Zhao Yajie, Wang Lele, Li Jiawei, Guo Bing, Zhang Juying, Guo Xiaolin, Luo Yuying, Wu Gonghua, Zhao Xing
/ （ 610041） Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2025 Mar 20;56(2):495-505. doi: 10.12182/20250360503.
To investigate the association between 8 insulin resistance (IR) surrogate markers and incident atherosclerotic cardiovascular disease (ASCVD) in population with cardiovascular-kidney-metabolic syndrome (CKM) of stages 0-3, and to identify the surrogate marker with the best predictive performance.
A study was conducted on 20121 community residents classified as CKM stages 0-3 from the Chengdu cohort of the China Multi-Ethic Cohort. A Cox proportional hazards model was used to calculate hazard ratios (HRs) between each IR surrogate marker and incident ASCVD. Cubic spline regression was employed to explore the dose-response relationships between these markers and incident ASCVD. The relative relationships between different markers and incident ASCVD were examined through the ratio of HRs (RHRs). Time-dependent area under the receiver operating characteristic curve (TDAUC) and Uno's C-statistic were calculated to compare the predictive performance of each marker for incident ASCVD. Based on the PREVENT equation components and the 8 surrogate markers under analysis, random forest feature selection was used to determine the contribution of each marker to accurate prediction.
During a follow-up period of 82741.93 person-years, 1447 incident cases of ASCVD were recorded, with an incidence density of 17.49 per 1000 person-years. Association analyses indicated that the triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL) and the TyG/(TG/HDL) index were not associated with incident ASCVD ( > 0.05). The TyG index combined with obesity measurement parameters emerged as a reliable predictor of ASCVD incidence. The most promising indicator, TyG index with waist-to-height ratio (TyG_WHtR), exhibited an inverted J-shaped association with incident ASCVD ( for nonlinearity = 0.045; TDAUC = 0.640; C = 0.634), while the TyG index with body mass index (TyG_BMI), waist circumference (TyG_WC), and waist-to-hip ratio (TyG_WHR) showed positive linear associations (all for trend < 0.05), with relatively lower predictive performance (C = 0.564, 0.588, and 0.598, respectively). Although both the TyG index and the metabolic score for insulin resistance (METS-IR) were associated with increased ASCVD risk (TyG: Q2 vs. Q1, HR = 1.23 and Q4 vs. Q1, HR = 1.24; METS-IR: for non-linearity = 0.045), they exhibited poor predictive performance for incident ASCVD.
The TyG index combined with obesity measurement parameters is an ideal IR surrogate marker for predicting incident ASCVD in populations with stages 0-3 CKM. Monitoring these markers will facilitate the prevention and control of cardiovascular diseases in CKM populations.
探讨8种胰岛素抵抗（IR）替代标志物与0 - 3期心血管-肾脏-代谢综合征（CKM）人群中动脉粥样硬化性心血管疾病（ASCVD）发病之间的关联，并确定预测性能最佳的替代标志物。
对来自中国多民族队列成都队列的20121名分类为0 - 3期CKM的社区居民进行了一项研究。采用Cox比例风险模型计算每种IR替代标志物与ASCVD发病之间的风险比（HRs）。采用三次样条回归探索这些标志物与ASCVD发病之间的剂量反应关系。通过HRs比值（RHRs）检查不同标志物与ASCVD发病之间的相对关系。计算受试者工作特征曲线下的时间依赖性面积（TDAUC）和Uno's C统计量，以比较每种标志物对ASCVD发病的预测性能。基于PREVENT方程成分和所分析的8种替代标志物，使用随机森林特征选择来确定每种标志物对准确预测的贡献。
在82741.93人年的随访期内，记录了1447例ASCVD发病病例，发病密度为每1000人年17.49例。关联分析表明，甘油三酯与高密度脂蛋白胆固醇比值（TG/HDL）和TyG/（TG/HDL）指数与ASCVD发病无关（>0.05）。TyG指数与肥胖测量参数相结合成为ASCVD发病的可靠预测指标。最有前景的指标，即TyG指数与腰高比（TyG_WHtR），与ASCVD发病呈倒J形关联（非线性检验P = 0.045；TDAUC = 0.640；C = 0.634），而TyG指数与体重指数（TyG_BMI）、腰围（TyG_WC）和腰臀比（TyG_WHR）呈正线性关联（趋势检验P均<0.05），预测性能相对较低（C分别为0.564、0.588和0.598）。虽然TyG指数和胰岛素抵抗代谢评分（METS - IR）均与ASCVD风险增加相关（TyG：Q2与Q1相比，HR = 1.23，Q4与Q1相比，HR = 1.24；METS - IR：非线性检验P = 0.045），但它们对ASCVD发病的预测性能较差。
TyG指数与肥胖测量参数相结合是预测0 - 3期CKM人群中ASCVD发病的理想IR替代标志物。监测这些标志物将有助于CKM人群心血管疾病的预防和控制。
