Moshkovits Yonatan, Goldman Adam, Chetrit Angela, Moshkovitz Shrem Hadar, Dankner Rachel
Department of Internal Medicine F, Sheba Medical Center, Ramat-Gan, Israel.
School of Medicine, Faculty of Medicine, Tel-Aviv University, Tel‑Aviv, Israel.
Cardiovasc Diabetol. 2024 Dec 18;23(1):438. doi: 10.1186/s12933-024-02533-3.
A direct comparison between glycemic-based and lipid-based insulin sensitivity indices (ISIs) for ECG findings and all-cause and cardiovascular mortality is lacking.
963 community-dwelling older adults, examined as part of the third phase of the Glucose intolerance, Obesity, and Hypertension study between 1999 and 2008, were followed until December 2016 and December 2019 for cardiovascular and all-cause mortality, respectively. Eleven different ISIs were calculated and evaluated against ECG findings, all-cause, and cardiovascular mortality with multivariable regression models. The area under the receiver operating curve (AUC) and net reclassification improvement (NRI) analysis were implemented to compare ISIs performance.
Mean age was 72.3 ± 7 years and 471 (49%) were females. Ischemic ECG changes were observed in 107 (11.2%) individuals. Upper quartile (Q) of triglyceride-glucose waist-to-height ratio (TyG-WTHR) was associated with 220% greater odds for ischemic changes on ECG compared with lower quartiles (Q) (95%CI:1.3-3.7, p = 0.004), an association that was not observed with other ISIs. During a median follow-up of 13 [IQR-8] and 11 [IQR-6] years for all-cause and CV mortality, respectively, 466 (48.4%) participants died, of them, 179 (38.4%) were attributed to cardiovascular causes. TyG-WTHR was the only ISI that was associated with both all-cause (HR = 1.3, 95%CI:1.0-1.6, p = 0.04) and cardiovascular (HR = 1.7, 95%CI:1.2-2.4, p = 0.004) mortality. Lipid based and glycemic ISIs showed similar predicative ability with slightly better predictive performance for TyG-WTHR for all-cause mortality (AUC = 0.46, 95%CI:0.4-0.5, p = 0.02). The NRI analysis revealed better reclassification ability for triglyceride-high-density-lipoprotein ratio (95%CI: 0.02-0.27, p = 0.03) and TyG-WTHR (95%CI: 0.0004-0.01, p = 0.03) for all-cause mortality while TyG-WTHR-based model correctly reclassified 19% of participants (95%CI: 0.02-0.36, p = 0.03) for cardiovascular mortality compared with model unadjusted for any ISIs and correctly reclassified 3% (95%CI:0.003-0.05, p = 0.02) compared with QUICKI based-model for all-cause mortality.
TyG-WTHR was the only ISI associated with ischemic changes on ECG and all-cause and cardiovascular mortality and significantly improved the predictive performance for all-cause cardiovascular mortality. While most glycemic-based and lipid-based ISIs showed similar predictive ability, TyG-WTHR stands as the preferred ISI and should be considered for screening at-risk individuals for cardiovascular morbidity and mortality.
缺乏基于血糖和基于血脂的胰岛素敏感性指数（ISI）与心电图表现、全因死亡率和心血管死亡率之间的直接比较。
963名社区居住的老年人作为葡萄糖不耐受、肥胖和高血压研究第三阶段的一部分，于1999年至2008年接受检查，并分别随访至2016年12月和2019年12月以了解心血管和全因死亡率。计算了11种不同的ISI，并通过多变量回归模型针对心电图表现、全因死亡率和心血管死亡率进行评估。采用受试者工作特征曲线下面积（AUC）和净重新分类改善（NRI）分析来比较ISI的性能。
平均年龄为72.3±7岁，471名（49%）为女性。107名（11.2%）个体观察到缺血性心电图改变。与较低四分位数（Q）相比，甘油三酯 - 葡萄糖腰高比（TyG - WTHR）的上四分位数（Q）与心电图缺血性改变的几率高220%相关（95%CI：1.3 - 3.7，p = 0.004），其他ISI未观察到这种关联。在全因死亡率和心血管死亡率的中位随访期分别为13[IQR - 8]年和11[IQR - 6]年期间，466名（48.4%）参与者死亡，其中179名（38.4%）归因于心血管原因。TyG - WTHR是唯一与全因死亡率（HR = 1.3，95%CI：1.0 - 1.6，p = 0.04）和心血管死亡率（HR = 1.7，95%CI：1.2 - 2.4，p = 0.004）均相关的ISI。基于血脂和基于血糖的ISI显示出相似的预测能力，TyG - WTHR对全因死亡率的预测性能略好（AUC = 0.46，95%CI：0.4 - 0.5，p = 0.02）。NRI分析显示，甘油三酯 - 高密度脂蛋白比值（95%CI：0.02 - 0.27，p = 0.03）和TyG - WTHR（95%CI：0.0004 - 0.01，p = 0.03）对全因死亡率具有更好的重新分类能力，而基于TyG - WTHR的模型与未针对任何ISI进行调整的模型相比，正确重新分类了19%的心血管死亡率参与者（95%CI：0.02 - 0.36，p = 0.03），与基于QUICKI的全因死亡率模型相比正确重新分类了3%（95%CI：0.003 - 0.05，p = 0.02）。
TyG - WTHR是唯一与心电图缺血性改变、全因死亡率和心血管死亡率相关的ISI，并显著提高了全因心血管死亡率的预测性能。虽然大多数基于血糖和基于血脂的ISI显示出相似的预测能力，但TyG - WTHR是首选的ISI，应考虑用于筛查心血管发病和死亡的高危个体。
