糖尿病患者中估计的葡萄糖处置率与心房颤动、心力衰竭及心血管死亡率的关联：一项来自英国生物银行的前瞻性队列研究

Association of estimated glucose disposal rate with atrial fibrillation, heart failure and cardiovascular mortality in patients with diabetes: a prospective cohort study from the UK Biobank.

作者信息

Tan Zhen, Liu Yijun, Liu Lei, Li Shuang, Xue Xinrui, Li Xiaoping, Ren Hongqiang

机构信息

Department of Cardiology, Suining Central Hospital, Suining, Sichuan, China.

Department of Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.

出版信息

Front Endocrinol (Lausanne). 2025 Jul 18;16:1579836. doi: 10.3389/fendo.2025.1579836. eCollection 2025.

DOI:10.3389/fendo.2025.1579836

PMID:40756509

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12313486/

Abstract

BACKGROUND

Estimated glucose disposal rate (eGDR) was a novel non-insulin-based marker of insulin resistance (IR), which had been used in many studies to evaluate the clinical prognosis of diabetes. However, the association of eGDR with atrial fibrillation (AF), heart failure (HF) and cardiovascular mortality in patients with diabetes remains unclear.

METHODS

The study utilized UK Biobank data from 31,733 participants. Kaplan-Meier curves and Log-rank tests assessed AF, HF, and cardiovascular mortality incidence. Multivariate Cox models and restricted cubic splines analyzed the associations of eGDR with these outcomes. Polygenic Risk Score (PRS) analysis evaluated the joint effects of eGDR and PRS. Boruta algorithm filtered key predictive variables. Subgroup analysis was performed using cardiovascular high-risk factors, and mediation analysis explored the relationships of eGDR with the outcomes.

RESULTS

Subjects with higher eGDR were more likely to be female, younger, more physically active, non-smoker, and non-drinker. The cumulative incidence of AF, HF, and cardiovascular mortality in the higher quartiles of GDR were significantly lower than those in the lowest quartile (log-rank < 0.001 for all). eGDR exhibited an independent negative linear correlation with the risk of AF (HR = 0.94, 95% CI: 0.91-0.96), HF (HR = 0.78, 95% CI: 0.74-0.82), and cardiovascular mortality (HR = 0.86, 95% CI: 0.83-0.88) risk. eGDR made the most significant contribution to the predicted outcomes. In diabetic patients with high genetic susceptibility, high eGDR could reduce the risk of AF (HR = 0.68, 95% CI: 0.51-0.90), HF (HR = 0.43, 95% CI: 0.29-0.62), and cardiovascular mortality (HR = 0.30, 95% CI: 0.22-0.42). Mediation analysis demonstrated that 10.7%, 7.9%, and 10.3% of the relationship between eGDR and AF, HF, and cardiovascular mortality among individuals with diabetes were mediated by eGFR, respectively.

CONCLUSIONS

This study demonstrated that higher eGDR levels were associated with a decreased risk of AF, HF, and cardiovascular mortality. Therefore, eGDR may serve as a valuable tool for predicting the risk of AF, HF, and cardiovascular mortality in patients with diabetes.

摘要

背景

估计葡萄糖处置率（eGDR）是一种新型的基于非胰岛素的胰岛素抵抗（IR）标志物，已在许多研究中用于评估糖尿病的临床预后。然而，eGDR与糖尿病患者心房颤动（AF）、心力衰竭（HF）和心血管死亡率之间的关联仍不明确。

方法

本研究利用了英国生物银行中31733名参与者的数据。Kaplan-Meier曲线和对数秩检验评估了AF、HF和心血管死亡率的发生率。多变量Cox模型和受限立方样条分析了eGDR与这些结局之间的关联。多基因风险评分（PRS）分析评估了eGDR和PRS的联合效应。Boruta算法筛选关键预测变量。使用心血管高危因素进行亚组分析，中介分析探讨eGDR与结局之间的关系。

结果

eGDR较高的受试者更可能为女性、更年轻、身体活动更多、不吸烟且不饮酒。GDR较高四分位数组中AF、HF和心血管死亡率的累积发生率显著低于最低四分位数组（所有对数秩检验P<0.001）。eGDR与AF风险（HR=0.94，95%CI：0.91-0.96）、HF风险（HR=0.78，95%CI：0.74-0.82）和心血管死亡率风险（HR=0.86，95%CI：0.83-0.88）呈独立的负线性相关。eGDR对预测结局的贡献最大。在遗传易感性高的糖尿病患者中，高eGDR可降低AF风险（HR=0.68，95%CI：0.51-0.90）、HF风险（HR=0.43，95%CI：0.29-0.62）和心血管死亡率风险（HR=0.30，95%CI：0.22-0.42）。中介分析表明，糖尿病患者中eGDR与AF、HF和心血管死亡率之间关系的10.7%、7.9%和10.3%分别由eGFR介导。