REVISTA ARGENTINA DE ENDOCRINOLOGÍA Y METABOLISMO
Bonneau G.A.1,2, Fridrich A.2, Pedrozo W.R.1,2, Castillo Rascón M.S.1,2, Albrekt A.L.1,2
La resistencia insulínica es una disminución de la función biológica de la insulina caracterizada por requerir un alto nivel de insulina plasmática para mantener la homeostasis metabólica. Su presencia está asociada con mayor riesgo de enfermedad cardiovascular. Nos propusimos conocer la frecuencia de hiperinsulinemia e insulinorresistencia en empleados del hospital Dr. Ramón Madariaga, correlacionar la insulinorresistencia a través del índice HOMA con edad, presión arterial, obesidad y obesidad abdominal y evaluar su relación con sexo, presión arterial, obesidad y obesidad abdominal. Se estudiaron 170 sujetos de ambos sexos que tenían entre 27 y 74 años de edad, de los cuales 134 fueron de sexo femenino y 36 de sexo masculino. Se obtuvieron datos antropométricos y presión arterial. Se realizó una extracción sanguínea con un ayuno de 12 horas para las determinaciones bioquímicas. Todos los análisis estadísticos se realizaron utilizando el programa Epi-info 2000, con un nivel de confianza del 95 % y un nivel de significación <0.05. Las frecuencias de insulinorresistencia e hiperinsulinemia que se obtuvieron fueron de 7.1 % y 8.2 % respectivamente. El índice HOMA mostró una correlación altamente significativa (p<0.001) para circunferencia de cintura (obesidad abdominal), índice de masa corporal y presión arterial. Cuando evaluamos el comportamiento del índice HOMA entre las diferentes categorías de presión arterial, IMC y circunferencia de cintura, encontramos diferencia significativa (p<0.001), para todos ellos. La valoración de la insulinorresistencia demostró la clara relación existente entre obesidad, obesidad abdominal e hipertensión. Esto permitirá identificar a los individuos con mayor riesgo para las enfermedades cardiovasculares y así poder implementar medidas terapéuticas (dieta, actividad física y/o farmacológicas) para poder retrasarlas o impedirlas, dando a nuestros pacientes una mejor calidad de vida.
According to 2008 data from the Ministry of Public Health of the Province of Misiones, cardiovascular disease is the main cause of mortality in that province, with a proportional mortality ratio of 28.3 %, and with a process known as atherosclerosis as the main responsible factor. Atherosclerosis is a chronic inflammatory process where endothelial dysfunction plays a major role. Insulin resistance (IR), described as a condition in which there is a decrease in the biological function of insulin and high plasma levels of insulin are required to maintain metabolic homeostasis, promotes atherosclerotic development and its presence is associated with an increased risk of cardiovascular disease. Our aim was to determine the frequency of hyperinsulinemia and IR in a group of employees at the Public Provincial Hospital Dr. Ramón Madariaga, to correlate IR with age, blood pressure, general and abdominal obesity and to evaluate our subjects’ performance using the HOMA index. One-hundred and seventy subjects of both genders (134 females and 36 males) with an age range between 27 and 74 years old were studied. Participation in the trial was voluntary and written consent was obtained using an authorization model based on the Declaration of Helsinki. Weight, height and waist circumference data were recorded under WHO standards. Subjects were classified as normal, overweight and obese depending on their Body Mass Index. Blood pressure was measured with a mercury sphygmomanometer and following the American Heart Association recommendations. Blood samples were collected after 8 hours of fasting and glucose was measured by enzymatic colorimetric methods (CV = 2.38 %). Insulin was measured by radioimmunoassay (CV=8 %). The Internal Quality Control was performed with a serum pool prepared in the laboratory, and the External Quality Control was carried out with controls provided by the Argentine Biochemical Foundation. All the statistical analyses were performed using the Epi-info 2000 program, with a confidence interval of 95 % and a significance level <0.05. The frequencies of IR and hyperinsulinemia obtained were 7.1 % and 8.2 %, respectively. The HOMA index showed a highly significant correlation (p<0.001) for waist circumference (abdominal obesity), body mass index (obesity) and blood pressure. When assessing the HOMA index performance, it was found that individuals with abdominal obesity had a higher IR (p<0.001). In addition, the IR index mean value increased with body mass index (p<0.001). Subjects with prehypertension and hypertension showed higher HOMA values as compared to subjects with normal blood pressure (p<0.001), when the evaluation was performed according to the different blood pressure categories. The assessment of insulin resistance showed a clear relationship between obesity, abdominal obesity and hypertension. This assessment will make it possible to identify individuals at increased risk for cardiovascular disease so as to institute therapeutic measures (diet, physical activity and / or pharmacological treatment) to delay or prevent the occurrence of disease, offering our patients a better quality of life.