Zhang Zixi, Zhou Jiabao, Wang Cancan, Wang Kang, Dai Yongguo, Lin Qiuzhen, Xiao Yichao, Liu Qiming
Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
Department of Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
PLoS One. 2025 May 20;20(5):e0324978. doi: 10.1371/journal.pone.0324978. eCollection 2025.
The stress hyperglycemia ratio (SHR) has emerged as a potential marker for predicting cardiovascular disease (CVD) and mortality. However, its relationship with CVD and all-cause mortality in middle-aged and older Chinese populations remains unclear.
This study analyzed data from the China Health and Retirement Longitudinal Study (CHARLS), including individuals aged 45 years and older. Cross-sectional analysis assessed the associations between SHR and CVD incidence, whereas longitudinal Cox regression models evaluated the relationships between SHR, CVD risk, and all-cause mortality. Restricted cubic spline analyses were employed to explore potential non-linear relationships. The predictive performance of SHR was compared with that of fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c).
The cross-sectional analysis identified an inverse association between the SHR and CVD incidence. Longitudinal analysis indicated that SHR was independently associated with an increased risk of CVD, with a significant L-shaped relationship (non-linear P = 0.001). Threshold effect analysis identified 0.985 as the inflection point for SHR, with hazard ratios (HRs) increasing sharply below this level (HR: 0.32, 95% CI: 0.17-0.61, P = 0.001). However, no significant non-linear relationship was observed between SHR and all-cause mortality (non-linear P = 0.942). FBG, HbA1c, and SHR provided similar predictive value for all-cause mortality (area under the curve: 0.526 vs. 0.535 vs. 0.513), without significant incremental predictive value.
The SHR is an independent predictor of CVD risk in middle-aged and older Chinese adults, with an L-shaped relationship. Future large-scale, multicenter studies are needed to validate these findings.
应激性高血糖比值（SHR）已成为预测心血管疾病（CVD）和死亡率的潜在标志物。然而，其与中国中老年人群中心血管疾病及全因死亡率的关系仍不明确。
本研究分析了中国健康与养老追踪调查（CHARLS）的数据，包括45岁及以上的个体。横断面分析评估了SHR与CVD发病率之间的关联，而纵向Cox回归模型则评估了SHR、CVD风险和全因死亡率之间的关系。采用受限立方样条分析来探索潜在的非线性关系。将SHR的预测性能与空腹血糖（FBG）和糖化血红蛋白（HbA1c）的预测性能进行比较。
横断面分析发现SHR与CVD发病率之间呈负相关。纵向分析表明，SHR与CVD风险增加独立相关，呈显著的L形关系（非线性P = 0.001）。阈值效应分析确定0.985为SHR的拐点，低于该水平时风险比（HR）急剧增加（HR：0.32，95%CI：0.17 - 0.61，P = 0.001）。然而，未观察到SHR与全因死亡率之间存在显著的非线性关系（非线性P = 0.942）。FBG、HbA1c和SHR对全因死亡率的预测价值相似（曲线下面积：0.526对0.535对0.513），无显著的增量预测价值。
SHR是中国中老年成年人CVD风险的独立预测因子，呈L形关系。未来需要大规模、多中心研究来验证这些发现。
