Mitchell B D, Haffner S M, Hazuda H P, Valdez R, Stern M P
Department of Medicine, University of Texas Health Science Center, San Antonio 78284-7873.
Am J Epidemiol. 1992 Jul 1;136(1):12-22. doi: 10.1093/oxfordjournals.aje.a116416.
Hyperinsulinemia is associated with an adverse pattern of cardiovascular risk factors, including obesity, elevated triglyceride levels, low levels of high-density lipoprotein (HDL) cholesterol, and elevated blood pressure. Whether hyperinsulinemia precedes (and perhaps causes) this deterioration in the risk factors or merely accompanies the deterioration is controversial. We therefore examined the 8-year changes in lipids, lipoproteins, and blood pressure as a function of baseline levels of fasting insulin in 1,383 nondiabetic Mexican-American and non-Hispanic white subjects enrolled between October 1979 and November 1982 in the San Antonio Heart Study, a population-based longitudinal study of cardiovascular risk factors and diabetes in San Antonio, Texas. After age and concomitant changes in body mass index were adjusted for, fasting insulin at baseline was found to be correlated positively with 8-year changes in triglyceride levels and negatively with 8-year changes in HDL cholesterol levels (p less than 0.05). Among the non-Hispanic whites, insulin was more strongly correlated with a decline in HDL cholesterol levels in women than in men (p less than 0.001). Fasting insulin was also positively correlated with changes in both systolic and diastolic blood pressure in non-Hispanic whites, but not in Mexican Americans, although these correlations were slightly diminished and no longer achieved statistical significance after subjects receiving antihypertensive medications were excluded. These results support the hypothesis that in nondiabetic subjects, insulin has a direct regulatory effect on triglyceride and HDL cholesterol levels. These data provide evidence for a possible role for insulin in blood pressure regulation, at least in non-Hispanic whites, although further analysis of this issue is warranted.
高胰岛素血症与不良的心血管危险因素模式相关，这些危险因素包括肥胖、甘油三酯水平升高、高密度脂蛋白（HDL）胆固醇水平降低以及血压升高。高胰岛素血症是先于（甚至可能导致）这些危险因素的恶化，还是仅仅伴随这种恶化，目前存在争议。因此，我们在1979年10月至1982年11月期间纳入圣安东尼奥心脏研究的1383名非糖尿病墨西哥裔美国人和非西班牙裔白人受试者中，研究了血脂、脂蛋白和血压的8年变化与空腹胰岛素基线水平之间的关系。该研究是一项基于人群的纵向研究，旨在研究德克萨斯州圣安东尼奥市的心血管危险因素和糖尿病。在对年龄和体重指数的伴随变化进行调整后，发现基线时的空腹胰岛素与甘油三酯水平的8年变化呈正相关，与HDL胆固醇水平的8年变化呈负相关（p<0.05）。在非西班牙裔白人中，胰岛素与女性HDL胆固醇水平下降的相关性比男性更强（p<0.001）。空腹胰岛素与非西班牙裔白人的收缩压和舒张压变化也呈正相关，但在墨西哥裔美国人中并非如此，不过在排除接受抗高血压药物治疗的受试者后，这些相关性略有减弱且不再具有统计学意义。这些结果支持了这样一种假设，即在非糖尿病受试者中，胰岛素对甘油三酯和HDL胆固醇水平具有直接调节作用。这些数据为胰岛素在血压调节中可能发挥的作用提供了证据，至少在非西班牙裔白人中是这样，尽管对此问题还需要进一步分析。
