Xing Zailing, Schocken Douglas D, Zgibor Janice C, Alman Amy C
College of Public Health, University of South Florida, Tampa, FL, USA.
School of Medicine, Duke University, Durham, NC, USA.
Endocrine. 2025 Feb;87(2):530-542. doi: 10.1007/s12020-024-04037-2. Epub 2024 Sep 18.
In nondiabetic people, the long-term effects of insulin resistance (IR) on heart failure (HF) and all-cause mortality have not been studied.
To examine the association between IR trajectories and incident HF and all-cause mortality in a nondiabetic population.
We studied 7835 nondiabetic participants from the Atherosclerosis Risk in Communities (ARIC) Study. We estimated IR with several methods: Homeostatic Model Assessment-Insulin Resistance (HOMA-IR), triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C), triglyceride glucose Index (TyG Index), and metabolic score for insulin resistance (METS-IR). The latent class analysis identified two trajectories for HOMA-IR ('low level' and 'high level'), and three trajectories for TG/HDL-C, TyG index, and METS-IR ('low level', 'moderate level', and 'high level'). Cox proportional hazard models were employed to examine the association.
Participants in the 'high level' group of HOMA-IR trajectory patterns were more likely to have incident HF and all-cause mortality with HRs (95% CIs) of 1.29 (1.11-1.50) and 1.31(1.19-1.44), respectively, compared to the 'low level' group. Similarly, participants in the 'moderate level' and 'high level' groups of TG/HDL-C, TyG index, and METS-IR trajectories had elevated risks of incident HF and all-cause mortality. However, no increased risk was found for all-cause mortality for men in the 'moderate level' and 'high level' group of TG/HDL-C, TyG index, and METS-IR relative to the 'low level' group.
Long-term moderate and high IR levels were positively associated with increased risks of incident HF for both males and females. For all-cause mortality, however, consistent associations were found only in women.
在非糖尿病患者中，胰岛素抵抗（IR）对心力衰竭（HF）和全因死亡率的长期影响尚未得到研究。
研究非糖尿病人群中IR轨迹与HF发病及全因死亡率之间的关联。
我们对社区动脉粥样硬化风险（ARIC）研究中的7835名非糖尿病参与者进行了研究。我们用几种方法评估IR：稳态模型评估-胰岛素抵抗（HOMA-IR）、甘油三酯与高密度脂蛋白胆固醇比值（TG/HDL-C）、甘油三酯葡萄糖指数（TyG指数）以及胰岛素抵抗代谢评分（METS-IR）。潜在类别分析确定了HOMA-IR的两种轨迹（“低水平”和“高水平”），以及TG/HDL-C、TyG指数和METS-IR的三种轨迹（“低水平”、“中等水平”和“高水平”）。采用Cox比例风险模型来研究这种关联。
与“低水平”组相比，HOMA-IR轨迹模式“高水平”组的参与者发生HF和全因死亡的可能性更高，风险比（HR）（95%置信区间）分别为1.29（1.11 - 1.50）和1.31（1.19 - 1.44）。同样，TG/HDL-C、TyG指数和METS-IR轨迹“中等水平”和“高水平”组的参与者发生HF和全因死亡的风险升高。然而，TG/HDL-C、TyG指数和METS-IR“中等水平”和“高水平”组的男性相对于“低水平”组，全因死亡率没有发现增加的风险。
长期中等和高水平的IR与男性和女性发生HF风险增加呈正相关。然而，对于全因死亡率，仅在女性中发现了一致的关联。
