代谢评分中胰岛素抵抗指数变化对中国中老年人群中风风险预测的作用

Changes in the metabolic score for insulin resistance index for risk prediction of stroke in middle-aged and older Chinese population.

作者信息

Wang Tingting, Yi Zhiheng, Tan Yuhan, Huang Yangshen, Li Tengli, Gao Shan, Wu Yaoling, Zhuang Weiduan, Guo Shaowei

机构信息

Department of Neurology, the First Affiliated Hospital of Shantou University Medical College, Shantou, China.

Shantou University Medical College, Shantou, China.

出版信息

EPMA J. 2024 Nov 19;15(4):599-610. doi: 10.1007/s13167-024-00388-y. eCollection 2024 Dec.

DOI:10.1007/s13167-024-00388-y

PMID:39635019

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11612103/

Abstract

BACKGROUND

As a major noncommunicable disease, stroke poses a major threat to public health. In the context of predictive, preventative, and personalised medicine (PPPM/3PM), early identification of high-risk individuals is crucial for targeted prevention and personalised treatment for stroke. This study aimed to investigate the association between changes in the Metabolic Score for Insulin Resistance Index (METS-IR) and incident stroke. From the perspective of PPPM/3PM, we hypothesised that monitoring dynamic changes of the METs-IR levels and targeting cumulative METs-IR index contribute to risk prediction, targeted prevention, and personalised management of stroke.

METHODS

All data were obtained from the China Health and Retirement Longitudinal Study (CHARLS), a nationwide prospective cohort study. The individuals were categorised into four subgroups based on the quartiles (Q) of the cumulative METS-IR index as a reflection of changes in the METS-IR values from 2012 to 2015. Logistic regression was employed to examine the association between cumulative METS-IR index and stroke incidence. Additionally, restricted cubic spline regression analysis was used to assess potential linearity.

RESULTS

Among the 4288 participants, 275 (6.4%) experienced a stroke. The risk of stroke events increased with higher cumulative METS-IR index levels. Compared with the lowest quartile (Q1), the OR of having a stroke was 1.20 (0.81, 1.78) for Q2, 1.51 (1.04, 2.21) for Q3 and 2.17 (1.52, 3.10) for the highest quartile (Q4). After adjusting for multiple potential confounders, Q4 (OR: 1.57, 95% CI: 1.04, 2.35) remained significantly associated with stroke. The association between the cumulative METS-IR index and stroke incidence was linear in males, females, and the overall population (all values for nonlinearity > 0.05).

CONCLUSIONS

A higher cumulative METS-IR index was associated with an increased risk of incident stroke among middle-aged and older Chinese individuals. In the context of PPPM/3PM, incorporating metabolic health into stroke risk assessment advances the prediction, prevention and personalised management of stroke.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s13167-024-00388-y.

摘要

背景

作为一种主要的非传染性疾病，中风对公众健康构成重大威胁。在预测、预防和个性化医疗（PPPM/3PM）的背景下，早期识别高危个体对于中风的针对性预防和个性化治疗至关重要。本研究旨在调查胰岛素抵抗指数代谢评分（METS-IR）变化与中风事件之间的关联。从PPPM/3PM的角度出发，我们假设监测METS-IR水平的动态变化并以累积METS-IR指数为目标有助于中风的风险预测、针对性预防和个性化管理。

方法

所有数据均来自中国健康与养老追踪调查（CHARLS），这是一项全国性的前瞻性队列研究。根据累积METS-IR指数的四分位数（Q）将个体分为四个亚组，以反映2012年至2015年期间METS-IR值的变化。采用逻辑回归分析累积METS-IR指数与中风发病率之间的关联。此外，使用受限立方样条回归分析来评估潜在的线性关系。

结果

在4288名参与者中，275人（6.4%）发生了中风。中风事件的风险随着累积METS-IR指数水平的升高而增加。与最低四分位数（Q1）相比，Q2发生中风的比值比（OR）为1.20（0.81，1.78），Q3为1.51（1.04，2.21），最高四分位数（Q4）为2.17（1.52，3.10）。在调整多个潜在混杂因素后，Q4（OR：1.57，95%置信区间：1.04，2.35）仍与中风显著相关。累积METS-IR指数与中风发病率之间的关联在男性、女性和总体人群中呈线性（所有非线性检验P值>0.05）。