Brunelli C, Spallarossa P, Cordera R, Caponnetto S
Dipartimento di Medicina Interna, Università degli Studi, Genova.
Cardiologia. 1994 Dec;39(12 Suppl 1):163-8.
A large body of evidence has been accumulating that insulin plays a role in coronary heart disease (CHD). Hyperinsulinemia has been considered a risk factor for CHD according to prospective studies. Cross-sectional studies found an association between hyperinsulinemia and prevalence of CHD, while population studies have shown that populations at increased risk for CHD are hyperinsulinemic. Strong relations between hyperinsulinemia and atherosclerotic coronary lesions have been demonstrated by angiographic studies. It has recently been observed that also patients with microvascular angina are hyperinsulinemic. Several mechanisms have been proposed to explain the role of hyperinsulinemia in the development of atherothrombosis. Hyperinsulinemia is the consequence of insulin resistance, a defect in insulin-mediated glucose uptake. Experimental evidence suggests that insulin has actions that may promote atherosclerosis, which clinical studies suggest the existence of a metabolic syndrome characterized by the presence of major coronary risk factors in which insulin resistance is the common link.
大量证据不断积累，表明胰岛素在冠心病（CHD）中发挥作用。根据前瞻性研究，高胰岛素血症被认为是冠心病的一个危险因素。横断面研究发现高胰岛素血症与冠心病患病率之间存在关联，而人群研究表明，冠心病风险增加的人群存在高胰岛素血症。血管造影研究证实了高胰岛素血症与动脉粥样硬化性冠状动脉病变之间的密切关系。最近观察到，微血管性心绞痛患者也存在高胰岛素血症。已经提出了几种机制来解释高胰岛素血症在动脉粥样硬化血栓形成发展中的作用。高胰岛素血症是胰岛素抵抗的结果，胰岛素抵抗是胰岛素介导的葡萄糖摄取缺陷。实验证据表明，胰岛素具有可能促进动脉粥样硬化的作用，临床研究表明存在一种以主要冠状动脉危险因素为特征的代谢综合征，其中胰岛素抵抗是共同环节。
