Burchfiel C M, Shetterly S M, Baxter J, Hamman R F
Department of Preventive Medicine and Biometrics, University of Colorado School of Medicine, Denver 80262.
Am J Epidemiol. 1992 Nov 1;136(9):1101-9. doi: 10.1093/oxfordjournals.aje.a116575.
The objective of this study was to determine whether a less favorable risk factor pattern for cardiovascular disease among persons with impaired glucose tolerance could be explained by fasting insulin, obesity, and/or a central distribution of body fat. Between 1984 and 1988, cardiovascular risk factors were examined cross-sectionally in Hispanic and non-Hispanic white participants in the San Luis Valley Diabetes Study who had either impaired (n = 173) or normal (n = 1,107) glucose tolerance. Sex-specific analysis of covariance models were constructed to adjust risk factor levels for age, age and insulin, and age, insulin, body mass index, and centrality index. Both males and females with impaired glucose tolerance had higher age-adjusted mean diastolic blood pressures, heart rates, uric acid levels, and triglyceride levels and lower levels of high density lipoprotein (HDL) cholesterol and HDL3 cholesterol than normal subjects; differences were significant for all risk factors except HDL cholesterol and HDL3 cholesterol in males. Differences in diastolic blood pressure in males, and differences in heart rate and triglyceride in both sexes, remained significant after adjustment for all covariates. However, differences in uric acid in males and differences in diastolic blood pressure and HDL3 cholesterol in females were attenuated to borderline significance levels. Differences in uric acid and HDL cholesterol in females were diminished to nonsignificant levels, especially after adjustment for obesity-related measures. With few exceptions, fasting insulin did not appear to play a major role in accounting for differences in these risk factors. With adjustment, ethnic differences (Hispanic vs. non-Hispanic white) were smaller and were statistically significant less often than differences observed between impaired and normal glucose tolerant groups. The authors concluded that hyperinsulinemia, obesity, and a central body fat distribution accounted for some, but usually not all, of the less favorable cardiovascular risk factor pattern found in subjects with impaired glucose tolerance.
本研究的目的是确定糖耐量受损者心血管疾病风险因素模式较差是否可由空腹胰岛素、肥胖和/或体脂的中心分布来解释。1984年至1988年期间，对圣路易斯谷糖尿病研究中的西班牙裔和非西班牙裔白人参与者进行了心血管风险因素的横断面检查，这些参与者的糖耐量受损（n = 173）或正常（n = 1107）。构建了性别特异性协方差分析模型，以调整年龄、年龄和胰岛素、年龄、胰岛素、体重指数和中心性指数的风险因素水平。糖耐量受损的男性和女性比正常受试者具有更高的年龄调整后平均舒张压、心率、尿酸水平和甘油三酯水平，以及更低的高密度脂蛋白（HDL）胆固醇和HDL3胆固醇水平；除男性的HDL胆固醇和HDL3胆固醇外，所有风险因素的差异均具有统计学意义。在调整所有协变量后，男性舒张压的差异以及男女心率和甘油三酯的差异仍然具有统计学意义。然而，男性尿酸的差异以及女性舒张压和HDL3胆固醇的差异减弱至临界显著水平。女性尿酸和HDL胆固醇的差异减弱至无统计学意义水平，尤其是在调整与肥胖相关的指标后。除少数例外，空腹胰岛素在解释这些风险因素的差异方面似乎并未发挥主要作用。经调整后，种族差异（西班牙裔与非西班牙裔白人）较小，且在统计学上显著的情况比糖耐量受损组与正常组之间的差异更少。作者得出结论，高胰岛素血症、肥胖和体脂中心分布解释了糖耐量受损受试者中发现的部分（但通常不是全部）较差的心血管风险因素模式。
