背景:尽管具有胰岛素增敏和抗动脉粥样硬化的临床效果,但关于脂联素的流行病学调查却有着一些自相矛盾的结果,如脂联素与冠心病之间的关系仍不明了.
目的:我们的目的在于调查脂联素与老年人冠心病之间的关系.
试验的设计,实施和参加者:这个病例-对照研究(n = 1386)的人群来自于心血管健康研究(1992-2001),对照组的年龄,性别,种族,基础心血管疾病和地区均与病例组相匹配
主要结果的检测:出现心绞痛,做经皮血管成型术和非致死性心梗或冠心病死亡被认为发生了冠心病事件.更严格的冠心病终点仅限于非致死性心梗或冠心病死亡.(1级终点与2级终点?)
结果:脂联素与患者基线的肥胖状态,胰岛素抵抗,血脂紊乱,炎症标志物和瘦素无明显的相关.在矫正各种因素如腰臀比,高血压,吸烟,酗酒,低密度脂蛋白,肌酐和瘦素后,我们发现随着脂联素浓度的增高,冠心病事件的风险有一定程度的提高(概率比为1.37,五分之一对座5比1-4?,95%置信区间:1.02-1.84),在发生非致死性心梗或冠心病死亡的人群中,这样的联系更为明显(概率比为1.69,95%置信区间:1.23-2.32).这些结果既与矫正体重的变化,健康状态或胱抑素C,也与矫正其他可能的潜在因素无关.
推论:该研究揭示了脂联素与老年人首发或既往冠心病风险增加之间的关系.我们需要进一步做的工作是研究脂联素可能对冠心病有利和不利方面的机制,以及在不同情况下两者的地位.
Adiponectin and Risk of Coronary Heart Disease in Older Men and Women
Context: Despite established insulin-sensitizing and antiatherogenic preclinical effects, epidemiological investigations of adiponectin have yielded conflicting findings, and its relationship with coronary heart disease (CHD) remains uncertain.
Objective: Our objective was to investigate the relationship between adiponectin and CHD in older adults.
Design, Setting, and Participants: This was a case-control study (n = 1386) nested within the population-based Cardiovascular Health Study from 1992–2001. Controls were frequency-matched to cases by age, sex, race, subclinical cardiovascular disease, and center.
Main Outcome Measures: Incident CHD was defined as angina pectoris, percutaneous or surgical revascularization, nonfatal myocardial infarction (MI), or CHD death. A more restrictive CHD endpoint was limited to nonfatal MI and CHD death.
Results: Adiponectin exhibited significant negative correlations with baseline adiposity, insulin resistance, dyslipidemia, inflammatory markers, and leptin. After controlling for matching factors, adjustment for waist to hip ratio, hypertension, smoking, alcohol, low-density lipoprotein cholesterol, creatinine, and leptin revealed a modestly increased risk of incident CHD with adiponectin concentrations at the upper end [odds ratio = 1.37 (quintile 5 vs. 1–4), 95% confidence interval 1.02–1.84]. This association was stronger when the outcome was limited to nonfatal MI and fatal CHD (odds ratio = 1.69, 95% confidence interval 1.23–2.32). The findings were not influenced by additional adjustment for weight change, health status, or cystatin C, nor were they abolished by adjustment for potential mediators.
Conclusions: This study shows an association between adiponectin and increased risk of first-ever CHD in older adults. Further research is needed to elucidate the basis for the concurrent beneficial and detrimental aspects of this relationship, and under what circumstances one or the other may predominate.
