目前研究顯示左心室肥厚及胰島素抗性與頸動脈內膜中層厚度相關，頸動脈
內膜中層厚度是高血壓 糖尿病及及中高齡族群亞臨床動脈粥樣硬化的指標 但在健康年輕族群中，這種關聯性尚不清楚。因此，本研究旨在釐清台灣陸軍年輕成年軍人其心電圖，心臟超音波檢查參數及各種非胰島素測量胰島素抗性指數與頸動脈內膜中層厚度之間的關聯性。我們紀錄自2018年至2020年，共有1822名18歲至40歲的台灣軍人接受年度健康檢查，其中包括心電圖和心臟超音波檢查。透過高解析度頸部超音波檢查測量左頸動脈球內膜中層厚度。臨床參數紀錄包括各項生理及血液生化檢查。以共變異數分析比較心電圖和心臟超音波參數特徵。另外分別測試四種非胰島素測量胰島素抗性指數(簡稱nIIR):三酸甘油酯濃度糖TyG 指數，三酸甘油酯/高密度脂蛋白比率糖胰島素抗性代謝評分(METS-IR)，以多變量線性迴歸分析來確定相關性。結果顯示心電圖定義的左心室肥厚，右心室肥厚和心率≥75/min的受試者與頸動脈內膜中層厚度≥0.8 mm呈正相關，而心臟超音波檢查左心室肥厚受試者與頸動脈內膜中層厚度≥0.8 mm呈負相關。所有參與者的頸動脈內膜中層厚度和三酸甘油酯之間存在關聯。較好的體適能表現會造成心肌肥厚但可能會降低動脈粥狀硬化的嚴重程度，導致心臟超音波與心電圖檢查結果矛盾 。這項研究表基於心心電圖顯示的三酸甘油酯可作為軍人族群中亞臨床動脈粥狀硬化的良好標誌。另外非胰島素測量下胰島素抗性指數可用心評估肥胖和無高病酸血症的年輕成年人族群頸動脈內膜中層厚度。而以三酸甘油酯為於礎的胰島素抗性指數是年輕族群的頸動脈內膜中層厚度較佳預測工具，可取代胰島素抗性代謝評分(METS-IR)。

Current studies have shown that left ventricular hypertrophy (LVH) and insulin resistance are associated with carotid intima-media thickness (cIMT), which is an indicator of hypertension and subclinical atherosclerosis in middle-aged and elderly people. However, in physically fit young adults, this association is unclear. There are no studies to clarify the association between left ventricular hypertrophy and
atherosclerosis with ultrasound and electrocardiogram (ECG) in young adults. Therefore, this study aimed to examine the association between ECG, cardiac ultrasound parameters and various insulin resistance indices with subclinical
atherosclerosis assessed by carotid intima-media thickness (cIMT) in young adults of the Taiwan Army. A total of 1822 Taiwanese military adults free of diabetes, aged 18
40 years, received an annual health examination including electrocardiography (ECG) and echocardiography in 2018–2020. Left carotid bulb cIMT was measured by high resolution ultrasonography. nIIR indices were assessed by TG concentrations, the TyG index, the TG/high-density lipoprotein cholesterol (HDL-C) ratio, and the metabolic
score for IR (METS-IR). Multiple logistic regression analysis was used to determine the associations between echocardiographic and ECG parameters. Multivariable linear
regression analyses were used to determine the associations between nIIR indices. ECG-based LVH, RVH and heart rate ≥75/min were associated with cIMT ≥0.8 mm, while echocardiographic LVH was inversely associated with cIMT ≥0.8 mm. In the overall participants, there was an association between cIMT and TG. Higher physical
fitness may cause cardiac muscle hypertrophy and reduce the atherosclerosis severity, possibly leading to the paradoxical echocardiographic finding. This study suggests that ECG-based LVH remains a good marker of subclinical atherosclerosis in our military population. This study also highlights that some nIIR indices could be used to assess
cIMT in young adults, particularly for those with obesity and those without hyperuricemia. The TG-based indices instead of the novel marker, METS-IR, are suggestive as stronger predictors of greater cIMT in young adults.

1.Stary HC, et al., A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the committee on vascular
lesions of the council on arteriosclerosis, American heart association. Circulation.; 92: 1355-74.1995
2. Hegele RA. The pathogenesis of atherosclerosis. Clin Chim Acta.; 246: 21-38. 1996
3. Suzuki H., et al., A role for macrophage scavenger receptors in atherosclerosis and susceptibility to infection. Nature; 386: 292-6. 1997
4. Yamada, Y., Doi, T., Hamakubo, T., and Kodama, T. Scavenger receptor family proteins: roles for atherosclerosis, host defence and disorders of the central nervous system. Cell Mol Life Sci; 54: 628- 640. 1998
5.Colles, S.M., Irwin, K.C., and Chisolm, G.M. Roles of multiple oxidized lipids in cellular injury. J. Lipid Res. 1996; 37: 2018-28.
6. Hansson, G.K. Cell-mediated immunity in atherosclerosis. Curr Opin Lipidol; 8: 301-11.1997
7. Ross R. The pathogenesis of atherosclerosis:a perspective for the 1990s. Nature; 362: 801-9.1993
8. Davies, M.J., Richardson, P.D., and Woolf, N. Risk of thrombosis in human atherosclerotic plaques: role of extracellular lipid, macrophage, and smooth muscle
cell content. Br Heart J; 69: 377- 81. 1993
9. Lee R.T., and Libby P. The unstable atheroma. Aterioscler Thromb Vasc Biol; 17: 1859- 67. 1997
10. Steinberg D, et al., Beyond cholesterol. Modifications of low-density lipoprotein that increase its atherogenicity. N Engl J Med; 320: 915-24.1989
11. Chevli, P.A., et al., Association of alcohol consumption and ideal cardiovascular health among South Asians: The mediators of atherosclerosis in south Asians living in
America (MASALA) study.Alcoholism, Clinical and Experimental Research, 44(9), 1825–1833. 2020
12. Lavie, C.J., et al., Sedentary behavior, exercise, and cardiovascular health. Circulation Research, 124(5), 799–815. 2019
13. Lin, G.M., et al., Cardiorespiratory fitness and carotid intima- media thickness in physically active young adults: CHIEF atherosclerosis study. Journal of Clinical Medicine, 11(13), 3653. 2022
14. Lin, G.M., et al., Secondhand to bacco smoke exposure, urine cotinine, and risk of incident atrial fibrillation: The multi-ethnic study of atherosclerosis. Progress in
Cardiovascular Diseases, 74, 38–44. 2022
15. Lin, G. M., et al., Muscular strength and carotid intima-media thickness in physically fit young adults: The CHIEF atherosclerosis study. Journal of Clinical
Medicine, 11(18), 5462. 2022
16. Lin, Y. K., et al., Athlete's heart assessed by sit-up strength exercises in military men and women: The CHIEF heart study. Frontiers in Cardiovascular Medicine, 8,
737607. 2022
17. Pasterkamp G, Falk E, Woutman H, Borst C. Techniques characteri- zing the coronary atherosclerotic plaque: influence on clinical decision making? J Am Coll Cardiol; 36: 13-21.2000
18. Helft G, et al., Atherosclerotic aortic component quantification by noninvasive magnetic resonance imaging: an in vivo study in rabbits. J Am Coll Cardiol; 37: 1149
54. 2001
19. Raggi P. Coronary calcium on electron beam tomography imaging as a surrogate marker of coronary artery disease. Am J Cardiol.; 87: 27A- 34A. 2001
20. Waki HM, et al., Ultrasonic tissue characterization of the atherosclerotic carotid artery: histological correlates or carotid integrated back-scatter. Circ J; 67: 1013-6.
2003
21. Chahal, H., et al., Relation between carotid intima-media thickness and left ventricular mass in type 1 diabetes mellitus from the epidemiology of diabetes interventions and complications [EDIC] study. The American Journal of Cardiology, 110(10), 1534–1540. 2012
22. Kishi, S., et al., Relationship of left ventricular mass to coronary atherosclerosis and myocardial ischaemia: The CORE320 multicenter study.European Heart Journal
Cardiovascular Imaging, 16(2), 166–176. 2015
23. Liao, Y.Y., et al., Risk factors for electrocardiographic left ventricular hypertrophy in a young Chinese general population: The Hanzhong adolescent cohort study. BMC Cardiovascular Disorders,21(1), 159. 2021
24. Meijs, M. F., et al., Relation of common carotid intima-media thickness with left ventricular mass caused by shared risk factors for hypertrophy. Journal of the American Society of Echocardiography, 22(5),499–504. 2009
25.Petersen, M.C.; Shulman, G.I. Mechanisms of insulin action and insulin resistance. Physiol. Rev., 98(4), 2133-2223. 2018
26. Yaribeygi, H., et al., Insulin resistance: Review of the underlying molecular mechanisms. J. Cell. Physiol., 234(6), 8152-8161. 2019
27. Wu, H.; Ballantyne, C.M. Metabolic inflammation and insulin resistance in obesity. Circ. Res., 126(11), 1549-1564. 2020
28.Zhang, X., et al., Correlation between noninsulin-based insulin resistance indices and increased arterial stiffness measured by the cardio–ankle vascular index in nonhypertensive chinese subjects: A cross-sectional study. Front. Cardiovasc. Med., 9, 903307. 2022
29.Khan, S.H., et al., Metabolic clustering of risk factors: Evaluation of Triglycerideglucose index (TyG index) for evaluation of insulin resistance. Diabetol. Metab. Syndr., 10(1), 74. 2018
30. Wen, J., et al., Elevated triglyceride-glucose (TyG) index predicts incidence of Prediabetes: A prospective cohort study in China. Lipids Health Dis., 19(1), 226. 2020
31. Iwani, N.A.K.Z., et al., Triglyceride to HDL-C ratio is associated with insulin resistance in overweight and obese children. Sci. Rep., 7(1), 40055. 2017
32. Bello-Chavolla., et al., METS-IR, a novel score to evaluate insulin sensitivity, is predictive of visceral adiposity and incident type 2 diabetes. Eur. J. Endocrinol., 178(5), 533-544. 2018
33. Aboonabi, A.; Meyer, R.R.; Singh, I. The association between metabolic syndrome components and the development of atherosclerosis.J. Hum. Hypertens., 33(12), 844-855. 2019
34. Liu, P. Y., et al., Athlete's heart in Asian military males: The CHIEF heart study. Frontiers in Cardiovascular Medicine; 8, 725852. 2021
35. Liu, P. Y., et al., Electrocardiographic and cardiometabolic risk markers of left ventricular diastolic dysfunction in physically active adults: CHIEF heart study. Frontiers in Cardiovascular Medicine, 9, 941912. 2022
36. Miao, M., et al., Triglyceride-glucose index and common carotid artery intima
media thickness in patients with ischemic stroke. Cardiovasc. Diabetol., 21(1), 43. 2022
37. Nimkuntod, P.; Tongdee, P. Plasma low-densitylipoprotein choles terol/high-density lipoprotein cholesterol concentration ratio and early marker of carotid artery atherosclerosis. J. Med. Assoc. Thai., 98(Suppl.4), S58-S63. 2015
38. Lin, G.M., et al., Cardiorespiratory fitness and carotid intima–media thickness in physically active young adults: CHIEF atherosclerosis study. J. Clin. Med., 11(13), 3653. 2022
39. Lin, Y. K., et al., Obesity phenotypes and electrocardiographic characteristics in physically active males: CHIEF study. Frontiers in Cardiovascular Medicine, 8,
738575. 2021
40. Lin, G. M., et al., Rationale and design of the cardiorespiratory fitness and hospitalization events in armed forces study in eastern Taiwan. World Journal of
Cardiology, 8(8), 464–471. 2016
41.Lin, G. M., et al., Rationale and design of the cardiorespiratory fitness and hospitalization events in armed forces study in eastern Taiwan. World Journal of Cardiology, 8(8),464–471.2016
42. Lin, G. M., et al., Muscular strength and carotid intima-media thickness in physically fit young adults: The CHIEF atherosclerosis study. Journal of Clinical Medicine, 11(18), 5462. 2022.
43. Lin.Y. K., et al., Athlete's heart assessed by sit-up strength exercises in military men and women: The CHIEF heart study. Frontiers in Cardiovascular Medicine, 8, 737607. 2022
44. Lin, G. M., et al., Secondhand to bacco smoke exposure, urine cotinine, and risk of incident atrial fibrillation: The multi-ethnic study of atherosclerosis. Progress in Cardiovascular Diseases,74,38–44.2022
45. Lin, Y. P., et al., Psychological stress and long-term blood pressure variability of military young males: The cardiorespiratory fitness and hospitalization events in armed forces study. World Journal of Cardiology, 12(12), 626–633.2020
46. Lin, Y. K., et al., Metabolic biomarker sand long-term blood pressure variability in military young male adults. World Journal of Clinical Cases, 8(11),2246–2254. 2020
47.Lin, J.W., et al., Sex-specific association between serum uric acid and elevated alanine aminotransferase in a military cohort: The CHIEF Study. Endocr. Metab. Immune Disord. Drug Targets, 19(3), 333-340. 2019
48. Lin, Y.K., et al., Sex-specific association of hyperuricemia with cardiometabolic abnormalities in a military cohort. Medicine, 99(12), 2020
49.Su, F. Y., et al., A comparison of Cornell and Sokolow- Lyon electrocardiographic criteria for left ventricular hypertrophy in a military male population in Taiwan: The cardiorespiratory fitness and hospItalization events in armed forces study. Cardiovascular Diagnosis and Therapy, 7(3), 244–251. 2017.
50. Su, F. Y., et al., Comparisons of traditional electrocardiographic criteria for left and right ventricular Hypertrophy in young Asian women: The CHIEF heart study.
Medicine (Baltimore), 99(42), e22836. 2020
51. Myers, G. B., Klein, H. A., & Stofer, B. E. The Electrocardiographic diagnosis of right ventricular hypertrophy. American Heart Journal, 35(1),1–40. 1948
52. Sokolow, M., & Lyon, T. P. The ventricular complex in right ventricular hypertrophy as obtained by unipolar precordial and limb leads. American Heart Journal, 38(2), 273–294. 1949
53. Alpert, M. A., & Munuswamy, K. Electrocardiographic diagnosis of left atrial enlargement. Archives of Internal Medicine, 149(5), 1161– 1165. 1989
54. Lévy, S. Diagnostic approach to cardiac arrhythmias. Journal of Cardiovascular Pharmacology, 17(Suppl 6), S24–S31. 1991
55. Lang, R. M., et al., Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography, 28(1), 1– 39. 2015
56. Devereux, R. B., et al., Electrocardiographic detection of left ventricular hypertrophy using echocardiographic determination of left ventricular mass as the
reference standard. Comparison of standard criteria, computer diagnosis and physician interpretation. Journal of the American College of Cardiology, 3, 82–87. 1984
57. Meng, F. C., et al., Association between electrocardiographic and echocardiographic right ventricular hypertrophy in a military cohort in Taiwan: The CHIEF study: ECG criteria for RVH. Indian Heart Journal, 69, 331–333. 2017
58. Meijs, M.F., et. al. Relation of common carotid intima-media thickness with left
ventricular mass caused by shared risk factors for hypertrophy. Journal of the American Society of Echocardiography, 22(5), 499–504. 2009
59. Liao, Y. Y., et al., Risk factors for electrocardiographic left ventricular hypertrophy in a young Chinese general population: The Hanzhong adolescent cohort study. BMC Cardiovascular Disorders, 21(1), 159. 2021
60. Tsai, K. Z., et al., Sex-specific cardiometabolic risk markers of left ventricular mass in physically active young adults: The CHIEF heart study. Scientific Reports, 12(1), 11536. 2022
61. Cao, X., et al., Interrelations between hypertension and Electrocardiographic left ventricular hypertrophy and their associations with cardiovascular mortality. The American Journal of Cardiology, 123(2), 2 7 4–2 8 3(2019).
62. Lehtonen, A. O., et al., Association between self- reported hypertension onset age and electrocardiographic left ventricular hypertrophy. Journal of Human Hypertension, 35(5), 479–482. 2021
63.Cuspidi, C., et al., Prevalence and clinical correlates of right ventricular hypertrophy in essential hypertension. Journal ofHypertension, 27(4), 854–860. 2009
64.Cuspidi, C., et al., Hypertension of the Italian Society of Hypertension. Right ventricular hypertrophy in systemic hypertension: An updated review of Clinical studies. Journal of Hypertension, 31(5), 858–865. 2013
65. Chao, W. H., et al., Association of electrocardiographic left and right ventricular hypertrophy with physical fitness of military males: The CHIEF study. European Journal of Sport Science, 19(9), 1214–1220. 2019
66.艾嵐婕: 評估兩種胰島素阻抗生化指標相關性：TyG與HOMA-IR之比較。碩士論文，國立陽基交通大學，民國111年7月。
67. Lin, G.M., et al., Cardiorespiratory fitness and carotid intima–media thickness in physically active young adults: CHIEF atherosclerosis study. J. Clin. Med., 11(13), 3653. 2022
68. Labreuche, J., et al., Association between change in plasma triglyceride levels and risk of stroke and carotid atherosclerosis. Atherosclerosis, 212(1), 9-15. 2010
69. Eikendal, A.L.M., et al., Common carotid intima-media thickness relates to cardiovascular events in adults aged <45 years. Hypertension, 65(4), 707-713. 2015
70. de Giorgis, T., et al., Triglycerides-to-HDL ratio as a new marker of endothelial dysfunction in obese prepubertal children. Eur. J. Endocrinol., 170(2), 173-180. 2014
71. Li, X., et al., Triglyceride to high-density lipoprotein cholesterol ratio and carotid intimamedial thickness in Chinese adolescents with newly diagnosed type 2 diabetes mellitus. Pediatr. Diabetes, 17(2), 87-92. 2016
72. Pacifico, L., et al., Association of serum triglyceride-to-HDL cholesterol ratio with carotid artery intima-media thickness, insulin resistance and nonalcoholic fatty liver disease in children and adolescents. Nutr. Metab. Cardiovasc. Dis., 24(7), 737-743. 2014
73. Miao, M., et al., Triglyceride-glucose index and common carotid artery intimamedia thickness in patients with ischemic stroke. Cardiovasc. Diabetol., 21(1), 43. 2022
74. Su, W., et al., Metabolic Score for Insulin Resistance, a novel score to evaluate insulin sensitivity, is associated with the urinary albumin‐to‐creatinine ratio in Chinese adults: A cross‐sectional reaction study. J. Diabetes Investig., 13(7), 12221234. 2022
75. Yoon, J., et al., The metabolic score for insulin resistance (METS-IR) as a predictor of incident ischemic heart disease: A longitudinal study among Korean without diabetes. J. Pers. Med., 11(8), 742. 2021
76. Lin, G.M., et al., Cardiorespiratory fitness and carotid intima–media thickness in physically active young adults: CHIEF atherosclerosis study. J. Clin. Med., 11(13), 3653. 2022
77. Borrayo, G., et al., TG/HDL-C ratio as cardio-metabolic biomarker even in normal weight women. Acta Endocrinol., 14(2),261-267. 2018.
78. Jia, X., et al., Association between triglyceride glucose index and carotid intimamedia thickness in obese and nonobese adults. J. Diabetes, 14(9), 596-605. 2022.
79. Teng, F., et al., Interaction between serum uric acid and triglycerides in relation to blood pressure. J. Hum. Hypertens., 25(11), 686-691. 2011.