Stern M P
Department of Medicine, University of Texas Health Science Center, San Antonio 78284, USA.
Ann Intern Med. 1996 Jan 1;124(1 Pt 2):110-6. doi: 10.7326/0003-4819-124-1_part_2-199601011-00006.
Recent evidence suggests that non-insulin-dependent diabetes mellitus (NIDDM) and cardiovascular disease, rather than being related as underlying disease and complication, share common genetic and environmental antecedents, that is, they "spring from the same soil." Fetal and early-life nutritional deficiencies appear to predispose persons to both NIDDM and cardiovascular disease in later life. The insulin resistance syndrome, including abdominal obesity, may constitute the intermediate link between fetal and early-life nutritional deficiency and later disease. The insulin resistance syndrome includes insulin resistance, hyperinsulinemia, abdominal obesity, dyslipidemia with high triglyceride and low high-density lipoprotein cholesterol levels, and hypertension. Each element of the insulin resistance syndrome has been firmly established as a risk factor for development of diabetes. In addition, most of these elements are also well-recognized cardiovascular risk factors, although the weight of evidence now suggests that hyperinsulinemia itself is not. This last point is significant because of concern that aggressive insulinization of diabetic patients, which has been proved to reduce microvascular complications, might paradoxically increase the risk for large-vessel atherosclerosis. Available clinical trials suggest that this fear is unwarranted, but definitive trials are needed to resolve this important clinical question.
最近的证据表明，非胰岛素依赖型糖尿病（NIDDM）和心血管疾病并非作为基础疾病和并发症相关联，而是有着共同的遗传和环境诱因，也就是说，它们“同根同源”。胎儿期和生命早期的营养缺乏似乎使个体在晚年易患NIDDM和心血管疾病。胰岛素抵抗综合征，包括腹型肥胖，可能是胎儿期和生命早期营养缺乏与后期疾病之间的中间环节。胰岛素抵抗综合征包括胰岛素抵抗、高胰岛素血症、腹型肥胖、甘油三酯升高和高密度脂蛋白胆固醇水平降低的血脂异常以及高血压。胰岛素抵抗综合征的每个要素都已被确认为糖尿病发生的危险因素。此外，这些要素中的大多数也是公认的心血管危险因素，尽管目前的证据表明高胰岛素血症本身并非如此。最后这一点很重要，因为有人担心，已被证明可减少微血管并发症的糖尿病患者强化胰岛素治疗可能会反常地增加大血管动脉粥样硬化的风险。现有的临床试验表明这种担忧是没有根据的，但仍需要确定性试验来解决这个重要的临床问题。
