冠心病和高血压患者不同胰岛素抵抗替代物与全因死亡率的关系：NHANES 纵向队列研究。

Association between different insulin resistance surrogates and all-cause mortality in patients with coronary heart disease and hypertension: NHANES longitudinal cohort study.

机构信息

Department of Cardiovascular Diseases, Guang 'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.

College of Management, Fudan University, Shanghai, China.

出版信息

Cardiovasc Diabetol. 2024 Feb 28;23(1):86. doi: 10.1186/s12933-024-02173-7.

DOI:10.1186/s12933-024-02173-7

PMID:38419039

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10903030/

Abstract

BACKGROUND

Studies on the relationship between insulin resistance (IR) surrogates and long-term all-cause mortality in patients with coronary heart disease (CHD) and hypertension are lacking. This study aimed to explore the relationship between different IR surrogates and all-cause mortality and identify valuable predictors of survival status in this population.

METHODS

The data came from the National Health and Nutrition Examination Survey (NHANES 2001-2018) and National Death Index (NDI). Multivariate Cox regression and restricted cubic splines (RCS) were performed to evaluate the relationship between homeostatic model assessment of IR (HOMA-IR), triglyceride glucose index (TyG index), triglyceride glucose-body mass index (TyG-BMI index) and all-cause mortality. The recursive algorithm was conducted to calculate inflection points when segmenting effects were found. Then, segmented Kaplan-Meier analysis, LogRank tests, and multivariable Cox regression were carried out. Receiver operating characteristic (ROC) and calibration curves were drawn to evaluate the differentiation and accuracy of IR surrogates in predicting the all-cause mortality. Stratified analysis and interaction tests were conducted according to age, gender, diabetes, cancer, hypoglycemic and lipid-lowering drug use.

RESULTS

1126 participants were included in the study. During the median follow-up of 76 months, 455 participants died. RCS showed that HOMA-IR had a segmented effect on all-cause mortality. 3.59 was a statistically significant inflection point. When the HOMA-IR was less than 3.59, it was negatively associated with all-cause mortality [HR = 0.87,95%CI (0.78, 0.97)]. Conversely, when the HOMA-IR was greater than 3.59, it was positively associated with all-cause mortality [HR = 1.03,95%CI (1.00, 1.05)]. ROC and calibration curves indicated that HOMA-IR was a reliable predictor of survival status (area under curve = 0,812). No interactions between HOMA-IR and stratified variables were found.

CONCLUSION

The relationship between HOMA-IR and all-cause mortality was U-shaped in patients with CHD and hypertension. HOMA-IR was a reliable predictor of all-cause mortality in this population.

摘要

背景

关于胰岛素抵抗（IR）替代物与冠心病（CHD）和高血压患者长期全因死亡率之间的关系的研究较少。本研究旨在探讨不同 IR 替代物与全因死亡率之间的关系，并确定该人群生存状况的有价值预测指标。

方法

数据来自国家健康和营养检查调查（NHANES 2001-2018）和国家死亡指数（NDI）。多变量 Cox 回归和限制性立方样条（RCS）用于评估稳态模型评估的 IR（HOMA-IR）、甘油三酯葡萄糖指数（TyG 指数）、甘油三酯葡萄糖-体重指数（TyG-BMI 指数）与全因死亡率之间的关系。当发现分段效应时，使用递归算法计算拐点。然后进行分段 Kaplan-Meier 分析、LogRank 检验和多变量 Cox 回归。绘制受试者工作特征（ROC）和校准曲线，以评估 IR 替代物预测全因死亡率的区分度和准确性。根据年龄、性别、糖尿病、癌症、使用降血糖和降脂药物进行分层分析和交互检验。

结果

研究纳入 1126 名参与者。在中位数为 76 个月的随访期间，有 455 名参与者死亡。RCS 显示 HOMA-IR 对全因死亡率有分段效应。3.59 是一个具有统计学意义的拐点。当 HOMA-IR 小于 3.59 时，它与全因死亡率呈负相关[HR=0.87，95%CI（0.78，0.97）]。相反，当 HOMA-IR 大于 3.59 时，它与全因死亡率呈正相关[HR=1.03，95%CI（1.00，1.05）]。ROC 和校准曲线表明 HOMA-IR 是生存状况的可靠预测指标（曲线下面积=0.812）。未发现 HOMA-IR 与分层变量之间存在交互作用。