Rutter Martin K, Meigs James B, Sullivan Lisa M, D'Agostino Ralph B, Wilson Peter W
Department of Medicine, Countess of Chester Hospital NHS Trust, Chester, CH2 1UL, UK.
Diabetes. 2005 Nov;54(11):3252-7. doi: 10.2337/diabetes.54.11.3252.
The metabolic syndrome and insulin resistance have been related to incident cardiovascular disease (CVD), but it is uncertain if metabolic syndrome predicts CVD independent of insulin resistance. Our study sample included 2,898 people without diabetes or CVD at baseline. Metabolic syndrome was defined by the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) criteria. Insulin resistance was defined by the homeostasis model assessment (HOMA-IR) and by Gutt et al.'s insulin sensitivity index (ISI(0,120)). Age- and sex-adjusted proportional hazards regression models assessed the association of baseline metabolic syndrome and insulin resistance to 7-year CVD risk (186 events). Metabolic syndrome and both measures of insulin resistance were individually related to incident CVD (age- and sex-adjusted hazard ratio [HR] for metabolic syndrome [present versus absent]: 2.0 [95% CI 1.5-2.6], P = 0.0001; for HOMA-IR: 1.9 [1.2-2.9], P = 0.003; and for ISI(0,120) [both highest versus lowest quartile]: 0.5 [0.3-0.7], P = 0.001). In models adjusted for age, sex, LDL cholesterol, and smoking status and including metabolic syndrome, ISI(0,120) levels were independently related to incident CVD (0.5 [0.3-0.8], P = 0.004), whereas HOMA-IR levels were not (1.3 [0.8-2.1], P = 0.24); metabolic syndrome was associated with increased CVD risk in both models (HR 1.6, P < or = 0.007 in both). In conclusion, metabolic syndrome and ISI(0,120) but not HOMA-IR independently predicted incident CVD. Metabolic syndrome may not capture all the CVD risk associated with insulin resistance.
代谢综合征和胰岛素抵抗与心血管疾病（CVD）的发生有关，但代谢综合征能否独立于胰岛素抵抗预测CVD尚不确定。我们的研究样本包括2898名基线时无糖尿病或CVD的人。代谢综合征由美国国家胆固醇教育计划（NCEP）成人高胆固醇检测、评估和治疗专家小组（成人治疗小组III）标准定义。胰岛素抵抗由稳态模型评估（HOMA-IR）和古特等人的胰岛素敏感性指数（ISI(0,120)）定义。年龄和性别调整后的比例风险回归模型评估了基线代谢综合征和胰岛素抵抗与7年CVD风险（186例事件）之间的关联。代谢综合征和两种胰岛素抵抗测量指标均与CVD的发生独立相关（代谢综合征的年龄和性别调整风险比[HR][存在与不存在]：2.0[95%CI 1.5-2.6]，P = 0.0001；HOMA-IR：1.9[1.2-2.9]，P = 0.003；ISI(0,120)[最高四分位数与最低四分位数]：0.5[0.3-0.7]，P = 0.001）。在调整了年龄、性别、低密度脂蛋白胆固醇和吸烟状况并纳入代谢综合征的模型中，ISI(0,120)水平与CVD的发生独立相关（0.5[0.3-0.8]，P = 0.004），而HOMA-IR水平则不然（1.3[0.8-2.1]，P = 0.24）；在两个模型中，代谢综合征均与CVD风险增加相关（HR 1.6，两者P均≤0.007）。总之，代谢综合征和ISI(0,120)而非HOMA-IR可独立预测CVD的发生。代谢综合征可能无法涵盖与胰岛素抵抗相关的所有CVD风险。
