Insulin Resistance,Body Mass Index,Waist Circumference are Independent Risk Factor for High Blood Pressure

Objectives: The purpose of the present study was to investigate the relationships between blood pressure (BP), insulin resistance as determined by a homeostasis model (HOMA‐IR), and body fat distribution. Methods: Anthropometric indices of adiposity, metabolic variables (fasting serum insulin and a homeostasis model assessment [HOMA] index of insulin sensitivity), BP and several cardiovascular risk factors were measured during a cross sectional survey of 53477 apparently healthy Korean subjects who requested a health status check. Hypertension was defined as a systolic BP ≥ 140 mmHg or a diastolic BP ≥ 90 mmHg and we excluded the subjects taking BP‐lowering medication. Results: Systolic and diastolic blood pressure (SBP, DBP) were positively and significantly associated with age, body mass index, waist circumference, and waist/hip ratio. In addition, SBP and DBP were positively associated with fasting serum insulin levels and the HOMA index. By multiple regression analysis age, waist circumference, body mass index, HOMA index and female sex were independently associated with either increased SBP or DBP. When the population is divided into quintiles according to insulin resistance (measured by HOMA analysis) prevalence of hypertension in the second, third, fourth and fifth quintiles compared to subjects in the first quintile are 1.004(95% CI 0.875–1.152, p=0.957), 1.200(95% CI 1.052–1.369, p=0.007), 1.312(95% CI 1.151–1.494 p < 0.001), and 1.603(95% CI 1.408–1.825 p < 0.001). In addition age, sex, body mass index and waist circumference were found to be significantly associated with hypertension. Conclusion: Our results showed that insulin resistance, body mass index and waist circumference are independent risk factors of a high BP in Koreans.     

In normoglycemic Koreans, insulin resistance and adipocity are independently correlated with high blood pressure.

BACKGROUND: There is some controversy about the role of insulin resistance (IR) in the regulation of blood pressure (BP). Moreover, a large study of the association between BP and IR has not been conducted in normal glucose tolerance Asians. The present study investigated the relationships between IR, body mass index (BMI) and waist circumference and BP in normoglycemic Koreans. METHODS AND RESULTS: Anthropometric indices of adiposity, metabolic variables (fasting serum insulin and a homeostasis model assessment (HOMA) index of insulin sensitivity), BP and several cardiovascular risk factors were measured during a cross-sectional survey of 49,076 normoglycemic Korean subjects. A high BP was defined as a systolic BP >/=140 mmHg or a diastolic BP >/=90 mmHg. The prevalence of high BP by HOMA grading was 0.985 (95% confidence interval (CI) 0.857-1.132, p=0.835), 1.180 (95% CI 1.032-1.350, p=0.016), 1.289 (95% CI 1.129-1.472, p<0.001), and 1.540 (95% CI 1.341-1.768, p<0.001) times higher in subjects in the second, third, fourth, and fifth quintiles, respectively, compared with those in the first quintile. In addition, age, sex, waist circumference and BMI were found to be significantly associated with a high BP. CONCLUSION: IR, BMI and waist circumference are independently correlated with high BP in normoglycemic Koreans.     

Relation between leptin and the metabolic syndrome in elderly women

BACKGROUND: Leptin has been shown to be linked to adiposity and insulin resistance in middle-aged participants. However, the association between leptin and metabolic syndrome independently of body fat and body fat distribution has not been evaluated in healthy elderly people. METHODS: We studied the independent relation between leptin and the components of the metabolic syndrome in 107 women aged 67-78 years with body mass index (BMI) ranging from 18.19 to 36.16 kg/m2. In all participants, we evaluated BMI, waist and hip circumferences, body composition by dual energy X-ray absorptiometry, fasting, and 2-hour glucose, lipids, insulin, homeostasis model assessment of insulin resistance (HOMA), systolic (SBP), diastolic blood pressure (DBP), and leptin. RESULTS: Significant correlation was found between leptin, BMI, waist circumference, fat mass, DBP, SBP, cholesterol, triglycerides, insulin, and HOMA. After adjusting for age and waist circumference, as well for age and fat mass, leptin was significantly related to insulin levels, HOMA, and cholesterol. In a stepwise multiple regression analysis using insulin levels or HOMA as dependent variables and age, waist circumference, fat mass, leptin, SBP, DBP, cholesterol, and triglycerides as independent variables, leptin entered the regression first, waist circumference second, and age third. CONCLUSION: Our study shows that leptin is significantly related to indices of adiposity in elderly women, and leptin is significantly associated with insulin levels, HOMA, and cholesterol independent of age, body fat, and fat distribution. Leptin, waist circumference, and age together explained 31% and 33% of insulin levels and HOMA variance, respectively, in healthy elderly women.     

The relationship of waist circumference to blood pressure: the Olivetti Heart Study

BACKGROUND: The association between overweight, high blood pressure (BP), and insulin resistance is well established, but the role of body fat distribution in this association has yet to be fully elucidated. The aim of this study was to investigate the role of central adiposity in the association between overweight, high BP, and insulin resistance. METHODS: A total of 1,079 men participated in the follow-up of the Olivetti Heart Study from 1994 to 1995. The present analysis includes 768 men, after the exclusion of 184 participants on pharmacological treatment for hypertension. In 65 men fasting blood glucose was >7 mmol/L; in 48, age was below or above 2 standard deviations from the mean of the population; and in 14 the data set was incomplete. Anthropometric indices of adiposity, metabolic variables (including fasting serum insulin and homeostasis model assessment [HOMA] index of insulin sensitivity), and BP were measured. RESULTS: In univariate analysis, waist circumference was the anthropometric index that best correlated with BP (P < .001). In multiple regression analysis, waist circumference remained the strongest independent predictor of BP after adjustment for confounders. Significant increase of systolic (P value for trend analysis < .001) and diastolic (P < .001) pressure, heart rate (P = .003), fasting and postload serum insulin (P < .001), and HOMA index of insulin sensitivity (P < .001) were observed across age-adjusted quintiles of waist circumference. Greater degrees of central adiposity were associated with higher prevalence of elevated BP values and insulin resistance (P value < .001, chi2 for linear trend). CONCLUSIONS: In middle-aged men, a central distribution of body fat is associated with increased BP, independently of body mass index and insulin resistance, thus suggesting a key role of central adiposity in the full expression of the "metabolic syndrome."     

非高血压人群血压与体脂和胰岛素抵抗相关

对 839名非高血压、无糖尿病史且空腹血糖 <5. 6mmol/L者进行分析,结果表明收缩压和舒张压均与McAuley指数呈负相关(r=-0. 25, -0. 27,均P<0. 01),但多元逐步回归分析表明收缩压、舒张压与McAuley指数无独立相关,而与体重指数、腰围呈独立正相关。     

A positive association between leptin and blood pressure of normal range in Japanese men.

The results of previous studies on the relationship between leptin and blood pressure are discordant. We investigated to what extent the serum leptin level was related to blood pressure independent of the degree of insulin resistance. The subjects were 1916 men aged 34-69 years whose mean body mass index (BMI) was 23.0 kg/m2. Blood pressure was regressed by leptin concentrations with adjustments for age, BMI, insulin resistance, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, physical activity, drinking habits and smoking status. Leptin was associated with diastolic blood pressure (DBP) (standardized beta: 0.092, p = 0.003), but not with systolic blood pressure (SBP) (standardized beta: 0.035, p = 0.25), although insulin resistance was positively associated with both SBP and DBP (standardized beta: 0.175 for SBP, p < 0.001 and 0.114 for DBP, p < 0.001) among all subjects. After subjects were divided into those with normal blood pressure (SBP <130 mmHg and DBP <85 mmHg) and those with higher blood pressure, leptin was positively and significantly associated with DBP (standardized beta: 0.106, p = 0.012) independent of the degree of insulin resistance, but not with SBP (standardized beta: 0.064, p = 0.13) among subjects in the normal blood pressure range. Among the subjects with higher blood pressure, however, neither the association of leptin with SBP nor that of leptin with DBP was statistically significant. These findings suggest that leptin may maintain and increase arterial tone, resulting in the elevation of DBP only within normal blood pressure range. It is also likely that leptin is a physiological mediator--or at least a marker--of some degree of DBP elevation in obesity.     

The ongoing role of serum uric acid in blood pressure

Positive association between blood pressure (BP) and uric acid is evident, but specific effect size of serum uric acid (SUA) at different levels on BP is unclear, and interaction effect of SUA with other metabolic factors on BP was rarely reported. A cross-sectional study was conducted by making use of data from an epidemic investigation. A total of 3658 subjects were enrolled in our data analysis. In male subjects, for each 1 mg/dL increase in the SUA level, systolic blood pressure (SBP) and diastolic blood pressure (DBP) increased by 1.339 mmHg [95% CI: 0.552–2.126] and 0.515 mmHg [95% CI: 0.013–1.016], respectively, after adjusting for age, fasting plasma glucose (FPG), triglyceride (TG), total cholesterol (TC), estimated-glomerular filtration rate (eGFR), body mass index (BMI), drinking, smoking, and waist–hip ratio (WHR). And in female subjects, for each 1 mg/dL increase in the SUA level, SBP and DBP increased by 1.180 mmHg [95% CI: 0.401–1.959] and 0.549 mmHg [95% CI: 0.086–1.011], respectively, after adjusting the same factors. In males, in subjects with SUA < 6 mg/dL, SBP increased by 0.585 mmHg [95% CI: ?0.976 to 2.146] for each 1 mg/dL increase in the SUA level, while in subjects with SUA ≥ 6 mg/dL, SBP increased by 3.271 mmHg [95% CI: 1.244–5.297] (p interaction = 0.0369), after adjusting age, BMI, smoking, drinking, TG, TC, FPG, eGFR, and WHR. This difference was not observed in DBP and females. Interaction effects between SUA and BMI, TG, FPG on BP were discovered. In conclusion, higher level of SUA has a stronger effect on BP and other metabolic factors: FPG, TG, and BMI could strengthen the effect of SUA on BP.     

Does metformin decrease blood pressure in patients with Type 2 diabetes intensively treated with insulin?

AIMS: We investigated in a double-blind study whether metformin reduces blood pressure (BP) in patients with Type 2 diabetes intensively treated with insulin. METHODS: A total of 220 patients with Type 2 diabetes were asked to undergo 24-h ambulatory BP monitoring (24-h ABPM). One hundred and eighty-two gave informed consent. Eighty-nine were randomized to metformin and 93 to placebo. Thirty-five subjects dropped out (13 placebo, 22 metformin users); 147 patients underwent a second 24-h ABPM, 16 weeks after randomization. RESULTS: Systolic BP (SBP), diastolic BP (DBP), pulse BP (PP), mean BP (MP) and heart rate (HR) were measured as office BP measurements and as 24-h ABPM for 24-h, day and night. Office BP measurements did not differ significantly between the placebo- and metformin-treated groups for any BP measure, but showed a non-significant trend for SBP reduction with metformin use (mean baseline-adjusted difference, metformin minus placebo: -4.2 mmHg, 95% CI, -9.9 to +1.5; P = 0.15). The baseline-adjusted differences of the ambulatory measurements were -0.2 mmHg (95% CI, -2.9 to +2.6) for the 24-h SBP, and +1.1 mmHg (95% CI, -0.7 to +2.8) for the 24-h DBP. On the whole, BP differences between metformin- and placebo-treated groups were not statistically significant. The only significant difference was for night-time PP (baseline-adjusted difference: -2.2 mmHg; 95% CI, -4.2 to -0.2). These results were not different after adjustment for age and diabetes duration, or for (changes in) body mass index, glycated haemoglobin, insulin dose or plasma homocysteine. CONCLUSION: Metformin does not significantly affect BP in patients with Type 2 diabetes intensively treated with insulin.     

Relationship between androgen levels and blood pressure in young women with polycystic ovary syndrome

The role of testosterone on the development of hypertension is controversial, especially in women with polycystic ovary syndrome (PCOS) who have higher prevalence of obesity and insulin resistance than women without PCOS. Little is known about the association between serum testosterone level and blood pressure in young women with PCOS. In the 151 young Taiwanese women with PCOS enrolled in this cross-sectional study, we measured the body mass index, waist circumference, blood pressure, fasting glucose, fasting insulin, lipid profile, and hormone profiles. The free androgen index, total testosterone, and sex hormone-binding globulin, but not the level of dehydroepiandrosterone sulfate, significantly correlated with both systolic blood pressure (SBP) and diastolic blood pressure (DBP). In multiple linear regression models adjusted for age, body mass index, and other anthropometric, metabolic, and hormonal variables, the level of serum free androgen index or total testosterone, but not the sex hormone-binding globulin, were independently related to SBP and DBP. The age- and body mass index-adjusted least-square mean of serum-free androgen index levels were significantly different between the highest quartile and other quartiles of the SBP and DBP levels. The high bioavailable testosterone levels (free androgen index: >or=19%) in women with PCOS increased the risk of elevated blood pressure (SBP >or=130 mm Hg and/or DBP >or=85 mm Hg) with an odds ratio of 3.817 (P=0.029; 95% CI: 1.14 to 12.74) after adjustment for age, anthropometric measures, and metabolic profiles. Our results suggest that the characteristic hyperandrogenemia in young women with PCOS was associated with an elevated SBP and DBP independent of age, insulin resistance, obesity, or dyslipidemia.     

A physical activity programme and its effects on insulin resistance and oxidative defense in obese male patients with type 2 diabetes mellitus

AIM: The aim of this study was to investigate the effects of regular aerobic execise on glycaemic control, insulin resistance, cardiovascular risk and oxidative stress-defense parameters in overweight and obese type 2 diabetic patients. METHODS: Changes from baseline to 3 and 6 months of aerobic exercise in total of 30 type 2 diabetics were assessed for physical activity index (PAI), fasting glycaemia (FG), glycated hemoglobin (HbA(1c)), median blood glucose (MBG), insulin resistance (HOMA), triglycerides (TG), cholesterol, the Ashwell Shape Chart Health Risk, SCORE risk, body mass index (BMI), waist and hip circumference, systolic (SBP) and diastolic (DBP) blood pressure, plasma and erythrocyte malondialdehyde (MDA), glutathione, sulphydryl groups and catalase (CAT) and were compared to the results of 30 healthy control subjects. RESULTS: At baseline, significant differences were recorded between the control and diabetes group for FG (P<0.001), HOMA (P<0.001), SBP and DBP (P<0.001), TG (P<0.01), MDA(pl) (P<0.01), CAT (P<0.01) and SCORE risk (P<0.001). Significant changes within the diabetes group were found for PAI (P<0.05), FG (P<0.001), MBG (P<0.05), HbA(1c)(P<0.05), HOMA (P<0.01), SBP and DBP (P<0.001) from baseline to 3 months, as well as for FG (P<0.01), HOMA (P<0.001), SBP and DBP (P<0.05) from 3 to 6 months. Significant (P<0.05) correlations were found for FG and PAI (R=0.432), as well as for HOMA and both HbA(1c)(R=0.412) and SCORE risk (R=-0.387) in the diabetes group. CONCLUSION: Regular aerobic exercise has beneficial effects on glycaemic control, insulin resistance, cardiovascular risk, oxidative stress-defense parameters in overweight and obese type 2 diabetics.     

Body weight and weight change in relation to blood pressure in normotensive men

We examined blood pressure (BP) in association with weight change since age 20, body mass index (BMI) at different ages and fat distribution in normotensive individuals using baseline survey data collected in the Shanghai Men's Health Study, an ongoing population-based prospective cohort study of Chinese men aged 40-74 years. All anthropometric and BP measurements were performed by medical professionals. Included in this analysis were 25 619 men who had no prior history of hypertension, diabetes or cardiovascular disease, never took any antihypertensive medication and had both normal systolic BP (SBP) and diastolic BP (DBP) (<140/90 mm Hg). Both SBP and DBP increased linearly across the whole range of weight gain since age 20. The adjusted mean differences between the highest and the lowest quintiles of weight gain were 6.0 mm Hg (95% confidence interval (CI): 5.6, 6.5) for SBP and 3.9 (95% CI: 3.6, 4.2) for DBP. When accounting for BMI at age 20, the multivariate-adjusted odds ratio of prehypertension (SBP, 120-139 and/or DBP, 80-89 mm Hg) was 4.1 (95% CI: 3.7, 4.5; P for trend <0.0001) comparing the extreme quintiles of weight gain. Similar positive associations were also observed for BMI at age 40, current BMI, circumferences of the waist and hips and waist-to-hip ratio. In conclusion, these data suggest that weight gain since age 20 and elevated adiposity may contribute significantly to the rise in BP in normotensive individuals, emphasizing the importance of weight control throughout adulthood in preventing high BP.     

Postmenopausal hypertension,abdominal obesity,apolipoprotein and insulin resistance

This study aimed to evaluate the association of abdominal obesity, apolipoprotein and insulin resistance (IR) with the risk of hypertension in postmenopausal women. We analyzed a total of 242 women aged between 35 and 70 years. Blood pressure (BP), anthropometric indices, lipid profile, fasting glucose, insulin, C-reactive protein (CRP) and apolipoprotein concentrations were measured. Homeostasis model assessment (HOMA) was used to assess IR. Hypertension was defined as a systolic BP (SBP) ≥140 mmHg and/or diastolic BP (DBP) ≥90 mmHg or current treatment with antihypertensive drugs. Women with hypertension showed significantly higher mean values of age, SBP and DBP, waist circumference (WC), fasting plasma glucose (FPG), insulin, HOMAIR and the apolipoprotein B (apoB). When analyses were done according to the menopausal status, higher prevalence of hypertension was observed in postmenopausal women (72.8% vs. 26.0%, p < 0.001) compared to their premenopausal counterparts. Postmenopausal women showed also significantly higher mean values of SBP and DBP, WC, HOMAIR and apoB. Multivariate linear regression analysis revealed that SBP was significantly affected by WC (p = 0.034), apoB (p = 0.038) and log HOMAIR (p = 0.007) in postmenopausal women. The interaction models revealed significant interaction between WC, apoB and log HOMAIR (WC×apoB×log HOMAIR) on SBP (p = 0.001) adjusted for age. In a multivariate logistic regression, adjusting for age and apoB, WC (p = 0.001), log HOMAIR (p = 0.007) and menopause (p = 0.008) were significantly associated with higher risk for hypertension. These results suggest that changes in WC, apoB and IR accompanying menopause lead to a greater prevalence of hypertension in postmenopausal women.     

血压正常高值人群心血管危险因素和脉搏波传导速度

目的探讨血压正常高值人群血管脉搏波速度与心血管危险因素的关系。方法选择血压正常人群195例,分为两组:理想血压组90人(BP<120/80mmHg);正常高值组105人(BP:120～139/80～89mmHg)。应用脉搏波速度(PWV)测定仪对所有入选者同时测定颈桡动脉脉搏波速度(CRPWV),颈股动脉脉搏波速度(CFPWV),并测身高、体重、体重指数(BMI)、腰围等,同时抽取空腹肘部静脉血测定血糖(BG)、血脂、内皮素(ET)、一氧化氮(NO)和胰岛素(INS)的浓度。结果1)两组间各因素比较BMI、腰围、收缩压(SBP)、舒张压(DBP)、甘油三酯(TG)、极低密度脂蛋白(VLDL)、BG、ET、NO、胰岛素抵抗指数(HOMAIR)、CRPWV、CFPWV存在统计学差异,P均<0.05。2)PWV与各因素的简单相关(Pearson)分析示:CFPWV与年龄、SBP、DBP、腰围、TG、胆固醇(CHO)、VLDL、BG、ET、NO、HOMAIR相关。CRPWV与年龄、腰围、SBP、DBP、TG、VLDL、BG、ET、NO、HOMAIR相关。3)多因素回归分析示:CFPWV=4.635 0.035SBP 0.047age 0.290TG-0.099BMI 0.010ET-0.009NO 0.076HOMAIR。R2=0.514。CRPWV=3.161 0.033DBP 0.034age 0.313BG 0.012ET-0.009NO。R2=0.274。结论1)血压正常高值者已经存在动脉弹性的减退。2)血压正常高值者动脉弹性的减退与内皮功能失调、血糖、血脂水平、胰岛素抵抗密切相关。     

Rosiglitazone reduces office and diastolic ambulatory blood pressure following 1-year treatment in non-diabetic subjects with insulin resistance

OBJECTIVE: Rosiglitazone (RSG) has been reported to reduce blood pressure (BP) in patients with type-2 diabetes, but similar effects in non-diabetic people with insulin resistance is less clear. Our aim was to test the long-term BP-lowering effects of RSG compared with placebo. METHODS: We recruited participants for BP evaluation of RSG treatment from a larger intervention trial. Office BP was recorded in 355 non-diabetic subjects with insulin resistance randomized to receive either RSG or placebo for 52 weeks. Ambulatory BP monitoring (ABPM; Spacelab 90207) was performed in a subgroup of 24 subjects (RSG: n = 11; placebo n = 13). RESULTS: After 1 year, the office BP decreased by -3.1 mmHg systolic (p<0.05) and -3.8 mmHg diastolic (p<0.001) in the RSG group versus placebo. In patients treated with RSG, at 1 year there was a trend for a reduction from baseline for mean 24-h diastolic BP (DBP), daytime DBP and night-time DBP (-4.39, -5.26 and -2.93 mmHg, respectively). However, only daytime DBP was significantly lower in the RSG group compared with control (adjusted mean difference: -4.41 mmHg, p = 0.007). There was also a non-significant trend for a reduction in mean 24-h systolic BP (SBP), daytime SBP and night-time SBP (-2.70, -2.51 and -3.35 mmHg, respectively). CONCLUSIONS: RSG treatment for 1 year was associated with a small but significant decrease in diastolic 24-h ambulatory diastolic BP, and both systolic and diastolic office BPs in non-diabetic people with insulin resistance.     

非糖尿病人群中补体C3、超敏C反应蛋白与胰岛素抵抗指数(HOMA2-IR)相关性分析

目的 观察非糖尿病人群血清补体C3、超敏C反应蛋白(hs-CRP)水平及其与胰岛素抵抗的关系.方法 纳入587例非糖尿病个体,测定体重、身高、血压、腰围、空腹血浆葡萄糖、血清胰岛素、血脂、补体C3及hs-CRP等,计算胰岛素抵抗指数(HOMA2-IR).以HOMA2-IR上四分位为切点划分胰岛素抵抗与非胰岛素抵抗.结果 胰岛素抵抗人群补体C3和hs-CRP显著高于非胰岛素抵抗人群.校正性别、年龄、BMI及腰围后,部分相关分析发现补体C3与HOMA2-IR显著正相关(r=0.19,P＜0.01).去除性别、年龄、收缩压、舒张压、总胆固醇、甘油三酯、高密度脂蛋白胆固醇和腰围的影响后,随着补体C3的升高发生胰岛素抵抗的危险增加3.78倍(OR=3.78,P＜0.05);而hs-CRP与胰岛素抵抗的发生无统计学意义.结论 在非糖尿病人群中,补体C3与胰岛素抵抗的相关性强于hs-CRP.

Abstract：

Objective To observe and compare the association of serum levels of of complement component 3(C3)and high-sensitive C-reactive protein(hs-CRP)with insulin resistance in non-diabetic subjects. Methods 587non-diabetic Chinese were recruited. Weight, height, blood pressure, waist circumference, fasting plasma glucose,fasting serum insulin, blood lipids, C3 and hs-CRP were measured. HOMA index(HOMA2-IR)was calculated.Insulin resistance was defined as the upper quartile of HOMA2-IR. Results C3 and hs-CRP were significantly higher in subjects with insulin resistance compared with subjects without insulin resistance. After controlling for age, gender,body mass index, and waist circumference, C3 was positively and significantly correlated with HOMA2-IR(r = 0.19,P＜0.01). As C3 increased, subjects were 3.78(OR= 3.78, P＜0.05)times more likely to suffer from insulin resistance, after adjustment for age, gender, systolic blood pressure, diastolic blood pressure, total cholesterol,triglycerides,high-density lipoprotein cholesterol, and waist circumference. However, hs-CRP was not significantly correlated with insulin resistance. Conclusions Serum complement component 3 has a more marked association with insulin resistance than hs-CRP in non-diabetic Chinese.     

天津市糖尿病高危人群血脂异常患病率及相关危险因素分析

目的 探讨天津市糖尿病高危人群血脂异常患病率及相关危险因素.方法 在天津地区采用随机数字法选取1 364名无明确糖尿病病史的健康查体者作为筛查对象.采用芬兰糖尿病风险积分表(FINDRSC)筛查糖尿病高危人群,将纳入的445名糖尿病高危人群按是否合并血脂异常分为血脂异常组(n =316)和血脂正常组(n=129).比较两组间一般情况、生化指标及胰岛素抵抗和胰岛β细胞功能状态,测定纤溶酶原激活物抑制因子-1(PAI-1)及颈动脉内膜-中层厚度(IMT),并分析糖尿病高危人群血脂异常患病率及相关危险因素.结果 天津地区糖尿病高危人群血脂异常总患病率为71.01％ (316/445),高甘油三酯血症、高胆固醇血症、高低密度脂蛋白-胆固醇血症、低高密度脂蛋白-胆固醇血症的患病率分别为47.86％(213/445)、21.57％(96/445)、19.55％(87/445)、39.33％(175/445).其中单纯型血脂异常患者占28.76％(128/445),混合型血脂异常患者占42.25％(188/445).血脂异常的程度与吸烟、FINDRSC评分、腰围、体重指数、收缩压、谷草转氨酶、谷丙转氨酶、血尿酸、C反应蛋白、同型半胱氨酸(Hcy)、IMT、PAI-1及稳态模型评估-胰岛素抵抗指数(HOMA2-IR)呈正相关(r=0.145～0.786,P均＜0.05),与规律运动及稳态模型评估-胰岛β细胞功能状态(HOMA2-％β)呈负相关(r=-0.344,-0.424,P均＜0.05).二分类Logistic回归分析提示,血脂异常的发生与体重指数(OR=1.754,95％CI:1.399～2.199),腰围(OR=1.091,95％ CI:1.004 ～1.186),收缩压(OR=1.201,95％CI:1.131 ～1.276),血尿酸(OR=1.008,95％ CI:1.002 ～1.014),PAI-1(OR=1.233,95％ CI:1.150 ～1.323),HOMA2-IR(OR=4.094,95％ CI:1.352～ 12.397)及HOMA2-％β(OR=0.921,95％CI:0.888 ～0.954)独立相关(P均＜0.05).结论 血脂异常尤其混合型血脂异常在天津地区糖尿病高危人群中的患病率很高;高体重指数、高腰围、高收缩压、高尿酸、高PAI-1、高胰岛素抵抗程度及胰岛β细胞功能减低是血脂异常的独立危险因素.     

Ile-Pro-Pro and Val-Pro-Pro tripeptide-containing milk product has acute blood pressure lowering effects in mildly hypertensive subjects

Casein-derived tripeptides isoleucine-proline-proline (Ile-Pro-Pro) and valine-proline-proline (Val-Pro-Pro) lower blood pressure (BP) in long-term clinical studies. Their acute effects on BP and vascular function, important for daily dosing scheme, were studied in a placebo-controlled double-blind crossover study using a single oral dose of a fermented milk product containing Ile-Pro-Pro and Val-Pro-Pro as well as plant sterols. Twenty-five subjects with untreated mild hypertension received in random order 250 g of study product (25 mg peptides and 2 g plant sterols) or placebo. Ambulatory BP was monitored for 8 h post-dose and arterial stiffness measured by pulse wave analysis at 2, 4, and 8 h. Blood and urine samples were analyzed for markers of the renin-angiotensin system (RAS) and endothelial function. Baseline adjusted treatment effect for systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial BP was -2.1 mmHg (95% CI: -4.1 to -0.1, p = 0.045), -1.6 mmHg (95% CI: -3.1 to -0.1, p = 0.03), and -1,9 mmHg (95% CI: -3-3 to -0.4, p = 0.0093), respectively, in favor of the active treatment for 8 h post- dose. No significant differences between the treatments were seen in brachial or aortic augmentation index, pulse wave velocity, or markers of RAS. Urinary excretion of cGMP, the second messenger of endothelial nitric oxide, was higher in the active group vs. placebo (p = 0.01). The results indicate that a single dose of a fermented milk product containing Ile-Pro-Pro and Val-Pro-Pro and plant sterols acutely lowers brachial SBP and DBP in mildly hypertensive subjects.     

藏族人群代谢综合征对早期动脉粥样硬化的影响

目的:探讨藏族人群代谢综合征对早期动脉粥样硬化的影响。方法:在查体的藏族人群中筛选代谢综合征(MS)患者。记录身高、体重、腰围、血压,测定空腹血糖(FPG)、空腹胰岛素(FINS)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白-胆固醇(HDL-C)、低密度脂蛋白-胆固醇(LDL-C)。超声检查颈动脉内中膜(IMT)厚度。结果:总共1187人参加筛选,其中MS患者206人。分为MS组和对照组。MS组的体重指数、收缩压、舒张压、TC、TG、FPG、FINS、胰岛素抵抗指数(HOMA指数)均显著高于对照组(P<0.01)。MS组的IMT较对照组增厚(P<0.001)。多元回归分析结果显示FPG、收缩压、舒张压、TG、HDL-C、腰围和HOMA指数均为颈动脉IMT的危险因子(P<0.05)。结论:藏族人群代谢综合征对早期动脉粥样硬化的形成有不利影响。     

C-reactive protein is elevated in obese patients with the metabolic syndrome

C-reactive protein (CRP) is associated with increased risk for cardiovascular disease and diabetes. Few studies have evaluated the importance of CRP in those with the cluster of cardiovascular risk factors known as the metabolic syndrome (MS). We studied 190 overweight subjects (83 men and 107 women), aged 25-75 years, screened for glucose intolerance, in order to assess whether CRP levels vary according to the presence of MS, and to examine the relationship between CRP levels and metabolic variables. The prevalence of the Adult Treatment Panel III MS was 36.8%. Subjects with the MS had a higher degree of insulin resistance (IR), measured by the homeostasis model assessment (HOMA) method (5.4+/-0.4 versus 3.6+/-0.3, p<0.001) and higher frequency of glucose intolerance (78.3% versus 44.4%, p<0.001) than those without the MS. CRP values were increased among those with the MS (4.85+/-0.47 mg/l versus 3.34+/-0.36 mg/l, p<0.05). CRP correlated with waist circumference (r=0.28, p<0.001) and body mass index (r=0.38, p<0.001) in both men and women; however the relationship of CRP with HOMA(IR) was only evident in men (r=0.37, p<0.01) while the association with free fatty acids (FFA) was only significant in women (r=0.20, p<0.05), even after adjusting for age, hispanic ethnicity and glucose tolerance status. Abdominal obesity (elevated waist circumference) was the single most important MS component associated with increased CRP levels (>3mg/dl) (OR=3.1, 95% C.I.: 1.4-10.1), followed by female gender and smoking. These results confirm that CRP levels are elevated in MS subjects at risk for glucose intolerance. In addition waist circumference, HOMA(IR) and FFA levels are associated with CRP levels, suggesting potential roles of obesity, insulin resistance and lipolysis in the development of the subclinical inflammation associated with the MS.