基层医疗中胰岛素抵抗替代指标对死亡率和预期寿命的影响：一项基于全国登记数据链接的横断面研究（LIPIDOGRAM2015）
Impact of surrogates for insulin resistance on mortality and life expectancy in primary care: a nationwide cross-sectional study with registry linkage (LIPIDOGRAM2015).
作者信息
Chen Yang, Zhong Ziyi, Gue Ying, Banach Maciej, McDowell Garry, Mikhailidis Dimitri P, Toth Peter P, Penson Peter E, Tomasik Tomasz, Windak Adam, Gierlotka Marek, Osadnik Tadeusz, Kuras Agnieszka, Miga Marcin, Jozwiak Jacek, Lip Gregory Y H
机构信息
Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom.
出版信息
Lancet Reg Health Eur. 2024 Dec 12;49:101182. doi: 10.1016/j.lanepe.2024.101182. eCollection 2025 Feb.
BACKGROUND
Insulin resistance (IR) is an important risk factor for multiple chronic diseases, increasing mortality and reducing life expectancy. The associations between emerging surrogates for IR, triglyceride-glucose index (TyG) and TyG-related indicators, with all-cause mortality and life expectancy in middle-aged and older patients in primary care are unclear.
METHODS
This study originated from the Polish primary care cohort LIPIDOGRAM2015, including patients aged ≥45 years. Baseline fasting triglycerides and fasting glucose were used to derive TyG. Other TyG-related indicators included TyG-adjusted body mass index (TyG-BMI), TyG-adjusted waist circumference (TyG-WC), TyG-adjusted waist-to-hip, and TyG-adjusted waist-to-height. In this longitudinal analysis, we assessed associations between TyG-related indicators with total all-cause mortality, premature (age at death ≤75 years) all-cause mortality and years of life lost (YLL).
FINDINGS
We included 10,688 patients (mean age 61.8 ± 9.3 years; 63.5% female). Cumulative total and premature all-cause mortality were 7.2% and 4.6%, respectively, during 5.7 years (IQR 5.6-5.7) of follow-up. Lowest (Q1) and highest quartile (Q4) of TyG-BMI and TyG-WC were associated with total all-cause mortality (second quartile [Q2]: reference; TyG-BMI: Q1: aHR 1.33, 95% CI 1.07-1.65, Q4: aHR 1.28, 95% CI 1.03-1.58; TyG-WC: Q1: aHR 1.44, 95% CI 1.14-1.82, Q4: aHR 1.29, 95% CI 1.04-1.59), similar results for premature all-cause mortality. Within age 45-80 years, compared with Q2 and third quartile, YLL were 4.49 and 5.46 years for TyG-BMI Q1 and Q4, respectively, 3.24 and 5.31 years for TyG-WC Q1 and Q4, respectively.
INTERPRETATION
TyG-BMI and TyG-WC demonstrated a U-shaped association with total and premature all-cause mortality. Low and high levels of TyG-BMI and TyG-WC were associated with reduced life expectancy. Despite the relatively short follow-up period, significant associations were still observed, but longer follow-up studies are required to further explore these relationships.
FUNDING
Polish Lipid Association, College of Family Physician in Poland, Valeant in Poland.
背景
胰岛素抵抗（IR）是多种慢性疾病的重要危险因素，会增加死亡率并缩短预期寿命。在初级保健中，IR的新兴替代指标——甘油三酯-葡萄糖指数（TyG）及TyG相关指标与中老年患者全因死亡率和预期寿命之间的关联尚不清楚。
方法
本研究源自波兰初级保健队列LIPIDOGRAM2015，纳入年龄≥45岁的患者。采用基线空腹甘油三酯和空腹血糖计算TyG。其他TyG相关指标包括TyG调整体重指数（TyG-BMI）、TyG调整腰围（TyG-WC）、TyG调整腰臀比和TyG调整腰高比。在这项纵向分析中，我们评估了TyG相关指标与全因总死亡率、过早（死亡年龄≤75岁）全因死亡率和寿命损失年数（YLL）之间的关联。
结果
我们纳入了10688例患者（平均年龄61.8±9.3岁；63.5%为女性）。在5.7年（四分位间距5.6 - 5.7年）的随访期间，累积全因总死亡率和过早全因死亡率分别为7.2%和4.6%。TyG-BMI和TyG-WC的最低（第一四分位数[Q1]）和最高四分位数（Q4）与全因总死亡率相关（第二四分位数[Q2]：参照；TyG-BMI：Q1：风险比[HR]1.33，95%置信区间[CI]1.07 - 1.65，Q4：HR 1.28，95%CI 1.03 - 1.58；TyG-WC：Q1：HR 1.44，95%CI 1.14 - 1.82，Q4：HR 1.29，95%CI 1.04 - 1.59），过早全因死亡率结果相似。在45 - 80岁年龄段内，与Q2和第三四分位数相比，TyG-BMI的Q1和Q4的YLL分别为4.49年和5.46年，TyG-WC的Q1和Q4的YLL分别为3.24年和5.31年。
解读
TyG-BMI和TyG-WC与全因总死亡率和过早全因死亡率呈U形关联。TyG-BMI和TyG-WC的低水平和高水平均与预期寿命缩短相关。尽管随访期相对较短，但仍观察到显著关联，不过需要更长时间的随访研究来进一步探究这些关系。
资助
波兰脂质协会、波兰家庭医生学院、波兰的 Valeant公司。
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