非裔美国人和白人高血压成年人中胰岛素与左心室几何结构及功能的关系：高血压遗传流行病学网络研究（HyperGEN研究）

Relation of insulin to left ventricular geometry and function in African American and white hypertensive adults: the HyperGEN study.

作者信息

Devereux Richard B, de Simone Giovanni, Palmieri Vittorio, Oberman Albert, Hopkins Paul, Kitzman Dalane W, Rao Dabeeru C, Arnett Donna K

机构信息

Division of Cardiology, Weill Medical College of Cornell University, New York, New York 10021, USA.

出版信息

Am J Hypertens. 2002 Dec;15(12):1029-35. doi: 10.1016/s0895-7061(02)03080-7.

DOI:10.1016/s0895-7061(02)03080-7

PMID:12460697

Abstract

BACKGROUND

It has been suggested that the trophic effects of insulin may contribute to left ventricular (LV) hypertrophy in hypertension, but few population-based data exist to assess the potential impact of insulin level on LV structure or systolic function.

METHODS

Fasting plasma insulin levels (log-transformed) in 1,542 nondiabetic African American or white hypertensive participants in the Hypertension Genetic Epidemiology Network (HyperGEN) study were compared to indices of LV geometry and function, with adjustment for potential confounders (age, sex, ethnicity, blood pressure (BP), body mass index, height and antihypertensive drugs).

RESULTS

In simple correlation analysis, a weak positive relation (r = 0.078, P =.002) was found between LV mass and insulin, principally due to positive correlations (r = 0.22 and 0.50) of both variables to body mass index. Multivariate analysis, adjusting for age, sex, ethnicity, body size, systolic BP, and antihypertensive drugs revealed a modest negative relation between insulin and LV mass (r = -0.08, P =.001) due to a negative relationship between insulin with LV chamber size (r = - 0.10, P <.001) and no significant relation to LV wall thicknesses. These results were confirmed in additional analysis controlling for a positive relation (r =.19, P <.0001) of insulin to heart rate, and the relation with insulin became slightly more negative when LV mass was indexed for height(2.7) (r = -0.13, P <.001). After adjustment for covariates, there were no significant relations of insulin to LV ejection fraction or stress-corrected midwall shortening; however, insulin was negatively related to stroke volume (r = -0.12, p < 0.001) and was weakly related positively to relative wall thickness (r =.053) (P =.04).

CONCLUSIONS

After adjustment for body mass index and other covariates, insulin in nondiabetic hypertensive individuals has weak negative relations to LV chamber size, mass, and stroke volume, and also has weak positive relations to relative wall thickness but not to measures of LV systolic function. Thus, native plasma insulin level may not play a major independent role in the pathogenesis of hypertensive LV hypertrophy or dysfunction.

摘要

背景

有研究表明，胰岛素的营养作用可能导致高血压患者左心室（LV）肥厚，但基于人群的数据很少，难以评估胰岛素水平对左心室结构或收缩功能的潜在影响。

方法

在高血压遗传流行病学网络（HyperGEN）研究中，对1542名非糖尿病非裔美国或白人高血压参与者的空腹血浆胰岛素水平（对数转换）与左心室几何形态和功能指标进行比较，并对潜在混杂因素（年龄、性别、种族、血压（BP）、体重指数、身高和降压药物）进行校正。

结果

在简单相关分析中，左心室质量与胰岛素之间存在微弱的正相关关系（r = 0.078，P = 0.002），主要是由于这两个变量与体重指数均呈正相关（r = 0.22和0.50）。多变量分析在对年龄、性别、种族、体型、收缩压和降压药物进行校正后，发现胰岛素与左心室质量之间存在适度的负相关关系（r = -0.08，P = 0.001），这是由于胰岛素与左心室腔大小呈负相关（r = -0.10，P < 0.001），与左心室壁厚度无显著关系。在控制胰岛素与心率的正相关关系（r = 0.19，P < 0.0001）的额外分析中证实了这些结果，当左心室质量按身高(2.7)进行指数化时，与胰岛素的关系变得更负（r = -0.13，P < 0.001）。在对协变量进行校正后，胰岛素与左心室射血分数或应力校正的室壁缩短无显著关系；然而，胰岛素与每搏输出量呈负相关（r = -0.12，p < 0.001），与相对室壁厚度呈微弱正相关（r = 0.053）（P = 0.04）。