Wu Zhenguo, Cui Huiliang, Li Wei, Zhang Yerui, Liu Li, Liu Zaibao, Zhang Wencheng, Zheng Tengfei, Yang Jianmin
The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China.
Department of Cardiology, People's Hospital of Qihe County, Dezhou, China.
Front Cardiovasc Med. 2022 Jul 29;9:918359. doi: 10.3389/fcvm.2022.918359. eCollection 2022.
Insulin resistance (IR) has emerged as a risk factor for coronary heart disease (CAD), but there is currently insufficient data on the association of non-insulin-based IR indexes [triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) ratio, triglyceride and glucose (TyG) index, and metabolic score for IR (METS-IR)] with the presence and severity of CAD. Thus, the present study aimed to examine the relationship between these three non-insulin-based IR indexes and CAD, as well as to further compare the predictive values of each index.
In total, 802 consecutive patients who underwent coronary angiography for suspected CAD from January 2016 to April 2017 were included in this study and were divided into the control group ( = 149) and CAD group ( = 653) according to the angiography results. The triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, triglyceride and glucose index (TyG index), and METS-IR were calculated according to the corresponding formulas. The severity of CAD was evaluated using the Gensini score (GS). The relationship of the TG/HDL-C ratio, TyG index, and METS-IR with CAD was analyzed, and the predictive values of the indexes were compared.
The TG/HDL-C ratio, TyG index, and METS-IR in the CAD group were significantly higher than those in the control group. The TG/HDL-C ratio and METS-IR in the high GS group were significantly higher than those in the non-high GS group. Multivariate logistic regression analysis showed that the TG/HDL-C ratio and METS-IR were independent predictors for the presence of CAD {adjusted odds ratio (OR) [95% confidence interval (CI)]: 1.32 (1.02-1.70) and 1.65 (1.32-2.05), respectively}, whereas only the METS-IR was an independent predictor of the severity of CAD [adjusted OR (95% CI): 1.22 (1.02-1.47)]. Further subgroup analysis indicated that statistical significance was observed only among men, younger patients (≤ 60), and patients with prediabetes mellitus (PDM). Receiver operator characteristic (ROC) analysis showed that the METS-IR had the highest predictive value for the prediction of both the presence and severity of CAD.
The TG/HDL-C ratio, TyG index, and METS-IR are valuable predictors of the presence and severity of CAD, and the METS-IR has the highest predictive value among the three non-insulin-based IR indexes.
胰岛素抵抗（IR）已成为冠心病（CAD）的一个危险因素，但目前关于非胰岛素型IR指标[甘油三酯（TG）/高密度脂蛋白胆固醇（HDL-C）比值、甘油三酯与葡萄糖（TyG）指数以及IR代谢评分（METS-IR）]与CAD的存在及严重程度之间关联的数据不足。因此，本研究旨在探讨这三个非胰岛素型IR指标与CAD之间的关系，并进一步比较各指标的预测价值。
本研究共纳入了2016年1月至2017年4月因疑似CAD接受冠状动脉造影的802例连续患者，并根据造影结果分为对照组（n = 149）和CAD组（n = 653）。根据相应公式计算甘油三酯与高密度脂蛋白胆固醇（TG/HDL-C）比值、甘油三酯与葡萄糖指数（TyG指数）以及METS-IR。使用Gensini评分（GS）评估CAD的严重程度。分析TG/HDL-C比值、TyG指数和METS-IR与CAD的关系，并比较各指标的预测价值。
CAD组的TG/HDL-C比值、TyG指数和METS-IR显著高于对照组。高GS组的TG/HDL-C比值和METS-IR显著高于非高GS组。多因素逻辑回归分析显示，TG/HDL-C比值和METS-IR是CAD存在的独立预测因素{调整后的比值比（OR）[95%置信区间（CI）]：分别为1.32（1.02 - 1.70）和1.65（1.32 - 2.05）}，而只有METS-IR是CAD严重程度的独立预测因素[调整后的OR（95%CI）：1.22（1.02 - 1.47）]。进一步的亚组分析表明，仅在男性、年轻患者（≤60岁）和糖尿病前期（PDM）患者中观察到统计学意义。受试者工作特征（ROC）分析表明，METS-IR对CAD的存在和严重程度预测具有最高的预测价值。
TG/HDL-C比值、TyG指数和METS-IR是CAD存在和严重程度的有价值预测指标，且METS-IR在三个非胰岛素型IR指标中具有最高的预测价值。
