Walker B R, Soderberg S, Lindahl B, Olsson T
University of Edinburgh, Department of Medicine, Western General Hospital, Edinburgh, UK.
J Intern Med. 2000 Feb;247(2):198-204. doi: 10.1046/j.1365-2796.2000.00609.x.
Recent data suggest that higher plasma cortisol may be associated with hypertension and insulin resistance in otherwise healthy men, as it is in Cushing's syndrome. However, obesity in women is associated with lower plasma cortisol concentrations. This study sought to establish whether plasma cortisol is associated with cardiovascular risk factors in women as it is in men, and whether these relationships in either sex are confounded by obesity.
A population-based cross-sectional study.
The MONICA study in northern Sweden.
From a target cohort of 2500, 1921 subjects took part and 226 were randomly selected because they attended between 07.00 and 09.00 h after an overnight fast. A 75 g oral glucose tolerance test was performed and blood sampled at baseline and 2 h after glucose.
Plasma cortisol was lower in relatively obese subjects: in men, this was observed only in the 2 h sample (r = -0.23, P = 0.02) and in women only in the fasting sample (r = -0.26, P < 0.01). Simple regression analysis did not identify relationships between plasma cortisol and blood pressure, serum lipids, fasting insulin or glucose tolerance. However, after adjusting for the effect of obesity by multiple regression, higher plasma cortisol was independently associated with higher diastolic blood pressure in men (r = 0.21, P = 0.04) but not in women, and higher fasting serum triglyceride levels in women (r = 0.28, P < 0. 001) but not in men.
Increasing obesity and plasma cortisol concentrations make independent and sex-specific contributions to variations in blood pressure and aspects of the insulin resistance syndrome. Adverse cardiovascular risk is greatest in those with the combination of obesity and failure to downregulate plasma cortisol levels.
近期数据表明，在其他方面健康的男性中，较高的血浆皮质醇可能与高血压和胰岛素抵抗有关，就如同在库欣综合征中一样。然而，女性肥胖与较低的血浆皮质醇浓度相关。本研究旨在确定血浆皮质醇是否如在男性中那样与女性的心血管危险因素相关，以及肥胖是否会混淆这两种性别的上述关系。
一项基于人群的横断面研究。
瑞典北部的莫尼卡研究。
从2500名目标队列中，1921名受试者参与研究，其中226名因在空腹过夜后07:00至09:00之间就诊而被随机选取。进行了75克口服葡萄糖耐量试验，并在基线和葡萄糖摄入后2小时采集血样。
相对肥胖的受试者血浆皮质醇较低：在男性中，仅在2小时样本中观察到这种情况（r = -0.23，P = 0.02），而在女性中仅在空腹样本中观察到（r = -0.26，P < 0.01）。简单回归分析未发现血浆皮质醇与血压、血脂、空腹胰岛素或葡萄糖耐量之间的关系。然而，在通过多元回归调整肥胖的影响后，较高的血浆皮质醇与男性较高的舒张压独立相关（r = 0.21，P = 0.04），但与女性无关；与女性较高的空腹血清甘油三酯水平独立相关（r = 0.28，P < 0.001），但与男性无关。
肥胖和血浆皮质醇浓度的增加对血压变化和胰岛素抵抗综合征的某些方面有独立且性别特异性的影响。肥胖且未能下调血浆皮质醇水平的人群心血管不良风险最大。
