的 样本将按人种（黑人/白色）大致均匀分层， 性别和检查时空腹血糖水平（<115，116-140， 且>140 mg/dl）。 成员将被邀请参加DOR的两部分临床考试， 将包括两小时的口服葡萄糖耐量试验和直接 使用胰岛素抑制试验评估胰岛素敏感性。 糖化血红蛋白，空腹和负荷后胰岛素水平，空腹 脂质，载脂蛋白，HDL和LDL亚类，脂蛋白（a），空腹 和后负荷血浆游离脂肪酸，凝血因子（纤维蛋白原， 因子VII和纤溶酶原激活物抑制剂）将在所有患者中测量。 科目 游离睾酮和性激素结合球蛋白 仅在女性中测量。 其他检查包括心电图， 超声心动图和颈动脉超声检查， 人体测量，手臂/脚踝血压，并仔细评估 饮食和身体活动模式。 有了这些信息，我们可以直接检查独立的协会 胰岛素抵抗与其他CVD危险因素在每个性别，种族， 葡萄糖耐量分层，评估胰岛素的可能作用 对临床和亚临床CVD的抵抗力和高血糖症，并搜索 对于可能改变某些患者胰岛素抵抗相关风险的辅因子， 人口。 克劳斯博士领导的劳伦斯伯克利实验室也提供 作为中心实验室，将测量或安排 测量所有脂质、胰岛素和凝血因子。

The Division of Research (DOR) of the Kaiser Permanente Medical Care Program (KPMCP) Northern California in collaboration with the Department of Medicine, Stanford University School of Medicine, and the Lawrence berkeley Laboratory, University of California, proposes to study the relation of insulin resistance to cardiovascular disease (CVD) and its risk factors across the spectrum of glucose tolerance in random sample of 400 adults drawn from more than 21,000 KPMCP members 40-69 years of age who took a Multiphasic Health Checkup in the preceding year. The sample will be stratified approximately equally on race (black/white), sex, and on fasting plasma glucose level at the checkup (<115, 116-140, and >140 mg/dl). Members will be invited to a two-part clinical examination at DOR that will include a two-hour oral glucose tolerance test and direct assessment of insulin sensitivity using the insulin suppression test. Glycosylated hemoglobin, fasting and postload insulin levels, fasting lipids, apolipoproteins, HDL and LDL subclasses, lipoprotein(a), fasting and postload plasma free fatty acids, clotting factors (fibrinogen, Factor VII, and plasminogen activator inhibitor) will be measured in all subjects. Free testosterone and sex hormone binding globulin would be measured in women only. Other tests include electrocardiographic, echocardiographic, and carotid ultrasonography examinations, anthropometry, arm/ankle blood pressures, and careful evaluation of dietary and physical activity patterns. With this information, we can directly examine independent associations of insulin resistance with other CVD risk factors in each sex, race, and glucose tolerance stratum, assess the possible contributions of insulin resistance and hyperglycemia to clinical and subclinical CVD, and search for cofactors that may modify insulin-resistance related risk in some populations. Lawrence Berkeley Laboratory, under Dr. Krauss, is also offering to serve as the central laboratory and will measure, or arrange to have measured, all lipids, insulin, and coagulation factors.