尿酸与胰岛素敏感性及高血压发病风险
Uric acid and insulin sensitivity and risk of incident hypertension.
作者信息
Forman John P, Choi Hyon, Curhan Gary C
机构信息
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
出版信息
Arch Intern Med. 2009 Jan 26;169(2):155-62. doi: 10.1001/archinternmed.2008.521.
BACKGROUND
Uric acid, insulin sensitivity, and endothelial dysfunction may be important in the development of hypertension. Corresponding circulating biomarkers are associated with risk of hypertension, but because these factors may be interrelated, whether they independently affect risk is unknown.
METHODS
In 1496 women aged 32 to 52 years without hypertension at baseline, we prospectively analyzed the associations between fasting plasma levels of uric acid, insulin, triglycerides, the insulin sensitivity index, and 2 biomarkers associated with endothelial dysfunction (homocysteine and soluble intercellular adhesion molecule-1) and the odds of incident hypertension. Odds ratios were adjusted for standard risk factors and then for all biomarkers plus estimated glomerular filtration rate and total cholesterol level. Population-attributable risk was estimated for biomarkers significantly associated with hypertension.
RESULTS
All the biomarkers were associated with incident hypertension after adjustment for standard hypertension risk factors. However, after simultaneously controlling for all the biomarkers, estimated glomerular filtration rate, and total cholesterol level, only uric acid and insulin levels were independently associated with incident hypertension. Comparing the highest and lowest quartiles of uric acid levels, the odds ratio was 1.89 (95% confidence interval, 1.26-2.82). A similar comparison yielded an odds ratio of 2.03 (95% confidence interval, 1.35-3.05) for insulin levels. Using an estimated basal incidence rate of 14.6 per 1000 annually, 30.8% of all hypertension occurring in young women annually is associated with uric acid levels of 3.4 mg/dL or greater (to convert to micromoles per liter, multiply by 59.485). For insulin levels of 2.9 microIU/mL or greater (to convert to picomoles per liter, multiply by 6.945), this proportion is 24.2%.
CONCLUSIONS
Differences in uric acid and insulin levels robustly and substantially affect the risk of hypertension in young women. Measuring these biomarkers in clinical practice may identify higher-risk individuals.
背景
尿酸、胰岛素敏感性和内皮功能障碍可能在高血压的发生发展中起重要作用。相应的循环生物标志物与高血压风险相关，但由于这些因素可能相互关联，它们是否独立影响风险尚不清楚。
方法
在1496名基线时无高血压的32至52岁女性中，我们前瞻性分析了空腹血浆尿酸、胰岛素、甘油三酯、胰岛素敏感性指数以及与内皮功能障碍相关的2种生物标志物（同型半胱氨酸和可溶性细胞间黏附分子-1）水平与高血压发病几率之间的关联。比值比针对标准风险因素进行了调整，然后针对所有生物标志物以及估算的肾小球滤过率和总胆固醇水平进行了调整。对与高血压显著相关的生物标志物估计了人群归因风险。
结果
在对标准高血压风险因素进行调整后，所有生物标志物均与高血压发病相关。然而，在同时控制所有生物标志物、估算的肾小球滤过率和总胆固醇水平后，只有尿酸和胰岛素水平与高血压发病独立相关。比较尿酸水平的最高和最低四分位数，比值比为1.89（95%置信区间，1.26 - 2.82）。胰岛素水平的类似比较得出比值比为2.03（95%置信区间，1.35 - 3.05）。使用每年每1000人14.6的估计基础发病率，每年年轻女性中发生的所有高血压中有30.8%与尿酸水平3.4mg/dL或更高有关（转换为微摩尔每升时，乘以59.485）。对于胰岛素水平2.9微国际单位/毫升或更高（转换为皮摩尔每升时，乘以6.945），这一比例为24.2%。
结论
尿酸和胰岛素水平的差异强烈且显著地影响年轻女性患高血压的风险。在临床实践中检测这些生物标志物可能识别出高风险个体。
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