Lindberg O, Tilvis R S, Stranberg T E, Valvanne J, Sairanen S, Ehnholm C, Tuomilehto J
University of Helsinki, Finland.
J Am Geriatr Soc. 1997 Apr;45(4):407-12. doi: 10.1111/j.1532-5415.1997.tb05163.x.
Although high insulin levels have been linked to cardiovascular disease, the role of insulin as an independent risk factor has been questioned. Our objective was to examine the association of fasting plasma insulin with cardiovascular disease as well as to investigate the prognostic value of insulin with respect to survival.
A 5-year follow-up of random samples from four birth cohorts age 65 (n = 660), 75 (n = 194), 80 (n = 179), and 85 (n = 162) years at baseline.
Two urban communities in southern Finland.
Clinical and laboratory investigation at base line with collection of date and cause of death information during follow-up.
Subjects with cardiovascular disease generally had higher levels of fasting plasma insulin than did subjects without cardiovascular disease (13.9 mU/L vs 11.2 mU/L, P < .001). Heart failure and hypertension were associated with significant 30 to 80% elevations of insulin levels in all but the oldest group. In the 65-year-old group, all vascular diseases were associated with significantly elevated insulin. The associations were generally not explained by body mass index or by use of diuretics or beta-blockers. During the follow-up insulin was generally not associated with an impaired survival. On the contrary, in subjects with manifest cardiovascular disease, high insulin was associated with a rather favorable 5-year survival prognosis. Exclusion of subjects who died during the first 500 days of follow-up did not change these associations.
Albeit fasting plasma insulin appeared to be secondarily associated with cardiovascular disease in this general aged population, it was related to a fair or favorable survival prognosis.
尽管高胰岛素水平与心血管疾病相关，但胰岛素作为独立危险因素的作用一直受到质疑。我们的目的是研究空腹血浆胰岛素与心血管疾病的关联，并探讨胰岛素对生存的预后价值。
对来自四个出生队列、基线年龄分别为65岁（n = 660）、75岁（n = 194）、80岁（n = 179）和85岁（n = 162）的随机样本进行为期5年的随访。
芬兰南部的两个城市社区。
在基线时进行临床和实验室检查，并在随访期间收集死亡日期和死因信息。
患有心血管疾病的受试者空腹血浆胰岛素水平通常高于无心血管疾病的受试者（13.9 mU/L对11.2 mU/L，P <.001）。除最年长组外，心力衰竭和高血压与胰岛素水平显著升高30%至80%相关。在65岁组中，所有血管疾病都与胰岛素显著升高相关。这些关联通常无法用体重指数、利尿剂或β受体阻滞剂的使用来解释。在随访期间，胰岛素一般与生存受损无关。相反，在患有明显心血管疾病的受试者中，高胰岛素与相当良好的5年生存预后相关。排除在随访的前500天内死亡的受试者并没有改变这些关联。
尽管在这个普通老年人群中空腹血浆胰岛素似乎与心血管疾病存在继发性关联，但它与良好或较好的生存预后相关。
