Cheng Wenke, Zhang Xianlin, Shi Jiqian, Ruan Huaiyu, Kang Pinfang, Sun Hongyan, Xu Meiyang, Du Zhongyan, Tang Bi
Department of Cardiology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China.
Department of Neurology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China.
Front Nutr. 2025 Jul 3;12:1601137. doi: 10.3389/fnut.2025.1601137. eCollection 2025.
Stress hyperglycemia ratio (SHR), which combines acute admission glucose with chronic glycemic indices, is a novel marker of stress hyperglycemia. Its association with acute myocardial infarction (AMI) risk in the general population remains unclear.
This prospective cohort study used data from the UK Biobank and included 337,620 participants without known cardiovascular disease (CVD). SHR was calculated as admission glucose/[(28.7 × HbA1c%) - 46.7], with levels categorized into quintiles. The primary outcome was incident AMI, while ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) were evaluated as secondary outcomes. Cox proportional hazards models assessed the relationship between SHR and incident AMI risk. An accelerated failure time model was used to evaluate the effect of SHR on time to AMI onset, and dynamic changes in SHR were analyzed using a restricted cubic spline (RCS).
During a median follow-up of 164.8 months (IQR: 155.7-173.6), 10,598 AMI events, including 3,019 STEMI and 5,711 NSTEMI cases, were recorded. Compared with the fourth quintile, the first, second, and third quintiles had increased AMI risks by 19% (HR 1.19; 95% CI 1.12-1.27), 16% (HR 1.16; 95% CI 1.09-1.24), and 7% (HR 1.07; 95% CI 1.00-1.14), respectively, with no significant increase observed in the highest quintile. RCS analysis revealed a U-shaped relationship between SHR and incident AMI risk (P for non-linearity < 0.001), with the lowest risk at an SHR of 0.966.
In the general population without known CVD, SHR exhibited a U-shaped association with incident AMI risk, with the lowest risk observed at an SHR of 0.966, particularly at levels below this threshold.
应激性高血糖比值（SHR）结合了急性入院血糖和慢性血糖指标，是应激性高血糖的一种新型标志物。其与普通人群急性心肌梗死（AMI）风险的关联尚不清楚。
这项前瞻性队列研究使用了英国生物银行的数据，纳入了337620名无已知心血管疾病（CVD）的参与者。SHR的计算方法为入院血糖/[（28.7×糖化血红蛋白百分比）-46.7]，其水平分为五个五分位数。主要结局是新发AMI，而ST段抬高型心肌梗死（STEMI）和非ST段抬高型心肌梗死（NSTEMI）作为次要结局进行评估。Cox比例风险模型评估SHR与新发AMI风险之间的关系。使用加速失效时间模型评估SHR对AMI发病时间的影响，并使用受限立方样条（RCS）分析SHR的动态变化。
在中位随访164.8个月（四分位间距：155.7 - 173.6）期间，记录了10598例AMI事件，包括3019例STEMI和5711例NSTEMI病例。与第四五分位数相比，第一、第二和第三五分位数的AMI风险分别增加了19%（风险比1.19；95%置信区间1.12 - 1.27）、16%（风险比1.16；95%置信区间1.09 - 1.24）和7%（风险比1.07；95%置信区间1.00 - 1.14），最高五分位数未观察到显著增加。RCS分析显示SHR与新发AMI风险之间呈U形关系（非线性P<0.001），SHR为0.966时风险最低。
在无已知CVD的普通人群中，SHR与新发AMI风险呈U形关联，SHR为0.966时风险最低，尤其是低于该阈值的水平。
