Burchfiel C M, Abbott R D, Curb J D, Sharp D S, Rodriguez B L, Arakaki R, Yano K
Honolulu Epidemiology Research Unit, Epidemiology and Biometry Program, Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, HI, USA.
Ann Epidemiol. 1998 Feb;8(2):92-8. doi: 10.1016/s1047-2797(97)00167-1.
Elevated insulin levels have been associated with cardiovascular disease, but the relationship of insulin with other risk factors and its position in the atherosclerotic pathway is uncertain. A cross-sectional study was conducted to determine whether insulin concentrations were associated with lipids and lipoproteins independently of adiposity and other cardiovascular risk factors.
Subjects included 3417 Japanese-American men from the Honolulu Heart Program who completed a follow-up examination between 1991 and 1993 and were 71-93 years of age. Men were categorized by quintiles of fasting and 2-hour insulin concentration.
Age-adjusted mean high-density lipoprotein (HDL) cholesterol and triglyceride levels varied significantly across quintiles of fasting and 2-hour insulin (P < 0.001, tests for trend), but insulin was not related to total cholesterol and low-density lipoprotein (LDL) cholesterol. HDL cholesterol decreased from 59.3 to 43.7 mg/dL and triglycerides increased from 95.6 to 175.8 mg/dL comparing lowest to highest quintiles of fasting insulin, respectively. These associations were slightly stronger in lean than obese subjects and in nondiabetic versus diabetic individuals particularly for 2-hour insulin levels. Multiple linear regression analysis adjusting for several adiposity measures separately (body mass index (BMI), subscapular skinfold thickness, waist circumference, and waist/hip ratio) and other cardiovascular risk factors attenuated associations slightly but they still remained statistically significant. Estimated differences in HDL cholesterol across extreme quintiles of fasting insulin were reduced slightly from 15.6 mg/dL with adjustment for age to 12.5 mg/dL with adjustment for age and BMI, and to 11.3 mg/dL with adjustment for age, BMI, and cardiovascular risk factors.
Insulin concentration was strongly and independently associated with HDL cholesterol and triglycerides in this cohort of elderly Japanese-American men. Since this study was cross-sectional, further investigation is required to determine whether elevated insulin levels are causally related to dyslipidemia.
胰岛素水平升高与心血管疾病相关，但胰岛素与其他危险因素的关系及其在动脉粥样硬化途径中的地位尚不确定。开展了一项横断面研究，以确定胰岛素浓度是否独立于肥胖及其他心血管危险因素与脂质和脂蛋白相关。
研究对象包括来自檀香山心脏项目的3417名日裔美国男性，他们在1991年至1993年间完成了随访检查，年龄在71至93岁之间。根据空腹和2小时胰岛素浓度的五分位数对男性进行分类。
经年龄调整后，空腹和2小时胰岛素五分位数间的平均高密度脂蛋白（HDL）胆固醇和甘油三酯水平差异显著（趋势检验，P<0.001），但胰岛素与总胆固醇和低密度脂蛋白（LDL）胆固醇无关。比较空腹胰岛素最低和最高五分位数时，HDL胆固醇分别从59.3mg/dL降至43.7mg/dL，甘油三酯从95.6mg/dL升至175.8mg/dL。这些关联在瘦人比肥胖者中以及非糖尿病者比糖尿病个体中略强，尤其是对于2小时胰岛素水平。分别针对几种肥胖指标（体重指数（BMI）、肩胛下皮褶厚度、腰围和腰臀比）及其他心血管危险因素进行调整的多元线性回归分析使关联略有减弱，但仍具有统计学意义。空腹胰岛素极端五分位数间HDL胆固醇的估计差异从调整年龄后的15.6mg/dL略有降低至调整年龄和BMI后的12.5mg/dL，调整年龄、BMI和心血管危险因素后降至11.3mg/dL。
在这群老年日裔美国男性中，胰岛素浓度与HDL胆固醇和甘油三酯密切且独立相关。由于本研究为横断面研究，需要进一步调查以确定胰岛素水平升高是否与血脂异常存在因果关系。
