Li Yan, Li Huijuan, Chen Xiaoyu, Liang Xueyan
Department of Clinical Pharmacy, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China.
Phase 1 Clinical Trial Laboratory, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China.
Front Endocrinol (Lausanne). 2024 Nov 22;15:1483468. doi: 10.3389/fendo.2024.1483468. eCollection 2024.
The estimated glucose disposal rate (eGDR), triglyceride glucose (TyG), triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, and metabolic score for insulin resistance (METS-IR) are dependent indicators of insulin resistance (IR). We aimed to evaluate the association between these indicators and the current or feature incidence of cardiovascular disease (CVD) in middle-aged and elderly individuals. This study tests the hypothesis that IR indices positively or negatively correlate with CVD, and that the potential predictive performance of the IR indices was not the same.
Middle-aged and elderly individuals from the National Health and Nutrition Examination Survey (NHANES) and the China Health and Retirement Longitudinal Study (CHARLS) with complete data on eGDR, TyG, TG/HDL-C, and METS-IR at baseline were obtained. The association between the four indices and CVD was evaluated using multivariate logistic regression analysis. In addition, an adjusted restricted cubic spline (RCS) was applied. Finally, the potential predictive performance of the IR indices was assessed using receiver operating characteristic (ROC) curves.
We included 7,220 participants (mean age: 61.9 ± 10.7 years; 54.0% male) from the NHANES cohort and 6,426 participants (mean age: 57.9 ± 8.4 years; 45.2% male) from the CHARLS cohort in the study. Multivariate logistic regression analysis indicated that a decreasing eGDR significantly increased the incidence of CVD both presently and in the future. Similarly, a higher TyG level and METS-IR were significantly associated with a higher incidence of CVD at both timeframes. However, the TG/HDL-C ratio was not significantly associated with CVD, heart disease, or stroke. No significant interactions were observed between the continuous or quartile variables of eGDR, TyG, TG/HDL-C, or METS-IR, and the incidence of various endpoints across most subgroups. The ROC curve indicated the superior predictive performance of the IR indices. Furthermore, the eGDR was superior to other IR indices for the prediction of CVD both at present and in the future in middle-aged and elderly individuals.
As continuous variables, eGDR, TyG, and METS-IR were significantly associated with the incidence of CVD, both currently and in the future, among middle-aged and elderly individuals. Notably, incorporating eGDR, TyG, or METS-IR and the basic model significantly increased the predictive value for CVD. Among these indices, the eGDR index stands out as the most promising parameter for predicting CVD, both at present and in the future.
估计的葡萄糖处置率（eGDR）、甘油三酯葡萄糖（TyG）、甘油三酯与高密度脂蛋白胆固醇之比（TG/HDL-C）以及胰岛素抵抗代谢评分（METS-IR）是胰岛素抵抗（IR）的相关指标。我们旨在评估这些指标与中老年人心血管疾病（CVD）的当前或未来发病率之间的关联。本研究检验以下假设：IR指标与CVD呈正相关或负相关，且IR指标的潜在预测性能不尽相同。
从美国国家健康与营养检查调查（NHANES）和中国健康与养老追踪调查（CHARLS）中获取在基线时具有完整eGDR、TyG、TG/HDL-C和METS-IR数据的中老年个体。使用多因素逻辑回归分析评估这四个指标与CVD之间的关联。此外，应用了调整后的受限立方样条（RCS）。最后，使用受试者工作特征（ROC）曲线评估IR指标的潜在预测性能。
本研究纳入了NHANES队列的7220名参与者（平均年龄：61.9±10.7岁；男性占54.0%）和CHARLS队列的6426名参与者（平均年龄：57.9±8.4岁；男性占45.2%）。多因素逻辑回归分析表明，eGDR降低会显著增加CVD目前及未来的发病率。同样，较高的TyG水平和METS-IR在两个时间点均与较高的CVD发病率显著相关。然而，TG/HDL-C比值与CVD、心脏病或中风无显著关联。在大多数亚组中，eGDR、TyG、TG/HDL-C或METS-IR的连续变量或四分位数变量与各种终点事件的发病率之间未观察到显著的相互作用。ROC曲线表明IR指标具有卓越的预测性能。此外，在预测中老年个体当前及未来的CVD方面，eGDR优于其他IR指标。
作为连续变量，eGDR、TyG和METS-IR与中老年个体当前及未来的CVD发病率均显著相关。值得注意的是，纳入eGDR、TyG或METS-IR以及基本模型可显著提高对CVD的预测价值。在这些指标中，eGDR指数是目前及未来预测CVD最具前景的参数。
