绝经后女性的胰岛素抵抗与心血管疾病风险：来自女性健康倡议的队列研究
Insulin Resistance and Risk of Cardiovascular Disease in Postmenopausal Women: A Cohort Study From the Women's Health Initiative.
作者信息
Schmiegelow Michelle D, Hedlin Haley, Stefanick Marcia L, Mackey Rachel H, Allison Matthew, Martin Lisa W, Robinson Jennifer G, Hlatky Mark A
机构信息
From the The Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA (M.D.S., M.A.H.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.D.S.); The Department of Medicine, Stanford University School of Medicine, Stanford, CA (H.H., M.L.S., M.A.H.); Department of Epidemiology Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA (R.H.M.); Department of Family and Preventive Medicine, University of California, San Diego (M.A.); Division of Cardiology, George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); and Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (J.G.R.).
出版信息
Circ Cardiovasc Qual Outcomes. 2015 May;8(3):309-16. doi: 10.1161/CIRCOUTCOMES.114.001563. Epub 2015 May 5.
BACKGROUND
Insulin resistance is associated with diabetes mellitus, but it is uncertain whether it improves cardiovascular disease (CVD) risk prediction beyond traditional cardiovascular risk factors.
METHODS AND RESULTS
We identified 15,288 women from the Women's Health Initiative Biomarkers studies with no history of CVD, atrial fibrillation, or diabetes mellitus at baseline (1993-1998). We assessed the prognostic value of adding fasting serum insulin, HOMA-IR (homeostasis model assessment-insulin resistance), serum-triglyceride-to-serum-high-density lipoprotein-cholesterol ratio TG/HDL-C, or impaired fasting glucose (serum glucose ≥110 mg/dL) to traditional risk factors in separate Cox multivariable analyses and assessed risk discrimination and reclassification. The study end point was major CVD events (nonfatal and fatal coronary heart disease and ischemic stroke) within 10 years, which occurred in 894 (5.8%) women. Insulin resistance was associated with CVD risk after adjusting for age and race/ethnicity with hazard ratios (95% confidence interval [CI]) per doubling in insulin of 1.21 (CI, 1.12-1.31), in HOMA-IR of 1.19 (CI, 1.11-1.28), in TG/HDL-C of 1.35 (CI, 1.26-1.45), and for impaired fasting glucose of 1.31 (CI, 1.05-1.64). Although insulin, HOMA-IR, and TG/HDL-C remained associated with increased CVD risk after adjusting for most CVD risk factors, none remained significant after adjusting for HDL-C: hazard ratios for insulin, 1.06 (CI, 0.98-1.16); for HOMA-IR, 1.06 (CI, 0.98-1.15); for TG/HDL-C, 1.11 (CI, 0.99-1.25); and for glucose, 1.20 (CI, 0.96-1.50). Insulin resistance measures did not improve CVD risk discrimination and reclassification.
CONCLUSIONS
Measures of insulin resistance were no longer associated with CVD risk after adjustment for high-density lipoprotein-cholesterol and did not provide independent prognostic information in postmenopausal women without diabetes mellitus.
CLINICAL TRIAL REGISTRATION INFORMATION
URL: http://www.clinicaltrial.gov. Unique identifier: NCT00000611.
背景
胰岛素抵抗与糖尿病相关，但它是否能在传统心血管危险因素之外改善心血管疾病（CVD）风险预测尚不确定。
方法与结果
我们从女性健康倡议生物标志物研究中识别出15288名女性，她们在基线时（1993 - 1998年）无心血管疾病、心房颤动或糖尿病病史。我们在单独的Cox多变量分析中评估了将空腹血清胰岛素、HOMA-IR（稳态模型评估 - 胰岛素抵抗）、血清甘油三酯与血清高密度脂蛋白胆固醇比值TG/HDL-C或空腹血糖受损（血清葡萄糖≥110mg/dL）添加到传统危险因素中的预后价值，并评估了风险辨别和重新分类。研究终点是10年内的主要心血管疾病事件（非致命和致命性冠心病及缺血性中风），894名（5.8%）女性发生了这些事件。在校正年龄和种族/族裔后，胰岛素抵抗与心血管疾病风险相关，胰岛素每增加一倍的风险比（95%置信区间[CI]）为1.21（CI，1.12 - 1.31），HOMA-IR为1.19（CI，1.11 - 1.28），TG/HDL-C为1.35（CI，1.26 - 1.45），空腹血糖受损为1.31（CI，1.05 - 1.64）。尽管在校正大多数心血管疾病危险因素后，胰岛素、HOMA-IR和TG/HDL-C仍与心血管疾病风险增加相关，但在校正高密度脂蛋白胆固醇后均不再显著：胰岛素的风险比为1.06（CI，0.98 - 1.16）；HOMA-IR为1.06（CI，0.98 - 1.15）；TG/HDL-C为1.11（CI，0.99 -
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