Yamazoe Masahiro, Hisamatsu Takashi, Miura Katsuyuki, Kadowaki Sayaka, Zaid Maryam, Kadota Aya, Torii Sayuki, Miyazawa Itsuko, Fujiyoshi Akira, Arima Hisatomi, Sekikawa Akira, Maegawa Hiroshi, Horie Minoru, Ueshima Hirotsugu
From the Department of Cardiology, Tokyo Medical and Dental University, Tokyo, Japan (M.Y.); Center for Epidemiologic Research in Asia (M.Y., K.M., A.K., H.A., H.U.), Department of Public Health (M.Y., T.H., K.M., S.K., M.Z., A.K., S.T., A.F., H.A., H.U.), Department of Cardiovascular and Respiratory Medicine (T.H., S.T., M.H.), Division of Endocrinology and Metabolism, Department of Medicine (I.M., H.M.), Shiga University of Medical Science, Otsu, Japan; Department of Environmental Medicine and Public Health, Faculty of Medicine, Shimane University, Izumo, Japan (T.H.); Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan (H.A.); and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (A.S.).
Arterioscler Thromb Vasc Biol. 2016 Aug;36(8):1703-8. doi: 10.1161/ATVBAHA.116.307612. Epub 2016 Jun 9.
The association between insulin resistance (IR) and coronary artery calcification (CAC) has been uncertain after adjustment for metabolic syndrome components. We aimed to evaluate whether IR is associated with CAC prevalence or progression independently of metabolic syndrome components.
We conducted a population-based study in a random sample of Japanese men aged 40 to 79 years and determined IR using the homeostasis model assessment of insulin resistance (HOMA-IR). The associations of HOMA-IR and other diabetic parameters per 1-SD increase with CAC prevalence and progression were evaluated using multivariable logistic regression. Of 1006 total participants at baseline (mean age, 64±10 years), CAC prevalence was observed in 646 (64.2%), and of 789 participants at follow-up (mean duration, 4.9±1.3 years), CAC progression was observed in 365 (46.3%). After adjustment for covariates including metabolic syndrome components, higher HOMA-IR was independently associated with CAC prevalence (adjusted odds ratio 1.34, 95% confidence interval 1.10-1.63; P=0.003) and progression (odds ratio 1.32, 95% confidence interval 1.09-1.60; P=0.004). In participants without diabetes mellitus, positive associations were similarly observed (prevalence: odds ratio 1.29, 95% confidence interval 1.04-1.60; P=0.022; and progression: odds ratio 1.25, 95% confidence interval 1.01-1.55; P=0.042), whereas glucose and hemoglobin A1c were not associated with CAC prevalence and progression.
Higher IR was associated with CAC prevalence and progression independently of metabolic syndrome components in Japanese men and also in those without diabetes mellitus. Among diabetic measures, IR and fasting insulin, but not glucose and hemoglobin A1c, predicted CAC progression in men without diabetes mellitus.
在对代谢综合征各组分进行校正后，胰岛素抵抗（IR）与冠状动脉钙化（CAC）之间的关联仍不明确。我们旨在评估IR是否独立于代谢综合征各组分与CAC的患病率或进展相关。
我们在年龄为40至79岁的日本男性随机样本中开展了一项基于人群的研究，并使用胰岛素抵抗稳态模型评估（HOMA-IR）来确定IR。使用多变量逻辑回归评估HOMA-IR和其他糖尿病参数每增加1个标准差与CAC患病率及进展的关联。在基线时的1006名总参与者中（平均年龄64±10岁），646名（64.2%）观察到CAC患病率，在随访的789名参与者中（平均病程4.9±1.3年），365名（46.3%）观察到CAC进展。在对包括代谢综合征各组分在内的协变量进行校正后，较高的HOMA-IR与CAC患病率（校正比值比1.34，95%置信区间1.10-1.63；P=0.003）和进展（比值比1.32，95%置信区间1.09-1.60；P=0.004）独立相关。在无糖尿病的参与者中，也观察到了类似的正相关（患病率：比值比1.29，95%置信区间1.04-1.60；P=0.022；进展：比值比1.25，95%置信区间1.01-1.55；P=0.042），而血糖和糖化血红蛋白与CAC患病率及进展无关。
在日本男性以及无糖尿病的男性中，较高的IR独立于代谢综合征各组分与CAC患病率及进展相关。在糖尿病测量指标中，IR和空腹胰岛素而非血糖和糖化血红蛋白可预测无糖尿病男性的CAC进展。
