Vasan Ramachandran S, Sullivan Lisa M, D'Agostino Ralph B, Roubenoff Ronenn, Harris Tamara, Sawyer Douglas B, Levy Daniel, Wilson Peter W F
National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts 01702-5803, USA.
Ann Intern Med. 2003 Oct 21;139(8):642-8. doi: 10.7326/0003-4819-139-8-200310210-00007.
Several experimental investigations have emphasized the favorable effects of insulin-like growth factor I (IGF-I) on left ventricular remodeling, partly through its antiapoptotic effects. Cross-sectional clinical studies have reported that low serum IGF-I levels in patients with heart failure correlate with cachexia and severity of ventricular dysfunction. It is unclear whether low serum IGF-I is a risk factor for heart failure.
To prospectively study the association between serum IGF-I level and the incidence of congestive heart failure.
Community-based, prospective cohort study.
Framingham, Massachusetts.
717 elderly individuals (mean age, 78.4 years; 67% women) who did not have myocardial infarction and congestive heart failure at baseline.
Incidence of a first episode of congestive heart failure on follow-up.
During follow-up (mean, 5.2 years), 56 participants (35 women) developed congestive heart failure. In multivariable Cox regression models adjusting for established risk factors at baseline, there was a 27% decrease in risk for heart failure for every 1 standard deviation increment in log IGF-I. Individuals with serum IGF-I level at or above the median value (140 microg/L) had half the risk for heart failure (hazard ratio, 0.49 [95% CI, 0.26 to 0.92]) of those with serum IGF-I levels below the median. These comparisons were maintained in analyses adjusting for the occurrence of a myocardial infarction on follow-up.
In our prospective, community-based investigation, serum IGF-I level was inversely related to the risk for congestive heart failure in elderly people without a previous myocardial infarction. Additional investigations are warranted to confirm these findings.
多项实验研究强调了胰岛素样生长因子I（IGF-I）对左心室重塑的有益作用，部分是通过其抗凋亡作用。横断面临床研究报告称，心力衰竭患者血清IGF-I水平低与恶病质及心室功能障碍的严重程度相关。目前尚不清楚血清IGF-I水平低是否为心力衰竭的危险因素。
前瞻性研究血清IGF-I水平与充血性心力衰竭发病率之间的关联。
基于社区的前瞻性队列研究。
马萨诸塞州弗雷明汉。
717名老年人（平均年龄78.4岁；67%为女性），基线时无心肌梗死和充血性心力衰竭。
随访期间首次发生充血性心力衰竭的发病率。
在随访期间（平均5.2年），56名参与者（35名女性）发生了充血性心力衰竭。在对基线时已确定的危险因素进行调整的多变量Cox回归模型中，log IGF-I每增加1个标准差，心力衰竭风险降低27%。血清IGF-I水平等于或高于中位数（140μg/L）的个体发生心力衰竭的风险是血清IGF-I水平低于中位数个体的一半（风险比，0.49[95%CI，0.26至0.92]）。在对随访期间发生心肌梗死进行调整的分析中，这些比较结果保持不变。
在我们基于社区的前瞻性调查中，血清IGF-I水平与无既往心肌梗死的老年人发生充血性心力衰竭的风险呈负相关。有必要进行进一步研究以证实这些发现。
