Shi Yujie, Zhang Zuo, Yang Jiajun, Cui Song
Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Front Cardiovasc Med. 2025 May 23;12:1583944. doi: 10.3389/fcvm.2025.1583944. eCollection 2025.
The association between insulin resistance and the comorbidity of ASCVD with hyperuricemia remains to be further explored. This study utilizes several insulin resistance indicators, including HOMA-IR, METS-IR, TyG, TyG-WHtR, TyG-WC, and TyG-BMI, to assess insulin resistance levels and investigate their association with the comorbidity of ASCVD and hyperuricemia in the study population.
This cross-sectional study included 16,092 participants from the National Health and Nutrition Examination Survey conducted between 2005 and 2018. Participants younger than 20 years old and those with missing data for exposure-related indicators were excluded. Six insulin resistance-related traditional and novel indicators-HOMA-IR, METS-IR, TyG, TyG-WC, TyG-WHtR, and TyG-BMI-were used as exposure factors, while the outcome was ASCVD with hyperuricemia. This study's analyses incorporated sample weights, clustering, and stratification to account for the complex multi-stage stratified probability sampling design employed in NHANES.
A total of 523 patients were diagnosed with ASCVD with hyperuricemia. The results were adjusted for different covariates. METS-IR showed a consistent positive correlation with the outcome in all models, with model 3 indicating that for each unit increase, the OR was 1.04 (95% CI: 1.03-1.05, < 0.0001). The study results showed that TyG-WC, TyG-WHtR, and TyG-BMI remained significantly associated across all models, with TyG-WHtR exhibiting the strongest association (OR = 1.64, 95% CI: 1.37-1.97, < 0.0001). Furthermore, RCS results showed significant nonlinear relationships for HOMA-IR, METS-IR, TyG-WC, TyG-WHtR, and TyG-BMI with ASCVD with hyperuricemia (-overall < 0.05, -nonlinear < 0.05). The ROC analysis revealed high AUC values for TyG-BMI and METS-IR, with AUCs of 0.942 and 0.941. TyG-WC and TyG-WHtR also showed relatively high AUC values of 0.902 and 0.899, respectively. In the calibration curve analysis, METS-IR demonstrated the highest calibration performance.
This NHANES-based study highlighted significant associations between insulin resistance indices, particularly METS-IR, TyG-WC, and TyG-WHtR, and ASCVD with hyperuricemia. Furthermore, it demonstrated the strong predictive capabilities of these indices for identifying individuals at risk for this comorbidity. These findings offer valuable insights into early detection and preventive strategies for ASCVD combined with hyperuricemia, emphasizing the practicality of these indices in clinical and public health settings.
胰岛素抵抗与动脉粥样硬化性心血管疾病（ASCVD）合并高尿酸血症之间的关联仍有待进一步探索。本研究采用多种胰岛素抵抗指标，包括稳态模型评估胰岛素抵抗（HOMA-IR）、代谢综合征胰岛素抵抗指数（METS-IR）、甘油三酯与空腹血糖乘积指数（TyG）、TyG与腰围身高比（TyG-WHtR）、TyG与腰围（TyG-WC）以及TyG与体重指数（TyG-BMI），以评估胰岛素抵抗水平，并研究其与研究人群中ASCVD合并高尿酸血症的相关性。
这项横断面研究纳入了2005年至2018年期间进行的美国国家健康与营养检查调查中的16,092名参与者。排除了年龄小于20岁的参与者以及暴露相关指标数据缺失的参与者。将六个与胰岛素抵抗相关的传统和新型指标——HOMA-IR、METS-IR、TyG、TyG-WC、TyG-WHtR和TyG-BMI——用作暴露因素，而结局是ASCVD合并高尿酸血症。本研究的分析纳入了样本权重、聚类和分层，以考虑美国国家健康与营养检查调查（NHANES）中采用的复杂多阶段分层概率抽样设计。
共有523名患者被诊断为ASCVD合并高尿酸血症。对结果进行了不同协变量的校正。METS-IR在所有模型中均与结局呈现一致的正相关，模型3表明，每增加一个单位，比值比（OR）为1.04（95%置信区间：1.03 - 1.05，P < 0.0001）。研究结果表明，TyG-WC、TyG-WHtR和TyG-BMI在所有模型中均保持显著相关性，其中TyG-WHtR的相关性最强（OR = 1.64，95%置信区间：1.37 - 1.97，P < 0.0001）。此外，限制立方样条（RCS）结果显示，HOMA-IR、METS-IR、TyG-WC、TyG-WHtR和TyG-BMI与ASCVD合并高尿酸血症之间存在显著的非线性关系（总体P < 0.05，非线性P < 0.05）。受试者工作特征（ROC）分析显示，TyG-BMI和METS-IR的曲线下面积（AUC）值较高，分别为0.942和0.941。TyG-WC和TyG-WHtR的AUC值也相对较高，分别为0.902和0.899。在校准曲线分析中，METS-IR表现出最高的校准性能。
这项基于NHANES的研究突出了胰岛素抵抗指标，特别是METS-IR、TyG-WC和TyG-WHtR，与ASCVD合并高尿酸血症之间的显著关联。此外，它还证明了这些指标在识别这种合并症风险个体方面具有强大的预测能力。这些发现为ASCVD合并高尿酸血症的早期检测和预防策略提供了有价值的见解，强调了这些指标在临床和公共卫生环境中的实用性。
