Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
J Atheroscler Thromb. 2012;19(11):977-85. doi: 10.5551/jat.13698. Epub 2012 Jul 14.
Although several surrogate measures of insulin resistance have been proposed, their associations with cardiovascular disease (CVD) have not been evaluated sufficiently.
A total of 2,356 community-dwelling Japanese individuals aged 40 to 79 years who underwent a 75 g oral glucose tolerance test were followed up for 14 years. The status of insulin resistance was estimated by using the Matsuda index or homeostasis model assessment of insulin resistance (HOMA-IR).
During follow-up, 260 subjects developed CVD. The age- and sex-adjusted hazard ratios of CVD significantly decreased with an increasing Matsuda index and rose with increasing HOMA-IR levels (both p for trend <0.05). After adjustment for age, sex, serum total cholesterol, electrocardiogram abnormalities, proteinuria, smoking habits, alcohol intake, and regular exercise, the risk of CVD was significantly lower in the third to fifth quintiles of the Matsuda index and higher in the fifth quintile of HOMA-IR values compared with the first quintile of the corresponding index (Matsuda index Q3: hazard ratio (HR)= 0.59 [95% confidence interval 0.40-0.87]; Q4: HR= 0.66 [0.45-0.97]; and Q5: HR= 0.67 [0.47-0.97]; HOMA-IR Q5: HR= 1.55 [1.05-2.29]); however, these associations were attenuated after further adjustment for the metabolic syndrome status. In regard to CVD subtypes, the risks for stroke and coronary heart disease significantly decreased with an increasing Matsuda index, while elevated HOMA-IR levels were a significant risk factor for stroke, but not for coronary heart disease.
Our findings suggest that insulin resistance significantly increases the risk of incident CVD through metabolic syndrome in Japanese.
尽管已经提出了几种胰岛素抵抗的替代指标，但它们与心血管疾病（CVD）的相关性尚未得到充分评估。
共有 2356 名年龄在 40 至 79 岁之间、接受 75 克口服葡萄糖耐量试验的社区居民接受了 14 年的随访。使用 Matsuda 指数或稳态模型评估的胰岛素抵抗（HOMA-IR）来估计胰岛素抵抗的状态。
在随访期间，260 名患者发生了 CVD。CVD 的年龄和性别调整后的风险比随着 Matsuda 指数的增加而显著降低，随着 HOMA-IR 水平的升高而升高（趋势 p 值均<0.05）。在校正年龄、性别、血清总胆固醇、心电图异常、蛋白尿、吸烟习惯、饮酒和定期运动后，Matsuda 指数的第三至第五五分位的 CVD 风险显著低于相应指数的第一五分位（Matsuda 指数 Q3：风险比（HR）=0.59[95%置信区间 0.40-0.87]；Q4：HR=0.66[0.45-0.97]；Q5：HR=0.67[0.47-0.97]；HOMA-IR Q5：HR=1.55[1.05-2.29]）；然而，这些关联在进一步调整代谢综合征状态后减弱。关于 CVD 亚型，随着 Matsuda 指数的增加，中风和冠心病的风险显著降低，而升高的 HOMA-IR 水平是中风的一个显著危险因素，但不是冠心病的危险因素。
我们的研究结果表明，在日本人群中，胰岛素抵抗通过代谢综合征显著增加了 CVD 的发病风险。
