Takishita S, Abe I, Kobayashi K, Takata Y, Eto T, Fukiyama K, Kojima K
Third Department of Internal Medicine, University of the Ryukyus School of Medicine, Okinawa, Japan.
Hypertens Res. 1996 Jun;19 Suppl 1:S13-8. doi: 10.1291/hypres.19.supplementi_s13.
To clarify whether significant interrelations between hyperinsulinemia and cardiovascular diseases exist in Japanese, we analyzed serum insulin levels, fasting and after oral glucose load, in relation to blood pressure (BP), serum lipids, and incidence of acute myocardial infarction (MI) and stroke in 584 male employees of a railroad company with borderline to mild hypertension (age: 49 +/- 7 years, BP: 139 +/-13/90 +/- 8 mmHg, body mass index: BMI 24.0 +/- 2.8, mean +/- SD). Those who were taking antihypertensive drugs and/or hypoglycemic agents were excluded. The subjects were classified into five groups of comparable size according to sigma IRI (area composed by insulin levels at 0, 1, 2 hours post glucose load). Although averaged age, levels of fasting glucose and HbA1c were not significantly different among quintiles, the hyperinsulinemic groups had higher levels of fasting IRI and sigma glucose. Multiple regression analysis revealed that sigma IRI was associated positively with BMI, sigma glucose, systolic BP, total cholesterol, and negatively with HDL-cholesterol. During 7-year follow-up 7 cases with MI and 15 cases with stroke were registered. The subjects with MI, but not with stroke were involved in higher deciles of insulin levels. These results indicate that the insulin resistance syndrome exists in Japanese middle-aged men with borderline to mild hypertension. The association with cardiovascular morbid events appeared to be evident in coronary heart disease but not in cerebrovascular disease.
为了阐明在日本人中高胰岛素血症与心血管疾病之间是否存在显著的内在联系，我们分析了一家铁路公司584名患有临界至轻度高血压的男性员工（年龄：49±7岁，血压：139±13/90±8 mmHg，体重指数：BMI 24.0±2.8，均值±标准差）空腹及口服葡萄糖负荷后血清胰岛素水平与血压（BP）、血脂以及急性心肌梗死（MI）和中风发病率的关系。服用抗高血压药物和/或降糖药物的人员被排除。根据胰岛素抵抗指数（IRI）总和（由葡萄糖负荷后0、1、2小时的胰岛素水平组成的面积）将受试者分为五组，每组人数相当。尽管五分位数之间的平均年龄、空腹血糖和糖化血红蛋白水平无显著差异，但高胰岛素血症组的空腹IRI和血糖总和水平较高。多元回归分析显示，IRI总和与BMI、血糖总和、收缩压、总胆固醇呈正相关，与高密度脂蛋白胆固醇呈负相关。在7年的随访期间，登记了7例心肌梗死病例和15例中风病例。心肌梗死患者（而非中风患者）的胰岛素水平处于较高的十分位数。这些结果表明，胰岛素抵抗综合征存在于患有临界至轻度高血压的日本中年男性中。与心血管疾病发病事件的关联在冠心病中似乎很明显，但在脑血管疾病中不明显。
