Paolisso G, Ferrannini E, Sgambato S, Varricchio M, D'Onofrio F
Institute of Gerontology and Geriatrics, First Medical School, University of Naples, Italy.
J Clin Endocrinol Metab. 1992 Dec;75(6):1409-12. doi: 10.1210/jcem.75.6.1464641.
An independent association between hypercholesterolemia and high insulin levels has not consistently emerged from large-scale epidemiologic observations. We selected 39 patients with elevated low-density (LDL) cholesterol levels but normal body weight, blood pressure, and glucose tolerance, and compared them to 36 normocholesterolemic, healthy control subjects accurately matched to the patients for age, gender, body mass index, and mean arterial blood pressure. Fasting serum total cholesterol concentrations and levels of LDL cholesterol, triglycerides, and apoprotein B were all higher in the patients with hypercholesterolemia than in controls (P < 0.025 or less), whereas high-density lipoprotein cholesterol and apoprotein A levels were significantly lower (P < 0.05 or less). Plasma insulin concentrations were elevated in hypercholesterolemic patients vs. controls both in the fasting state (86 +/- 6 vs. 59 +/- 8 pmol/L) and 2 h after a 75-g oral glucose load (412 +/- 16 vs. 276 +/- 18 pmol/L, P < 0.02 for both). Two-hour plasma glucose concentrations were also significantly raised in the patients (7.8 +/- 0.2 mmol/L) compared to controls (6.4 +/- 0.1 mmol/L, P < 0.025). In a multiple regression model including serum triglyceride concentrations, LDL cholesterol was still significantly related to both fasting and 2-h plasma insulin concentrations, contributing approximately 20% to the overall variability of these measures. Thus, in this group of patients with type IIa familial combined hyperlipoproteinemia hypercholesterolemia was associated with hyperinsulinemia even when controlling for other confounders (age, gender, body mass, glucose tolerance, and blood pressure).
高胆固醇血症与高胰岛素水平之间的独立关联在大规模流行病学观察中并未始终显现出来。我们选取了39名低密度脂蛋白胆固醇水平升高但体重、血压和糖耐量正常的患者，并将他们与36名胆固醇水平正常的健康对照者进行比较，这些对照者在年龄、性别、体重指数和平均动脉血压方面与患者精确匹配。高胆固醇血症患者的空腹血清总胆固醇浓度、低密度脂蛋白胆固醇、甘油三酯和载脂蛋白B水平均高于对照组（P<0.025或更低），而高密度脂蛋白胆固醇和载脂蛋白A水平则显著较低（P<0.05或更低）。与对照组相比，高胆固醇血症患者无论是在空腹状态下（86±6 vs. 59±8 pmol/L）还是在口服75克葡萄糖负荷后2小时（412±16 vs. 276±18 pmol/L，两者P<0.02），血浆胰岛素浓度均升高。与对照组（6.4±0.1 mmol/L，P<0.025）相比，患者的2小时血浆葡萄糖浓度也显著升高（7.8±0.2 mmol/L）。在一个包括血清甘油三酯浓度的多元回归模型中，低密度脂蛋白胆固醇仍与空腹和2小时血浆胰岛素浓度显著相关，对这些指标的总体变异性贡献约20%。因此，在这组IIa型家族性混合性高脂血症患者中，即使在控制了其他混杂因素（年龄、性别、体重、糖耐量和血压）后，高胆固醇血症仍与高胰岛素血症相关。
