Galvan A Q, Galetta F, Natali A, Muscelli E, Sironi A M, Cini G, Camastra S, Ferrannini E
Department of Internal Medicine, University of Pisa School of Medicine, and the Metabolism Unit of the CNR Institute of Clinical Physiology, University of Pisa, Italy.
Circulation. 2000 Oct 31;102(18):2233-8. doi: 10.1161/01.cir.102.18.2233.
Hyperinsulinemia and insulin resistance may contribute to the development of cardiac hypertrophy. In humans, however, the evidence is inconclusive.
We studied 50 nondiabetic subjects covering a wide range of age (20 to 65 years), body mass index (BMI, 19 to 40 kg x m(-2)), and mean blood pressure (72 to 132 mm Hg). Plasma insulin concentrations and secretory rates were measured at baseline and during an oral glucose tolerance test; insulin sensitivity was measured by the insulin clamp technique. Left ventricular mass (LVM) (by 2D M-mode echocardiography) was distributed normally and was higher in obese (BMI >/=27 kg x m(-2), n=16) or hypertensive patients (blood pressure >140/90 mm Hg, n=21) (50+/-8 and 55+/-10 g x m(-2.7), respectively) than in 13 nonobese, normotensive subjects (40+/-8 g x m(-2.7), P:=0.0004). In a multivariate model adjusting for sex, age, BMI, and blood pressure, neither insulin concentrations (fasting or postglucose) nor insulin sensitivity or secretory rates were significant correlates of LVM. Systolic blood pressure (P:=0.003) and BMI (P:=0.01) were the only independent correlates of LVM. From the regression, the impact of hypertension (as a systolic pressure of 180 versus 140 mm Hg=+20%) was twice as large as that of obesity (as a BMI of 35 versus 25 kg x m(-2)=+11%), the two factors being additive.
When adequate account is taken of body mass and blood pressure, insulin, as concentration, secretion, or action, is not an independent determinant of LVM in nondiabetic subjects.
高胰岛素血症和胰岛素抵抗可能促使心脏肥大的发生。然而，在人类中，证据并不确凿。
我们研究了50名非糖尿病受试者，其年龄范围较广（20至65岁），体重指数（BMI，19至40 kg·m⁻²），平均血压（72至132 mmHg）。在基线和口服葡萄糖耐量试验期间测量血浆胰岛素浓度和分泌率；通过胰岛素钳夹技术测量胰岛素敏感性。左心室质量（LVM）（通过二维M型超声心动图测量）呈正态分布，肥胖（BMI≥27 kg·m⁻²，n = 16）或高血压患者（血压>140/90 mmHg，n = 21）的LVM（分别为50±8和55±10 g·m⁻².⁷）高于13名非肥胖、血压正常的受试者（40±8 g·m⁻².⁷，P = 0.0004）。在调整了性别、年龄、BMI和血压的多变量模型中，胰岛素浓度（空腹或葡萄糖后）、胰岛素敏感性或分泌率均与LVM无显著相关性。收缩压（P = 0.003）和BMI（P = 0.01）是LVM的唯一独立相关因素。根据回归分析，高血压（收缩压为180 mmHg与140 mmHg相比= +20%）的影响是肥胖（BMI为35 kg·m⁻²与25 kg·m⁻²相比= +11%）的两倍，这两个因素具有相加性。
当充分考虑体重和血压时，胰岛素作为浓度、分泌或作用，并非非糖尿病受试者LVM的独立决定因素。
