Wang Menghe, Lin Weiquan, Liu Hui, Qian Zhengmin Min, Chen Jiamin, Rao Manting, Zhou Qin, Zhuang Zitong, Luo Liying, Fang Yingying, Liu Xiangyi, Burroughs Tom, McMillin Stephen Edward, Lin Hualiang, Zhang Zhoubin, Chen Ge
Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, PR China.
Department of Basic Public Health Services, Guangzhou Center for Disease Control and Prevention (Guangzhou Health Supervision Institute), Guangzhou, PR China; Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention(Guangzhou Health Supervision Institute), Guangzhou, PR China.
Diabetes Res Clin Pract. 2025 Aug;226:112327. doi: 10.1016/j.diabres.2025.112327. Epub 2025 Jun 13.
To evaluate the association between eight insulin resistance (IR) indices and incident cardiovascular disease (CVD) and compare their predictive efficacy in older adults with cardiovascular-kidney-metabolic (CKM) syndrome stages 0-3.
We analyzed 463,545 participants from the Guangzhou Older Longitudinal Dynamic Health (GOLD-Health) cohort. Cox proportional hazards and restricted cubic spline (RCS) models assessed associations between IR indices (triglyceride glucose [TyG], TyG-BMI, TyG-WC, TyG-WHtR, lipid accumulation product [LAP], atherosclerotic index [AIP], visceral adiposity index [VAI], Chinese visceral adiposity index [CVAI]) and CVD incidence. Predictive capacity was compared using receiver operating characteristic (ROC) curves.
Over 1,371,009 person-years, 14,414 incident CVD cases (10.51/1000 person-years) were identified. Compared to the lowest quartiles, participants in highest quartile had an increased risk of CVD. The hazard ratios for the fourth quartile were 1.150 for TyG, 1.116 for TyG-BMI, 1.190 for TyG-WC, 1.177 for TyG-WHtR, 1.130 for LAP, 1.142 for AIP, 1.114 for VAI and 1.186 for CVAI (all P value ≤ 0.001). TyG-WC had the highest area under the curve (AUC) (0.763). Subgroup analyses revealed stronger associations in CKM stage 3.
All eight IR indices can predict CVD in older adults at CKM stage 0-3, with TyG-WC showing optimal predictive performance.
评估八种胰岛素抵抗（IR）指标与心血管疾病（CVD）发病之间的关联，并比较它们在0 - 3期心血管-肾脏-代谢（CKM）综合征老年人群中的预测效能。
我们分析了来自广州老年纵向动态健康（GOLD-Health）队列的463,545名参与者。Cox比例风险模型和受限立方样条（RCS）模型评估了IR指标（甘油三酯葡萄糖[TyG]、TyG-BMI、TyG-WC、TyG-WHtR、脂质蓄积产物[LAP]、动脉粥样硬化指数[AIP]、内脏脂肪指数[VAI]、中国内脏脂肪指数[CVAI]）与CVD发病率之间的关联。使用受试者工作特征（ROC）曲线比较预测能力。
在超过1,371,009人年的随访中，共识别出14,414例CVD发病病例（10.51/1000人年）。与最低四分位数相比，最高四分位数的参与者患CVD的风险增加。第四四分位数的风险比分别为：TyG为1.150，TyG-BMI为1.116，TyG-WC为1.190，TyG-WHtR为1.177，LAP为1.130，AIP为1.142，VAI为1.114，CVAI为1.186（所有P值≤0.001）。TyG-WC的曲线下面积（AUC）最高（0.763）。亚组分析显示在CKM 3期的关联更强。
所有八种IR指标均可预测0 - 3期CKM综合征老年人群的CVD，其中TyG-WC显示出最佳的预测性能。
