Асоціація індексів інсулінорезистентності з метаболічними чинниками серцево-судинного ризику у пацієнтів із гіпертонічною хворобою

Abstract

Objective — to identify possible association of insulin resistance (IR) indices with metabolic factors (MF) of cardiovascular risk (CVR) in patients (pts) with essential hypertension (EH).Materials and methods. The prospective study involved 255 patients (123 (48.2 %) women and 132 (51.8 %) men aged 23 to 79 years (the mean age 59.39 ± 1.09 years old) with EH of I — III stages who were examined and undergone treatment in the hospital of the GI «L. T. Mala National Therapy Institute of NAMS of Ukraine» (Kharkiv). Patients were divided into four groups by two IR indices (triglyceride-glucose index (TGGI) and atherogenic index of blood plasma (AIBP)): IR presence was considered at TGGI > 4.82 and AIBP > 0.21, and TGGI 4.82 numbered 121 pts. There were 129 of pts in the group with AIBp 0.21. All the groups were age- and gender-matched. The analysis was performed for such anthropometric parameters as body mass index (BMI), body fat percentage (BFP), total fat mass (TFM), and fat mass index (FMI), calculated with the use of standard formulas. The following parameters were obtained from patients’ medical histories: blood levels of glucose and uric acid (UA), lipid parameters including total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), very-low-density lipoprotein cholesterol (VLDL-C), low-density lipoprotein cholesterol (LDL-C), atherogenity coefficient (AC) and non-HDL-C. The state of lipid transport system and system of lipoprotein lipolysis were additionally estimated by calculation of lipid ratios such as non-HDL-C/TC, TC/HDL-C and TG/HDL-C. The data were analyzed before the drug therapy administration.Results and discussion. It has been established that in patients with atherogenic dyslipidemia, the association of IR indices (TGGI and AIBP) as MF of CVR was implemented via disturbances in the system of lipoprotein lipolysis of TG-containing lipoproteins and in the system of reverse cholesterol transport. This was confirmed by the significant differences of corresponding lipid parameters and lipid ratios (non-HDL-C, AC, TG/HDL-C, TC/HDL-C). The association of TGGI and AIBP with hyperglycemia and changes of UA levels was realized through such MF of CVR as glucose intolerance, type 2 diabetes mellitus and elevated UA levels (predominantly in women). In pts with EH and IR, the TGGI was mostly associated with such MF of CVR as increased BMI due to body fat accumulation, while AIBP was mostly associated with body fat lipolysis that was confirmed by the decreased correlation between BMI and parameters of visceral obesity (BFP, TFM and FMI). Based on the obtained data, level AIBP < 0.21 cannot serve as an accurate lipid index of IR absence due to BMI elevation among the pts with this index and due to a strong correlation between glycemia level and TGGI value (r = 0.653; p < 0.0001).Conclusions. The most significant (in frequency) MF of CVR associated with IR in pts with EH were hyperglycemia, hypercholesterolemia, elevated levels of TG, low HDL-C, hyperuricemia as well as BMI elevation due to body fat depositions and activation of their lipolysis confirmed by correlation analysis.