Joseph Joshua J, Echouffo-Tcheugui Justin B, Kalyani Rita R, Yeh Hsin-Chieh, Bertoni Alain G, Effoe Valery S, Casanova Ramon, Sims Mario, Correa Adolfo, Wu Wen-Chih, Wand Gary S, Golden Sherita H
Division of Endocrinology, Diabetes, and Metabolism (J.J.J., R.R.K., H.-C.Y., G.S.W., S.H.G.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Division of Endocrinology, Diabetes, and Hypertension (J.B.E.-T.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Rollins School of Public Health (J.B.E.-T.), Emory University, Atlanta, Georgia 30322; Division of Public Health Sciences (A.G.B., V.S.E., R.C.), Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157; Department of Medicine (M.S., A.C.), University of Mississippi Medical Center, Jackson, Mississippi 39216; and Department of Medicine (W.-C.W.), Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903.
J Clin Endocrinol Metab. 2016 Apr;101(4):1770-8. doi: 10.1210/jc.2016-1002. Epub 2016 Feb 23.
Previous research has suggested that activation of the renin-angiotensin-aldosterone system may promote insulin resistance and β-cell dysfunction, but the association with incident diabetes in African Americans is unknown.
We examined the association of aldosterone and renin with insulin resistance, β-cell function, and incident diabetes in a large African American cohort.
The Jackson Heart Study is a prospective study of the development and progression of cardiovascular disease in African Americans.
Participants were recruited from the tricounty area of metropolitan Jackson, Mississippi.
A total of 5301 African American adults, aged 21–94 years, were assessed at baseline and through 12 years of follow-up. Data on aldosterone, renin, and risk factors were collected at baseline (2000–2004). Diabetes (fasting glucose ≥ 126 mg/dL, physician diagnosis, use of diabetes drugs, or glycated hemoglobin ≥ 6.5%) was assessed at baseline and through 12 years of follow-up. Participants were excluded for missing data on baseline covariates or diabetes follow-up. Cox regression was used to estimate hazard ratios (HR) for incident diabetes using sequential modeling adjusting for age, sex, education, occupation, systolic blood pressure, current smoking, physical activity, dietary intake, and body mass index.
Aldosterone, renin, and diabetes risk factors were measured.
Outcomes included the homeostatic model assessment of insulin resistance (HOMA-IR) and incident diabetes.
Among 3234 participants over a median of 8.0 years of follow-up, there were 554 cases of incident diabetes. Every 1% increase in log-transformed aldosterone was associated with a 0.18% higher log-transformed HOMA-IR in cross-sectional analyses of nondiabetic participants (P < .001). Log-transformed aldosterone and renin levels in the fifth vs first quintile were associated with a 78% (HR 1.78, 95% confidence interval 1.35–2.34) and 35% (HR 1.35, 95% confidence interval 1.06–1.72) increase in diabetes risk, respectively, in fully adjusted models.
Activation of the renin-angiotensin-aldosterone system may play a significant role in the development of insulin resistance and diabetes in African Americans.
先前的研究表明，肾素-血管紧张素-醛固酮系统的激活可能会促进胰岛素抵抗和β细胞功能障碍，但在非裔美国人中与新发糖尿病的关联尚不清楚。
我们在一个大型非裔美国人队列中研究了醛固酮和肾素与胰岛素抵抗、β细胞功能及新发糖尿病之间的关联。
杰克逊心脏研究是一项关于非裔美国人心血管疾病发生和发展的前瞻性研究。
参与者从密西西比州杰克逊市大都市的三县地区招募。
共有5301名年龄在21 - 94岁的非裔美国成年人在基线时接受评估，并进行了12年的随访。在基线时（2000 - 2004年）收集了醛固酮、肾素及危险因素的数据。在基线时及12年随访期间评估糖尿病情况（空腹血糖≥126mg/dL、医生诊断、使用糖尿病药物或糖化血红蛋白≥6.5%）。因基线协变量或糖尿病随访数据缺失而排除参与者。使用Cox回归通过对年龄、性别、教育程度、职业、收缩压、当前吸烟情况、身体活动、饮食摄入和体重指数进行序贯建模来估计新发糖尿病的风险比（HR）。
测量醛固酮、肾素及糖尿病危险因素。
结局包括胰岛素抵抗的稳态模型评估（HOMA-IR）和新发糖尿病。
在3234名参与者中，中位随访时间为8.0年，有554例新发糖尿病病例。在非糖尿病参与者的横断面分析中，对数转换后的醛固酮每增加1%，对数转换后的HOMA-IR就会高出0.18%（P <.001）。在完全调整模型中，第五分位数与第一分位数相比，对数转换后的醛固酮和肾素水平分别使糖尿病风险增加78%（HR 1.78，95%置信区间1.35 - 2.34）和35%（HR 1.35，95%置信区间1.06 - 1.72）。
肾素-血管紧张素-醛固酮系统的激活可能在非裔美国人胰岛素抵抗和糖尿病的发生中起重要作用。
