Garg P K, Biggs M L, Kaplan R, Kizer J R, Heckbert S R, Mukamal K J
Division of Cardiology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
Department of Biostatistics, University of Washington, Seattle, WA, USA.
Nutr Metab Cardiovasc Dis. 2018 Jul;28(7):716-721. doi: 10.1016/j.numecd.2018.02.016. Epub 2018 Mar 2.
Existing literature in individuals without diabetes has not demonstrated a relationship between IR and incident AF; however, data are limited and only fasting glucose measures of IR were assessed. We evaluated the relationship of both fasting and post-glucose load IR measures with the development of atrial fibrillation in nondiabetic older adults.
Among Cardiovascular Health Study participants, a population-based cohort of 5888 adults aged 65 years or older enrolled in two waves (1989-1990 and 1992-1993), those without prevalent AF or diabetes and with IR measures at baseline were followed for the development of AF, identified by follow-up visit electrocardiograms, hospital discharge diagnosis coding, or Medicare claims data, through 2014. Fasting IR was determined by the homeostatic model of insulin resistance (HOMA-IR) and post-glucose load IR was determined by the Gutt index. Cox proportional hazards models were used to determine the association of IR with risk of AF. Analyses included 3601 participants (41% men) with a mean age of 73 years. Over a median follow-up of 12.3 years, 1443 (40%) developed AF. After multivariate adjustment, neither HOMA-IR nor the Gutt index was associated with risk of developing AF [hazard ratios (95% confidence intervals): 0.96 (0.90, 1.03) for 1-SD increase in HOMA-IR and 1.03 (0.97, 1.10) for 1-SD decrease in the Gutt index].
We found no evidence of an association between either fasting or post-glucose load IR measures and incident AF.
现有针对非糖尿病个体的文献尚未证实胰岛素抵抗（IR）与房颤发生之间存在关联；然而，数据有限，且仅评估了空腹血糖的IR指标。我们评估了空腹及葡萄糖负荷后IR指标与非糖尿病老年人心房颤动发生之间的关系。
在心血管健康研究参与者中，这是一个基于人群的队列，共5888名65岁及以上的成年人分两批入组（1989 - 1990年和1992 - 1993年），对那些无房颤或糖尿病病史且基线时有IR指标的参与者进行随访，直至2014年，通过随访心电图、出院诊断编码或医疗保险理赔数据来确定房颤的发生情况。空腹IR通过胰岛素抵抗稳态模型（HOMA - IR）测定，葡萄糖负荷后IR通过古特指数（Gutt index）测定。采用Cox比例风险模型来确定IR与房颤风险的关联。分析纳入了3601名参与者（41%为男性），平均年龄73岁。在中位随访12.3年期间，1443人（40%）发生了房颤。经过多变量调整后，HOMA - IR和古特指数均与房颤发生风险无关[风险比（95%置信区间）：HOMA - IR每增加1个标准差为0.96（0.90，1.03），古特指数每降低1个标准差为1.03（0.97，1.10）]。
我们未发现空腹或葡萄糖负荷后IR指标与房颤发生之间存在关联的证据。
