Baghbani-Oskouei Aidin, Tohidi Maryam, Hasheminia Mitra, Azizi Fereidoun, Hadaegh Farzad
1Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Nutr Metab (Lond). 2019 Nov 9;16:76. doi: 10.1186/s12986-019-0402-3. eCollection 2019.
To examine the association between changes in fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and insulin-glucose ratio (IGR) levels, over approximately 3 years with incident hypertension.
A total of 2814 Iranian participants (1123 men) without hypertension and known diabetes at baseline and the first examination were followed for a median of 6.32 years. The associations between quartiles of changes in fasting insulin and IR indices with incident hypertension were assessed using multivariate Cox proportional hazard regression analyses with first quartile as reference. The models were adjusted for baseline values of insulin or each IR index, and age, sex, smoking, physical activity, educational levels, marital status, history of cardiovascular diseases, baseline levels of systolic and diastolic blood pressures, estimated glomerular filtration rate, triglycerides, total cholesterol, high-density lipoprotein cholesterol, fasting plasma glucose (only for insulin change) and both body mass index (BMI) per se, and its change. Akaike's information criteria (AIC) was applied as indicator for goodness of fit of each predictive model. The discrimination ability of models was calculated using the Harrell's C statistic.
During the study, 594 incident cases of hypertension (253 men) were identified. The 4th quartile of changes in insulin, HOMA-IR, and IGR showed hazard ratios (95% confidence interval) of 1.31 (1.01-1.69), 1.18 (0.92-1.52), and 1.53 (1.18-1.98) for hypertension, respectively, in fully-adjusted models. Changes in fasting insulin levels and IR indices showed significant increasing trends for incident hypertension, moving from 1st to 4th quartiles (all -values < 0.05). Focusing on model fitness, no superiority was found between changes in fasting insulin, HOMA-IR, and IGR to predict incident hypertension. The discriminatory powers of changes in fasting insulin and IR indices as assessed by C index were similar (i.e. about 80%).
Changes in fasting insulin and IR indices were significantly associated with developing hypertension among normotensive population even after considering BMI changes.
研究在大约3年时间里，空腹胰岛素、胰岛素抵抗稳态模型评估（HOMA-IR）以及胰岛素-葡萄糖比值（IGR）水平的变化与高血压发病之间的关联。
共有2814名伊朗参与者（1123名男性）在基线和首次检查时无高血压及已知糖尿病，随访时间中位数为6.32年。使用多变量Cox比例风险回归分析评估空腹胰岛素变化四分位数和胰岛素抵抗指数与高血压发病之间的关联，以第一四分位数作为参照。模型针对胰岛素或各胰岛素抵抗指数的基线值、年龄、性别、吸烟、身体活动、教育水平、婚姻状况、心血管疾病史、收缩压和舒张压基线水平、估计肾小球滤过率、甘油三酯、总胆固醇、高密度脂蛋白胆固醇、空腹血糖（仅针对胰岛素变化）以及体重指数（BMI）本身及其变化进行了调整。赤池信息准则（AIC）用作各预测模型拟合优度的指标。使用Harrell's C统计量计算模型的辨别能力。
在研究期间，确定了594例高血压发病病例（253名男性）。在完全调整模型中，胰岛素、HOMA-IR和IGR变化的第四四分位数显示高血压的风险比（95%置信区间）分别为1.31（1.01-1.69）、1.18（0.92-1.52）和1.53（1.18-1.98）。空腹胰岛素水平和胰岛素抵抗指数的变化显示高血压发病呈显著上升趋势，从第一四分位数到第四四分位数（所有P值<0.05）。关注模型拟合度，在预测高血压发病方面，空腹胰岛素、HOMA-IR和IGR的变化之间未发现优势差异。通过C指数评估，空腹胰岛素和胰岛素抵抗指数变化的辨别能力相似（即约80%）。
即使考虑了BMI变化，空腹胰岛素和胰岛素抵抗指数的变化与血压正常人群高血压发病仍显著相关。
