估计的葡萄糖处置率的预测价值及其与心肌梗死、心力衰竭、心房颤动和缺血性中风的关联。

The predictive value of estimated glucose disposal rate and its association with myocardial infarction, heart failure, atrial fibrillation and ischemic stroke.

作者信息

Huang Hao, Xiong Yan, Zhou Jie, Tang Yijia, Chen Fuli, Li Gang, Huang Hui, Zhou Long

机构信息

Department of Cardiology & Institute of Cardiovascular Diseases, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.

出版信息

Diabetes Obes Metab. 2025 Mar;27(3):1359-1368. doi: 10.1111/dom.16132. Epub 2025 Jan 2.

DOI:10.1111/dom.16132

PMID:39743837

Abstract

AIMS

The relationship between the incidence of major cardiovascular diseases (CVDs) and estimated glucose disposal rate (eGDR), a proxy measurement for insulin resistance (IR), is not well understood in the general population. The predictive value of eGDR and other proxies of IR for CVD incidents have not been examined in previous studies. This study aimed to investigate the association between eGDR and various CVD events, including myocardial infarction (MI), heart failure (HF), atrial fibrillation (AF) and ischemic stroke. Additionally, the predictive values of eGDR, triglyceride-glucose (TyG) index, TyG-waist circumference (WC), TyG-body mass index (BMI), TyG-waist-to-height ratio (WHtR), triglyceride (TG)-to-high density lipoprotein cholesterol (HDL-C) ratio (TG/HDL-C) and the metabolic score for insulin resistance (METS-IR) for CVD events were compared.

METHODS

The study population was extracted from the UK Biobank, and the CVD events were documented by linking to hospital records. Cox proportional hazards model and the restricted cubic spline model were used to assess the association between eGDR and the risk of CVDs with adjustment for potential confounders. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to compare the predictive values of eGDR, TyG, TyG-WC, TyG-BMI, TyG-WHtR, TG/HDL-C and METS-IR.

RESULTS

A total of 360 953 participants were included in this study. During a median follow-up of 13.8 years, 12 698 MI, 10 360 HF, 23 638 AF and 6512 ischemic stroke events were documented. Compared with participants in the lowest quartile category of eGDR, those in the highest quartile category had the adjusted hazard ratio (HR) and 95% confidence interval (CI) of 0.59 (0.51-0.67) for MI, 0.66 (0.56-0.76) for HF, 0.88 (0.80-0.98) for AF and 0.73 (0.61-0.89) for ischemic stroke. eGDR outperformed TyG, TyG-WC, TyG-BMI, TyG-WHtR, TG/HDL-C and METS-IR in terms of predicting MI (AUC: 0.661), HF (AUC: 0.690), AF (AUC: 0.653) and ischemic stroke (AUC: 0.646).

CONCLUSIONS

eGDR was inversely associated with the incidence of MI, HF, AF and ischemic stroke in the general population. eGDR could serve as a more valuable predictive indicator than TyG, TyG-WC, TyG-BMI, TyG-WHtR, TG/HDL-C and METS-IR for CVD events in clinical practice.

摘要

目的

在一般人群中，主要心血管疾病（CVD）的发病率与估计葡萄糖处置率（eGDR，胰岛素抵抗（IR）的替代指标）之间的关系尚未完全明确。既往研究未考察eGDR及其他IR替代指标对CVD事件的预测价值。本研究旨在探讨eGDR与各种CVD事件之间的关联，包括心肌梗死（MI）、心力衰竭（HF）、心房颤动（AF）和缺血性卒中。此外，还比较了eGDR、甘油三酯-葡萄糖（TyG）指数、TyG-腰围（WC）、TyG-体重指数（BMI）、TyG-腰高比（WHtR）、甘油三酯（TG）与高密度脂蛋白胆固醇（HDL-C）之比（TG/HDL-C）以及胰岛素抵抗代谢评分（METS-IR）对CVD事件的预测价值。

方法

研究人群来自英国生物银行，通过与医院记录关联来记录CVD事件。采用Cox比例风险模型和受限立方样条模型评估eGDR与CVD风险之间的关联，并对潜在混杂因素进行校正。采用受试者工作特征（ROC）曲线和曲线下面积（AUC）比较eGDR、TyG、TyG-WC、TyG-BMI、TyG-WHtR、TG/HDL-C和METS-IR的预测价值。

结果

本研究共纳入360953名参与者。在中位随访13.8年期间，记录了12698例MI、10360例HF、23638例AF和6512例缺血性卒中事件。与eGDR最低四分位数组的参与者相比，最高四分位数组的参与者发生MI的校正风险比（HR）及95%置信区间（CI）为0.59（0.51 - 0.67），HF为 0.66（0.56 - 0.76），AF为0.88（0.80 - 0.98），缺血性卒中为0.73（0.61 - 0.89）。在预测MI（AUC：0.661）、HF（AUC：0.690）、AF（AUC：0.653）和缺血性卒中（AUC：0.646）方面，eGDR优于TyG、TyG-WC、TyG-BMI、TyG-WHtR、TG/HDL-C和METS-IR。