Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Internal Medicine, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Diabetes Investig. 2024 Feb;15(2):208-218. doi: 10.1111/jdi.14101. Epub 2023 Oct 24.
AIMS/INTRODUCTION: The aim was to examine the joint effect of metabolic syndrome (MetS) and insulin resistance (IR) with ideal cardiovascular health (iCVH) status on incident cardiovascular diseases (CVDs).
The study included 6,240 Iranian adults ≥30 years, free of prior cardiovascular disease. Ideal cardiovascular health was determined based on American Heart Association's Life Simple 7. Metabolic syndrome was defined according to the Joint Interim Statement Criteria, and insulin resistance was defined as HOMA-IR ≥1.85 in women and ≥2.17 in men. Multivariable Cox proportional hazard ratios (HRs) were applied to examine the impact of metabolic syndrome, and insulin resistance at various levels of iCVH status.
During the median follow-up of 14.0 years, 909 cases of cardiovascular disease occurred. Metabolic syndrome and insulin resistance were significantly associated with incident cardiovascular disease events. In the poor and intermediate status, metabolic syndrome increased cardiovascular disease events with HRs of 1.83 and 1.57, respectively; the corresponding values for insulin resistance in the mentioned categories were 1.91 and 1.25, respectively (P values < 0.05). In the intermediate and poor iCVH status, hypertriglyceridemia was linked to a 40% and 35% higher risk of cardiovascular disease, the corresponding values for low HDL-C was 20% and 60%, respectively (P values < 0.05). Although adding metabolic syndrome, its dyslipidemia and insulin resistance to iCVH status in both poor and intermediate status significantly improve the prediction of cardiovascular disease using net reclassification improvement (P values < 0.05), the value of C-index did not change.
Metabolic syndrome and the dyslipidemia component had a negligible but significant improvement in the prediction of cardiovascular disease among individuals with non-optimal iCVH status.
目的/引言：本研究旨在探讨代谢综合征（MetS）和胰岛素抵抗（IR）与理想心血管健康（iCVH）状态联合对心血管疾病（CVD）发病的影响。
本研究纳入了 6240 名年龄≥30 岁、无心血管疾病病史的伊朗成年人。根据美国心脏协会的“生活简单 7 项”标准来确定理想心血管健康状况。代谢综合征的定义依据联合临时声明标准，胰岛素抵抗的定义为女性 HOMA-IR≥1.85，男性 HOMA-IR≥2.17。采用多变量 Cox 比例风险比（HR）来检验代谢综合征和胰岛素抵抗在不同 iCVH 状态水平下对心血管疾病的影响。
在中位随访 14.0 年期间，发生了 909 例心血管疾病事件。代谢综合征和胰岛素抵抗与心血管疾病事件的发生显著相关。在较差和中等状态下，代谢综合征使心血管疾病事件的风险分别增加了 1.83 倍和 1.57 倍；相应的胰岛素抵抗风险分别为 1.91 倍和 1.25 倍（P 值均<0.05）。在中等和较差的 iCVH 状态下，高三酰甘油血症使心血管疾病的风险分别增加了 40%和 35%，低 HDL-C 血症的相应风险分别增加了 20%和 60%（P 值均<0.05）。虽然在较差和中等状态下，将代谢综合征及其血脂异常和胰岛素抵抗因素纳入 iCVH 状态可显著提高心血管疾病的预测效果（P 值均<0.05），但 C 指数的值没有改变。
在非理想 iCVH 状态的个体中，代谢综合征及其血脂异常成分对心血管疾病的预测有一定的但不显著的改善。
