Winocour P H, Kaluvya S, Brown L, Farrer M, Millar J P, Neil H, Alberti K G
Department of Medicine, University of Newcastle upon Tyne.
Q J Med. 1991 Jun;79(290):539-60.
Hyperinsulinaemia is said to be a risk factor for cardiovascular disease, but the extent to which different insulinaemic measures are associated with vascular risk factors in ostensibly healthy individuals, and whether they operate independently in men and women, remains uncertain. The association between risk factors and various insulinaemic measures was examined in 148 men and 118 women who were normoglycaemic, normotensive, and non-obese (body mass index in men less than 27, in women less than 25). A 75 g glucose tolerance test was administered after blood sampling for fibrinogen, lipids, lipoproteins and insulin. Insulin was also measured after 1 and 2 hours. Significant univariate correlations (p less than 0.01) were most consistently recorded between insulinaemic measures and fasting serum triglycerides in men and women, whilst systolic blood pressure only correlated with insulinaemia in women, and diastolic blood pressure correlated with fasting and 2 hour insulinaemic measures in men and women. Inconsistent associations were noted with total serum cholesterol in men and women, with high density lipoprotein cholesterol, body mass index, apoprotein B and A1 in men, and with fibrinogen in women. Age was not correlated with any insulinaemic measure in men or women. Differences in vascular risk factors between quintiles of the insulinaemic measures were examined, after correction for body mass index. The dominant association with fasting and post-glucose load insulinaemic measures was with triglycerides, especially in women, with less frequent graded differences between quintiles observed for total cholesterol, and diastolic and systolic blood pressures in men and women. The incidence of other risk factors often only differed in the lowest or highest quintile in comparison to other quintiles, suggesting a threshold rather than a graded effect. Furthermore, differences in HDL cholesterol and apoprotein B were only recorded for top quintiles of post-glucose challenge/integrated insulinaemic measures in men, whilst serum fibrinogen concentrations only differed significantly in women in the top insulinaemic area under the curve quintile. In the absence of additional risk factors such as diabetes, hypertension and obesity, insulinaemic measures are not consistently related to blood pressure and measures of lipid metabolism and coagulation, and are thus a weak predictor of other cardiovascular risk factors. The vascular risk profile associated with insulin appears somewhat different in apparently healthy men and women.
高胰岛素血症被认为是心血管疾病的一个风险因素，但在表面健康的个体中，不同的胰岛素水平测量指标与血管危险因素之间的关联程度，以及它们在男性和女性中是否独立起作用，仍不明确。在148名男性和118名女性中进行了研究，这些人血糖正常、血压正常且非肥胖（男性体重指数小于27，女性体重指数小于25），研究了危险因素与各种胰岛素水平测量指标之间的关联。在采集用于检测纤维蛋白原、血脂、脂蛋白和胰岛素的血样后，进行了75克葡萄糖耐量试验。在1小时和2小时后也测量了胰岛素。男性和女性的胰岛素水平测量指标与空腹血清甘油三酯之间最一致地记录到显著的单变量相关性（p小于0.01），而收缩压仅在女性中与胰岛素血症相关，舒张压在男性和女性中与空腹及2小时胰岛素水平测量指标相关。在男性和女性中，与总血清胆固醇、男性的高密度脂蛋白胆固醇、体重指数、载脂蛋白B和A1以及女性的纤维蛋白原的关联不一致。年龄在男性或女性中与任何胰岛素水平测量指标均无相关性。在校正体重指数后，检查了胰岛素水平测量指标五分位数之间血管危险因素的差异。与空腹和葡萄糖负荷后胰岛素水平测量指标的主要关联是与甘油三酯，尤其是在女性中，男性和女性总胆固醇、舒张压和收缩压五分位数之间观察到的分级差异较少。与其他五分位数相比，其他危险因素的发生率通常仅在最低或最高五分位数中有所不同，这表明存在阈值效应而非分级效应。此外，仅在男性中葡萄糖激发后/综合胰岛素水平测量指标的最高五分位数中记录到高密度脂蛋白胆固醇和载脂蛋白B的差异，而在女性中，仅在曲线下面积胰岛素水平最高五分位数中血清纤维蛋白原浓度有显著差异。在没有糖尿病、高血压和肥胖等其他危险因素的情况下，胰岛素水平测量指标与血压以及脂质代谢和凝血指标之间的关系并不一致，因此是其他心血管危险因素的弱预测指标。在表面健康的男性和女性中，与胰岛素相关的血管风险特征似乎有所不同。
