Non-Invasive Cardiovascular Imaging Laboratory, Brigham and Women's Hospital, Boston, Massachusetts, USA.
J Am Coll Cardiol. 2013 Apr 23;61(16):1698-706. doi: 10.1016/j.jacc.2013.01.053.
This study assessed whether impaired fasting glucose (IFG), insulin resistance, and waist-to-hip ratio (WHR) had effects on cardiac remodeling, independent of obesity, in the MESA (Multi-Ethnic Study of Atherosclerosis) trial.
Recent studies have suggested that central obesity and insulin resistance may be primary mediators of obesity-related cardiac remodeling independent of body mass index (BMI).
We investigated 4,364 subjects without diabetes in the MESA trial. IFG (100 to 125 mg/dl) or insulin resistance (by homeostatic model assessment of insulin resistance [HOMA-IR]) and WHR were used for cardiometabolic phenotyping. Multivariate linear regression analysis was used to determine the effects of the cardiometabolic markers on left ventricular (LV) remodeling, assessed primarily through the LV mass-to-volume ratio obtained by cine cardiac magnetic resonance imaging.
Individuals with IFG were more likely to be older and hypertensive, with increased prevalence of cardiometabolic risk factors regardless of BMI. In each quartile of BMI, subjects with above-median HOMA-IR, above-median WHR, or IFG had a higher LV mass-to-volume ratio (p < 0.05 for all). HOMA-IR (p < 0.0001), WHR (p < 0.0001), and the presence of IFG (p = 0.04), but not BMI (p = 0.24), were independently associated with LV mass-to-volume ratio after adjustment for age, sex, hypertension, race, and dyslipidemia.
Insulin resistance and WHR were associated with concentric LV remodeling independent of BMI. These results support the emerging hypothesis that the cardiometabolic phenotype, defined by insulin resistance and central obesity, may play a critical role in LV remodeling independently of BMI.
本研究旨在评估空腹血糖受损（IFG）、胰岛素抵抗和腰臀比（WHR）是否对 MESA（动脉粥样硬化多民族研究）试验中的心脏重构有影响，而与肥胖无关。
最近的研究表明，中心性肥胖和胰岛素抵抗可能是肥胖相关心脏重构的主要介导因素，而与体重指数（BMI）无关。
我们调查了 MESA 试验中 4364 名无糖尿病的受试者。IFG（100 至 125mg/dl）或胰岛素抵抗（通过稳态模型评估的胰岛素抵抗[HOMA-IR]）和 WHR 用于心脏代谢表型分析。多元线性回归分析用于确定心脏代谢标志物对通过电影心脏磁共振成像获得的左心室（LV）重构的影响。
IFG 患者年龄较大且更易患高血压，无论 BMI 如何，其患心脏代谢危险因素的比例均较高。在 BMI 的每个四分位数中，HOMA-IR、WHR 或 IFG 高于中位数的受试者均具有较高的 LV 质量/容积比（所有 p<0.05）。HOMA-IR（p<0.0001）、WHR（p<0.0001）和 IFG 的存在（p=0.04），而不是 BMI（p=0.24），在调整年龄、性别、高血压、种族和血脂异常后，与 LV 质量/容积比独立相关。
胰岛素抵抗和 WHR 与 BMI 独立相关，与 LV 向心性重构相关。这些结果支持这样一种新兴假说，即由胰岛素抵抗和中心性肥胖定义的心脏代谢表型可能在 BMI 独立的情况下在 LV 重构中发挥关键作用。
