Wannamethee S G, Shaper A G, Durrington P N, Perry I J
Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine, London, UK.
J Hum Hypertens. 1998 Nov;12(11):735-41. doi: 10.1038/sj.jhh.1000714.
In recent years it has been proposed that hypertension is part of a cluster of metabolic risk factors (syndrome X) involving hyperlipidaemia and hyperglycaemia, with hyperinsulinaemia as the common link. This study has investigated: (1) the prevalence of the metabolic syndrome and its component variables and their relationship to body mass index (BMI) and non-fasting insulin levels in a general population; and (2) the distribution and clustering of metabolic variables in normotensives and hypertensives.
Cross-sectional study of 5222 men aged 40-59 years with no history of coronary heart disease (CHD), diabetes mellitus or stroke drawn from general practices in 18 British towns. The men were a subgroup of the 7735 men in the British Regional Heart Study (BRHS) cohort whose baseline non-fasting serum was analysed for insulin, using a specific ELISA method.
Hyperinsulinaemia, hyperglycaemia, high serum total cholesterol, high triglyceride and hyperuricaemia were defined as the top 20% of the distribution in the 5222 men. Low HDL-cholesterol was defined as the bottom 20%.
BMI and non-fasting insulin were both significantly and strongly associated with non-diabetic hyperglycaemia, lipid abnormalities (HDL-cholesterol, triglyceride and total cholesterol) and hyperuricaemia. BMI was strongly associated with hypertension whereas non-fasting insulin showed a much weaker relationship which was abolished after adjustment for BMI. However, only 2.9% of men showed the 'full metabolic syndrome' (hypertension, hyperglycaemia and dyslipidaemia) and a large proportion of these men were hyperinsulinaemic (65%) or obese (47%). Dyslipidaemia (any one of low-HDL-cholesterol, high triglyceride or high cholesterol) was common in both normotensives and hypertensives (40.5% vs 46.4%). Hypertensives showed significantly higher levels of total cholesterol, triglyceride, blood glucose, urate and more clustering of hyperglycaemia and dyslipidaemia than normotensives even after adjustment for BMI.
Hypertensives were more likely to have lipid abnormalities and clustering of risk factors than normotensives even after adjustment for BMI. The metabolic syndrome is more strongly associated with hyperinsulinaemia than with obesity but it is relatively uncommon in men with no history of cardiovascular disease or diabetes. Given the weak relationship between hypertension and hyperinsulinaemia, the latter is unlikely to explain the higher levels of lipid abnormalities and clustering seen in hypertensives. Overweight/obesity may be primarily involved in the pathways to hypertension and lipid abnormalities but the unravelling of these relationships require more specific measures of adipose tissue distribution, composition and function.
近年来，有人提出高血压是一组代谢危险因素（X综合征）的一部分，该综合征包括高脂血症和高血糖症，而高胰岛素血症是其共同联系。本研究调查了：（1）一般人群中代谢综合征及其组成变量的患病率，以及它们与体重指数（BMI）和非空腹胰岛素水平的关系；（2）血压正常者和高血压患者中代谢变量的分布与聚集情况。
对来自英国18个城镇普通诊所的5222名40至59岁、无冠心病（CHD）、糖尿病或中风病史的男性进行横断面研究。这些男性是英国地区心脏研究（BRHS）队列中7735名男性的一个亚组，使用特定的ELISA方法对其基线非空腹血清进行胰岛素分析。
高胰岛素血症、高血糖症、高血清总胆固醇、高甘油三酯血症和高尿酸血症定义为5222名男性中分布在前20%的情况。低高密度脂蛋白胆固醇定义为分布在后20%的情况。
BMI和非空腹胰岛素均与非糖尿病性高血糖症、脂质异常（高密度脂蛋白胆固醇、甘油三酯和总胆固醇）以及高尿酸血症显著且密切相关。BMI与高血压密切相关，而非空腹胰岛素的关系则弱得多，在调整BMI后这种关系消失。然而，只有2.9%的男性表现出“完全代谢综合征”（高血压、高血糖症和血脂异常），其中很大一部分男性存在高胰岛素血症（65%）或肥胖（47%）。血脂异常（低高密度脂蛋白胆固醇、高甘油三酯或高胆固醇中的任何一项）在血压正常者和高血压患者中都很常见（分别为40.5%和46.4%）。即使在调整BMI后，高血压患者的总胆固醇、甘油三酯、血糖、尿酸水平仍显著更高，且高血糖症和血脂异常的聚集情况比血压正常者更明显。
即使在调整BMI后，高血压患者比血压正常者更易出现脂质异常和危险因素聚集。代谢综合征与高胰岛素血症的关联比与肥胖的关联更强，但在无心血管疾病或糖尿病病史的男性中相对不常见。鉴于高血压与高胰岛素血症之间的关系较弱，后者不太可能解释高血压患者中较高的脂质异常水平和聚集情况。超重/肥胖可能主要参与了高血压和脂质异常的发病途径，但要阐明这些关系需要更具体的脂肪组织分布、组成和功能测量方法。
