Kuusisto J, Mykkänen L, Pyörälä K, Laakso M
Department of Medicine, Kuopio University Hospital, Finland.
Circulation. 1995 Feb 1;91(3):831-7. doi: 10.1161/01.cir.91.3.831.
Both hyperinsulinemia and microalbuminuria have been shown to increase coronary heart disease (CHD) risk, but the interaction among hyperinsulinemia, microalbuminuria, and the risk for CHD has not been investigated in previous studies.
The risk of CHD in relation to hyperinsulinemia and microalbuminuria was examined in a cohort of 1069 elderly nondiabetic subjects from Kuopio, east Finland, during 3.5 years of follow-up. The overall incidence of CHD death was 2.8%, and 6.9% of study subjects died of CHD or had a nonfatal myocardial infarction (later referred to as all CHD events). In the highest fasting-insulin quintile (fasting insulin > or = 114.0 pmol/L), there was a slightly but insignificantly higher incidence rate of both CHD mortality and all CHD events compared with lower quintiles. The incidence rates of CHD mortality and all CHD events were significantly higher in the highest urinary albumin/creatinine ratio (ACR) quintile (ACR > or = 3.22 mg/mmol) compared with lower quintiles (P < .05 and P < .01, respectively). Hyperinsulinemic microalbuminuria (simultaneous presence of fasting insulin > or = 114.0 pmol/L and ACR > or = 3.22 mg/mmol) markedly increased the risk of CHD mortality (12.5%, P < .001) and all CHD events (18.8%, P < .001) compared with normoinsulinemic subjects without microalbuminuria (2.2% and 5.8%, respectively). In univariate logistic regression analyses, hyperinsulinemic microalbuminuria was a strong predictor of both CHD death (odds ratio [OR], 5.93; P < .001) and all CHD events (OR, 3.39; P = .002). Multivariate logistic regression analyses were also performed, including sex, current smoking, waist-hip ratio, systolic blood pressure, and HDL cholesterol, with insulin, ACR, or both as independent variables. Even after adjustment for these variables, hyperinsulinemic microalbuminuria remained a strong predictor of CHD death (OR, 7.91; P < .001) and all CHD events (OR, 2.95; P = .014). The group with hyperinsulinemic microalbuminuria was characterized by the most adversely affected risk factor pattern (high triglycerides > or = 2.3 mmol/L, low HDL cholesterol < or = 0.9 mmol/L in men and < or = 1.20 mmol/L in women, and hypertension).
Simultaneous occurrence of hyperinsulinemia and microalbuminuria identifies a group of subjects with a highly increased risk for CHD in elderly nondiabetic subjects.
高胰岛素血症和微量白蛋白尿均已被证明会增加冠心病（CHD）风险，但此前的研究尚未对高胰岛素血症、微量白蛋白尿与冠心病风险之间的相互作用进行调查。
在对来自芬兰东部库奥皮奥的1069名老年非糖尿病受试者进行的3.5年随访中，研究了与高胰岛素血症和微量白蛋白尿相关的冠心病风险。冠心病死亡的总体发生率为2.8%，6.9%的研究对象死于冠心病或发生了非致命性心肌梗死（以下统称为所有冠心病事件）。在空腹胰岛素水平最高的五分位数组（空腹胰岛素≥114.0 pmol/L）中，与较低五分位数组相比，冠心病死亡率和所有冠心病事件的发生率略高，但无统计学意义。与较低五分位数组相比，尿白蛋白/肌酐比值（ACR）最高的五分位数组（ACR≥3.22 mg/mmol）的冠心病死亡率和所有冠心病事件的发生率显著更高（分别为P<0.05和P<0.01）。与无微量白蛋白尿的正常胰岛素血症受试者（分别为2.2%和5.8%）相比，高胰岛素血症合并微量白蛋白尿（同时存在空腹胰岛素≥114.0 pmol/L和ACR≥3.22 mg/mmol）显著增加了冠心病死亡风险（12.5%，P<0.001）和所有冠心病事件的风险（18.8%，P<0.001）。在单因素逻辑回归分析中，高胰岛素血症合并微量白蛋白尿是冠心病死亡（优势比[OR]，5.93；P<0.001）和所有冠心病事件（OR，3.39；P = 0.002）的有力预测指标。还进行了多因素逻辑回归分析，将性别、当前吸烟情况、腰臀比、收缩压和高密度脂蛋白胆固醇纳入其中，以胰岛素、ACR或两者作为自变量。即使在对这些变量进行调整后，高胰岛素血症合并微量白蛋白尿仍然是冠心病死亡（OR，7.91；P<0.001）和所有冠心病事件（OR，2.95；P = 0.014）的有力预测指标。高胰岛素血症合并微量白蛋白尿组的特征是危险因素模式受影响最不利（高甘油三酯≥2.3 mmol/L，男性高密度脂蛋白胆固醇≤0.9 mmol/L，女性≤1.20 mmol/L，以及高血压）。
高胰岛素血症和微量白蛋白尿同时出现表明老年非糖尿病受试者中一组患冠心病风险极高的人群。
