Bonora Enzo, Formentini Gianni, Calcaterra Francesco, Lombardi Simonetta, Marini Franco, Zenari Luciano, Saggiani Francesca, Poli Maurizio, Perbellini Sandro, Raffaelli Andrea, Cacciatori Vittorio, Santi Lorenza, Targher Giovanni, Bonadonna Riccardo, Muggeo Michele
Endocrinology and Metabolic Diseases, University of Verona Medical School, Verona, Italy.
Diabetes Care. 2002 Jul;25(7):1135-41. doi: 10.2337/diacare.25.7.1135.
To evaluate whether homeostasis model assessment-estimated insulin resistance (HOMA-IR) is an independent predictor of cardiovascular disease (CVD) in type 2 diabetes.
Conventional CVD risk factors (sex, age, smoking, plasma lipids, blood pressure, and metabolic control) and insulin resistance (estimated by HOMA) were evaluated at baseline in 1,326 patients with type 2 diabetes examined within the Verona Diabetes Complications Study. At baseline and after a mean follow-up of 4.5 years, CVD was assessed by medical history, physical examination, electrocardiography, and echo-Doppler of carotid and lower limb arteries. Death certificates and medical records of subjects who died during the follow-up were carefully scrutinized to identify cardiovascular deaths. In statistical analyses, CVD was an aggregate end point including both fatal and nonfatal coronary, cerebrovascular, and peripheral vascular disease as well as ischemic electrocardiographic abnormalities and vascular lesions identified by echo-Doppler.
At baseline, 441 subjects were coded positive for CVD (prevalent cases). Incident cases numbered 126. Multiple logistic regression analyses showed that, along with sex, age, smoking, HDL/total cholesterol ratio, and hypertension, HOMA-IR was an independent predictor of both prevalent and incident CVD. A 1-unit increase in (log)HOMA-IR value was associated with an odds ratio for prevalent CVD at baseline of 1.31 (95% CI 1.10-1.56, P = 0.002) and for incident CVD during follow-up of 1.56 (95% CI 1.14-2.12, P < 0.001).
HOMA-IR is an independent predictor of CVD in type 2 diabetes. The improvement of insulin resistance might have beneficial effects not only on glucose control but also on CVD in patients with type 2 diabetes.
评估稳态模型评估估算的胰岛素抵抗（HOMA-IR）是否为2型糖尿病患者心血管疾病（CVD）的独立预测指标。
在维罗纳糖尿病并发症研究中对1326例2型糖尿病患者进行了基线评估，包括常规CVD危险因素（性别、年龄、吸烟、血脂、血压和代谢控制）以及胰岛素抵抗（通过HOMA估算）。在基线时以及平均随访4.5年后，通过病史、体格检查、心电图以及颈动脉和下肢动脉的超声多普勒检查对CVD进行评估。仔细审查随访期间死亡患者的死亡证明和病历，以确定心血管死亡情况。在统计分析中，CVD为综合终点，包括致命和非致命的冠状动脉、脑血管和外周血管疾病，以及缺血性心电图异常和超声多普勒检查发现的血管病变。
基线时，441例受试者CVD编码为阳性（现患病例）。新发病例有126例。多因素logistic回归分析显示，除性别、年龄、吸烟、高密度脂蛋白/总胆固醇比值和高血压外，HOMA-IR是现患和新发CVD的独立预测指标。（log）HOMA-IR值每增加1个单位，基线时现患CVD的比值比为1.31（95%CI 1.10-1.56，P=0.002），随访期间新发CVD的比值比为1.56（95%CI 1.14-2.12，P<0.001）。
HOMA-IR是2型糖尿病患者CVD的独立预测指标。改善胰岛素抵抗可能不仅对血糖控制有益，对2型糖尿病患者的CVD也有益。
