胰岛素抵抗是2型糖尿病绝经后女性冠心病风险增加的主要决定因素。

Insulin resistance as a major determinant of increased coronary heart disease risk in postmenopausal women with Type 2 diabetes mellitus.

作者信息

Stoney R M, O'Dea K, Herbert K E, Dragicevic G, Giles G G, Cumpston G N, Best J D

机构信息

Nutrition Department, Alfred Hospital, Melbourne, Australia.

出版信息

Diabet Med. 2001 Jun;18(6):476-82. doi: 10.1046/j.1464-5491.2001.00504.x.

DOI:10.1046/j.1464-5491.2001.00504.x

PMID:11472467

Abstract

AIM

To investigate the risk factors associated with clinically defined coronary heart disease (CHD) in women with Type 2 diabetes mellitus (DM).

METHODS

CHD status was assessed via standard history and resting electrocardiogram in 41 postmenopausal diabetic and 41 age- and body mass index-matched normoglycaemic women recruited from a community-based cohort. The following parameters were assessed: body composition by dual energy X-ray absorptiometry, blood pressure, metabolic and lipoprotein profile and haemostatic factors.

RESULTS

Diabetic women with CHD (n = 14) had greater insulin resistance, calculated by homeostasis model assessment (10.2 (7.0-14.8) vs. 6.5 (5.5-7.7), P = 0.010), and higher plasminogen activator inhibitor-1 (PAI-1) levels (45 (29-69) vs. 24 (19-32) ng/ml, P = 0.013), than those without CHD. They also had higher triglycerides (2.9 (2.2-3.8) vs. 2.1 (1.8-2.4) mmol/l, P = 0.016) and a trend towards reduced low-density lipoprotein particle size (25.5 +/- 0.6 vs. 25.8 +/- 0.5 nm, P = 0.097). In a logistic regression model, insulin resistance was a significant independent predictor of CHD status (odds ratio = 1.33, 95% confidence interval = 1.06-1.68, P = 0.015). In contrast, in normoglycaemic women the major risk factors for CHD were elevated cholesterol, apolipoprotein(a), apolipoprotein B and systolic blood pressure (P = 0.018, P = 0.016, P = 0.006 and P = 0.049, respectively).

CONCLUSIONS

Increased insulin resistance in association with elevated PAI-1 and dyslipidaemia appears to underpin the increased risk of CHD in women with Type 2 DM. Therapeutic approaches that increase insulin sensitivity may serve to reduce CHD risk in this vulnerable group. Diabet. Med. 18, 476-482 (2001)

摘要

目的

研究2型糖尿病（DM）女性患者中与临床确诊冠心病（CHD）相关的危险因素。

方法

通过标准病史和静息心电图对从社区队列中招募的41名绝经后糖尿病女性和41名年龄及体重指数匹配的血糖正常女性的冠心病状况进行评估。评估了以下参数：通过双能X线吸收法测定的身体成分、血压、代谢和脂蛋白谱以及止血因子。

结果

患有冠心病的糖尿病女性（n = 14）通过稳态模型评估计算得出的胰岛素抵抗更高（10.2（7.0 - 14.8）对6.5（5.5 - 7.7），P = 0.010），纤溶酶原激活物抑制剂 - 1（PAI - 1）水平更高（45（29 - 69）对24（19 - 32）ng/ml，P = 0.013），高于未患冠心病的女性。她们的甘油三酯水平也更高（2.9（2.2 - 3.8）对2.1（1.8 - 2.4）mmol/l，P = 0.016），并且低密度脂蛋白颗粒大小有减小的趋势（25.5 ± 0.6对25.8 ± 0.5 nm，P = 0.097）。在逻辑回归模型中，胰岛素抵抗是冠心病状况的显著独立预测因素（比值比 = 1.33，95%置信区间 = 1.06 - 1.68，P = 0.015）。相比之下，在血糖正常的女性中，冠心病的主要危险因素是胆固醇、载脂蛋白(a)、载脂蛋白B升高和收缩压升高（分别为P = 0.018、P = 0.016、P = 0.006和P = 0.049）。