Zhou You, Xie Yingli, Du Laijing, Dong Jingjing, He Kunlun
School of Medicine, Nankai University, No.94 Weijin Road, Nankai District, Tianjin, 300071, China.
The First Affiliated Hospital and Clinical Medicine College, Henan University of Science and Technology, Luoyang, 471003, China.
Diabetol Metab Syndr. 2024 Sep 11;16(1):220. doi: 10.1186/s13098-024-01463-0.
The metabolic score for insulin resistance (METS-IR) has been validated as a novel, simple, and reliable surrogate marker for insulin resistance; however, its utility for evaluating the prognosis of heart failure with preserved ejection fraction (HFpEF) remains to be elucidated. Therefore, we aimed to analyze the association between METS-IR and the long-term prognosis of HFpEF.
We enrolled a total of 4,702 participants with HFpEF in this study. The participants were divided into three groups according to METS-IR tertiles: (Ln [2 × fasting plasma glucose + fasting triglycerides] × body mass index) / (Ln [high-density lipoprotein cholesterol]). The occurrence of primary endpoints, including all-cause mortality and cardiovascular (CV) death, was documented.
There were 3,248 participants with HFpEF (mean age, 65.7 ± 13.8 years; male, 59.0%) in total who were included in the final analysis. The incidence of primary outcomes from the lowest to the highest METS-IR tertiles were 46.92, 86.01, and 124.04 per 1000 person-years for all-cause death and 26.75, 49.01, and 64.62 per 1000 person-years for CV death. The multivariate Cox hazards regression analysis revealed hazard ratios for all-cause and CV deaths of 2.48 (95% CI 2.10-2.93; P < 0.001) and 2.29 (95% CI 1.83-2.87; P < 0.001) when the highest and lowest METS-IR tertiles were compared, respectively. In addition, the predictive efficacy of METS-IR remained significant across various comorbidity subgroups (all P < 0.05). Further, adding the METS-IR to the baseline risk model for all-cause death improved the C-statistic value (0.690 for the baseline model vs. 0.729 for the baseline model + METS-IR, P < 0.01), the integrated discrimination improvement value (0.061, P < 0.01), the net reclassification improvement value (0.491, P < 0.01), and the clinical net benefit.
An elevated METS-IR, which is associated with an increased mortality risk, is a potential valuable prognostic marker for individuals with HFpEF.
胰岛素抵抗代谢评分（METS-IR）已被确认为一种用于评估胰岛素抵抗的新型、简单且可靠的替代指标；然而，其在评估射血分数保留的心力衰竭（HFpEF）预后方面的作用仍有待阐明。因此，我们旨在分析METS-IR与HFpEF患者长期预后之间的关联。
本研究共纳入4702例HFpEF患者。根据METS-IR三分位数将患者分为三组：（Ln[2×空腹血糖+空腹甘油三酯]×体重指数）/（Ln[高密度脂蛋白胆固醇]）。记录主要终点事件的发生情况，包括全因死亡率和心血管（CV）死亡率。
最终分析共纳入3248例HFpEF患者（平均年龄65.7±13.8岁；男性占59.0%）。从最低到最高METS-IR三分位数组，全因死亡的年发生率分别为每1000人年46.92、86.01和124.04例，CV死亡的年发生率分别为每1000人年26.75、49.01和64.62例。多因素Cox风险回归分析显示，最高与最低METS-IR三分位数组相比，全因死亡和CV死亡的风险比分别为2.48（95%CI 2.10-2.93；P<0.001）和2.29（95%CI 1.83-2.87；P<0.001）。此外，在各种合并症亚组中，METS-IR的预测效能均保持显著（所有P<0.05）。进一步分析发现，将METS-IR纳入全因死亡的基线风险模型可提高C统计量值（基线模型为0.690，基线模型+METS-IR为0.729，P<0.01）、综合判别改善值（0.061，P<0.01）、净重新分类改善值（0.49l，P<0.01）以及临床净获益。
METS-IR升高与死亡风险增加相关，是HFpEF患者潜在的有价值的预后标志物。
