Comparison of three non-insulin-based insulin resistance indexes in predicting the presence and severity of coronary artery disease

Abstract

Background: Insulin resistance (IR) has emerged as a risk factor for coronary heart disease (CAD), but there is currently insufficient data on the association of non-insulin-based IR indexes [triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) ratio, triglyceride and glucose (TyG) index, and metabolic score for IR (METS-IR)] with the presence and severity of CAD. Thus, the present study aimed to examine the relationship between these three non-insulin-based IR indexes and CAD, as well as to further compare the predictive values of each index.

Materials and methods: In total, 802 consecutive patients who underwent coronary angiography for suspected CAD from January 2016 to April 2017 were included in this study and were divided into the control group (n = 149) and CAD group (n = 653) according to the angiography results. The triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, triglyceride and glucose index (TyG index), and METS-IR were calculated according to the corresponding formulas. The severity of CAD was evaluated using the Gensini score (GS). The relationship of the TG/HDL-C ratio, TyG index, and METS-IR with CAD was analyzed, and the predictive values of the indexes were compared.

Results: The TG/HDL-C ratio, TyG index, and METS-IR in the CAD group were significantly higher than those in the control group. The TG/HDL-C ratio and METS-IR in the high GS group were significantly higher than those in the non-high GS group. Multivariate logistic regression analysis showed that the TG/HDL-C ratio and METS-IR were independent predictors for the presence of CAD {adjusted odds ratio (OR) [95% confidence interval (CI)]: 1.32 (1.02-1.70) and 1.65 (1.32-2.05), respectively}, whereas only the METS-IR was an independent predictor of the severity of CAD [adjusted OR (95% CI): 1.22 (1.02-1.47)]. Further subgroup analysis indicated that statistical significance was observed only among men, younger patients (≤ 60), and patients with prediabetes mellitus (PDM). Receiver operator characteristic (ROC) analysis showed that the METS-IR had the highest predictive value for the prediction of both the presence and severity of CAD.

Conclusion: The TG/HDL-C ratio, TyG index, and METS-IR are valuable predictors of the presence and severity of CAD, and the METS-IR has the highest predictive value among the three non-insulin-based IR indexes.

Keywords: Gensini score; coronary artery disease; metabolic score for insulin resistance (METS-IR); triglyceride and glucose index (TyG index); triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio.

FIGURE 1

Comparison of the TG/HDL-C ratio, TyG index, and METS-IR between the high GS group and the non-high GS group. GS, Gensini score; TG/HDL-C ratio, the ratio of triglycerides to high-density lipoprotein cholesterol; TyG index, triglyceride and glucose index; METS-IR, metabolic score for insulin resistance. *p < 0.05; **p < 0.01.

FIGURE 2

Correlations between the TG/HDL-C ratio, TyG index, METS-IR, and the GS. GS, Gensini score; TG/HDL-C ratio, the ratio of triglycerides to high-density lipoprotein cholesterol; TyG index, triglyceride and glucose index; METS-IR, metabolic score for insulin resistance. *p < 0.05; ***p < 0.001.

FIGURE 3

Subgroup and interaction analyses between the METS-IR (Per SD) and high GS across various subgroups. OR, odds ratio; CI, confidence interval; GS, Gensini score; NGR, normal glucose regulation; PDM, prediabetes mellitus; DM, diabetes mellitus. p-values in bold are <0.05.

FIGURE 4

ROC curves of the TG/HDL-C ratio, TyG index, and METS-IR for the prediction of CAD and high GS. ROC curves, receiver operator characteristic curves; CAD, coronary heart disease; GS, Gensini score; TG/HDL-C ratio, the ratio of triglycerides to high-density lipoprotein cholesterol; TyG index, triglyceride and glucose index; METS-IR, metabolic score for insulin resistance.