Bertoni Alain G, Wong Nathan D, Shea Steven, Ma Shuangge, Liu Kiang, Preethi Srikanthan, Jacobs David R, Wu Colin, Saad Mohammed F, Szklo Moyses
Department of Epidemiology and Prevention, Wake Forest University, Winston-Salem, North Carolina, USA.
Diabetes Care. 2007 Nov;30(11):2951-6. doi: 10.2337/dc07-1042. Epub 2007 Aug 17.
To investigate the association of insulin resistance and clinically defined metabolic syndrome (MetS) with subclinical atherosclerosis and examine whether these relationships vary by race/ethnicity or sex.
Subclinical atherosclerosis was assessed by coronary artery calcium (CAC) and carotid intima-medial thickness (IMT) in 5,810 participants without diabetes in the Multi-Ethnic Study of Atherosclerosis, a cohort of adults aged 45-84 years without prior cardiovascular disease (CVD). Fasting insulin and glucose were utilized to estimate insulin resistance by the homeostasis model assessment of insulin resistance (HOMA-IR) index, and the revised National Cholesterol Education Program definition of MetS was utilized. Multivariable linear or relative risk regression was used to analyze the association between HOMA-IR and subclinical atherosclerosis and assess its independence from MetS components.
HOMA-IR was associated with increased IMT after adjustment for demographics (age, site, and education), smoking, education, and LDL cholesterol in each ethnic group, except Hispanic subjects, and in both men and women. After further adjusting for nonglucose MetS components, HOMA-IR was not associated with increased IMT. Subjects in the highest quintile of HOMA-IR had an elevated prevalence of CAC in each ethnic group and both sexes, after adjustment for demographics, smoking, and LDL but not after further adjustment for nonglucose MetS components. Among those with detectable CAC, there was no significant relationship between HOMA-IR and the amount of CAC.
Although HOMA-IR was associated with increased subclinical atherosclerosis, the association was not independent of the risk factors that comprise MetS. Determination of HOMA-IR is unlikely to contribute to improved determination of risk of subclinical CVD.
研究胰岛素抵抗及临床定义的代谢综合征（MetS）与亚临床动脉粥样硬化的关联，并探讨这些关系是否因种族/民族或性别而异。
在动脉粥样硬化多民族研究中，对5810名无糖尿病的参与者进行了亚临床动脉粥样硬化评估，该队列研究对象为年龄在45 - 84岁且无既往心血管疾病（CVD）的成年人，通过冠状动脉钙化（CAC）和颈动脉内膜中层厚度（IMT）进行评估。利用空腹胰岛素和血糖，通过胰岛素抵抗稳态模型评估（HOMA - IR）指数来估计胰岛素抵抗，并采用美国国家胆固醇教育计划修订版对MetS进行定义。使用多变量线性或相对风险回归分析HOMA - IR与亚临床动脉粥样硬化之间的关联，并评估其独立于MetS各组分的情况。
在调整人口统计学因素（年龄、地点和教育程度）、吸烟、教育程度和低密度脂蛋白胆固醇后，除西班牙裔受试者外，各民族组以及男性和女性中，HOMA - IR均与IMT增加相关。在进一步调整非血糖MetS组分后，HOMA - IR与IMT增加不再相关。在调整人口统计学因素、吸烟和低密度脂蛋白胆固醇后，HOMA - IR最高五分位数的受试者在各民族组和两性中CAC患病率均升高，但在进一步调整非血糖MetS组分后则不然。在可检测到CAC的人群中，HOMA - IR与CAC量之间无显著关系。
尽管HOMA - IR与亚临床动脉粥样硬化增加相关，但这种关联并非独立于构成MetS的危险因素。测定HOMA - IR不太可能有助于改善亚临床CVD风险的判定。
