Insulin resistance assessed by estimated glucose disposal rate and risk of atherosclerotic cardiovascular diseases incidence: the multi-ethnic study of atherosclerosis

Abstract

Background: To investigate the relationship between estimated glucose disposal rate (eGDR), a surrogate indicator of insulin resistance, and atherosclerotic cardiovascular diseases (ASCVD) incidence risk.

Methods: This prospective cohort study utilized data from the 6026 participants from the Multi-Ethnic Study of Atherosclerosis. The eGDR (mg/kg/min) was computed as 21.158 - (0.09 × waist circumference [cm]) - (3.407 × hypertension [yes/no]) - (0.551 × HbA1c [%]). The population was categorized into four subgroups according to the quartiles (Q) of eGDR. Cox proportional hazard models were applied to assess the associations between eGDR and ASCVD incidence, and restricted cubic spine (RCS) was employed to examine the dose-response relationship.

Results: The mean age of participants was 63.6 ± 10.1 years, comprising 3163 (52.5%) women. Over a median follow-up duration of 14.1 years, 565 (9.4%) developed ASCVD, including 256 (4.2%) myocardial infarctions, 234 (3.9%) strokes, and 358 (5.9%) fatal coronary heart disease. Compared to the lowest quartile, the adjusted hazard ratios (95% confidence intervals) for incident ASCVD for Q2-Q4 were 0.87 (0.68-1.10), 0.63 (0.47-0.84), and 0.43 (0.30-0.64), respectively. Per 1 standard deviation increase in eGDR was associated with a 30% (HR: 0.70, 95% CI 0.60-0.80) risk reduction of ASCVD, with the subgroup analyses indicating that age and hypertension modified the association (P for interaction < 0.05). RCS analysis indicated a significant and linear relationship between eGDR and ASCVD incidence risk.

Conclusion: eGDR level was negatively associated with incident ASCVD risk in a linear fashion among the general population. Our findings may contribute to preventive measures by improving ASCVD risk assessment.

Fig. 1

Study selection flow chart. MESA, Multi-Ethnic Study of Atherosclerosis; ASVD, atherosclerotic cardiovascular disease

Fig. 2

Kaplan–Meier survival curves for ASCVD (A), MI (B), stroke (C), and fatal CHD incidence with different quartile levels of eGDR. Abbreviations: ASCVD, atherosclerotic cardiovascular disease; MI, myocardial infarction; CHD, coronary heart disease; eGDR, estimated glucose disposal rate

Fig. 3

Restricted cubic spline curves for ASCVD (A), MI (B), stroke (C), and fatal CHD (D) according to the estimated glucose disposal rate. Hazard ratios are indicated by solid lines and 95% confidence intervals by shaded areas. The horizontal dotted line represents the hazard ratio of 1.0. The multivariate models adjusted for age, gender, race, education, body mass index, blood glucose status, low-density lipoprotein, high-density lipoprotein, triglyceride, and medication usage. Abbreviations: ASCVD, atherosclerotic cardiovascular disease; MI, myocardial infarction; CHD, coronary heart disease

Fig. 4

Subgroup analysis of the association between estimated glucose disposal rate and atherosclerotic cardiovascular disease (A), myocardial infarction (B), stroke (C), and fatal coronary heart disease (D). HRs were calculated as per 1 standard deviation increase in estimated glucose disposal rate. HR, hazard ratios; CI, confidence interval