高胰岛素血症作为缺血性心脏病的独立危险因素。

Hyperinsulinemia as an independent risk factor for ischemic heart disease.

作者信息

Després J P, Lamarche B, Mauriège P, Cantin B, Dagenais G R, Moorjani S, Lupien P J

机构信息

Lipid Research Center, Laval University Hospital Research Center, Quebec, Canada.

出版信息

N Engl J Med. 1996 Apr 11;334(15):952-7. doi: 10.1056/NEJM199604113341504.

DOI:10.1056/NEJM199604113341504

PMID:8596596

Abstract

BACKGROUND

Prospective studies suggest that hyperinsulinemia may be an important risk factor for ischemic heart disease. However, it has not been determined whether plasma insulin levels are independently related to ischemic heart disease after adjustment for other risk factors, including plasma lipoprotein levels.

METHODS

In 1985 we collected blood samples from 2103 men from suburbs of Quebec City, Canada, who were 45 to 76 years of age and who did not have ischemic heart disease. A first ischemic event (angina pectoris, acute myocardial infarction or death from coronary heart disease) occurred in 114 men (case patients) between 1985 and 1990. Each case patient was matched for age, body-mass index, smoking habits, and alcohol consumption with a control selected from among the 1989 men who remained free of ischemic heart disease during follow-up. After excluding men with diabetes, we compared fasting plasma insulin and lipoprotein concentrations at base line in 91 case patients and 105 controls.

RESULTS

Fasting insulin concentrations at base line were 18 percent higher in the case patients than in the controls (P<0.001). Logistic-regression analysis showed that the insulin concentration remained associated with ischemic heart disease (odds ratio for ischemic heart disease with each increase of 1 SD in the insulin concentration, 1.7; 95 percent confidence interval, 1.3 to 2.4) after adjustment for systolic blood pressure, use of medications, and family history of ischemic heart disease. Further adjustment by multivariate analysis for plasma triglyceride, apolipoprotein B, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol concentrations did not significantly diminish the association between the insulin concentration and the risk of ischemic heart disease (odds ratio, 1.6; 95 percent confidence interval, 1.1 to 2.3).

CONCLUSIONS

High fasting insulin concentrations appear to be an independent predictor of ischemic heart disease in men.

摘要

背景

前瞻性研究表明，高胰岛素血症可能是缺血性心脏病的一个重要危险因素。然而，在对包括血浆脂蛋白水平在内的其他危险因素进行校正后，血浆胰岛素水平是否与缺血性心脏病独立相关尚未确定。

方法

1985年，我们从加拿大魁北克市郊区2103名45至76岁且无缺血性心脏病的男性中采集了血样。1985年至1990年间，114名男性（病例患者）发生了首次缺血性事件（心绞痛、急性心肌梗死或冠心病死亡）。每例病例患者均按照年龄、体重指数、吸烟习惯和饮酒量与1989名在随访期间未患缺血性心脏病的对照者进行匹配。在排除糖尿病男性后，我们比较了91例病例患者和105名对照者基线时的空腹血浆胰岛素和脂蛋白浓度。

结果

病例患者基线时的空腹胰岛素浓度比对照者高18%（P<0.001）。逻辑回归分析显示，在校正收缩压、药物使用情况和缺血性心脏病家族史后，胰岛素浓度仍与缺血性心脏病相关（胰岛素浓度每增加1个标准差，缺血性心脏病的优势比为1.7；95%可信区间为1.3至2.4）。通过多变量分析进一步校正血浆甘油三酯、载脂蛋白B、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇浓度后，胰岛素浓度与缺血性心脏病风险之间的关联并未显著减弱（优势比为1.6；95%可信区间为1.1至2.3）。