Assessment of six insulin resistance surrogate indexes for predicting stroke incidence in Chinese middle-aged and elderly populations with abnormal glucose metabolism: a nationwide prospective cohort study

Abstract

Background: Estimate glucose disposal rate (eGDR), Chinese visceral adiposity index (CVAI), triglyceride-glucose (TyG), TyG-body mass index (TyG-BMI), metabolic score for insulin resistance (METS-IR), and atherogenic index of plasma (AIP) are considered surrogate indexes of insulin resistance (IR). There is a lack of studies comparing the predictive values of different IR surrogate indexes for stroke risk among individuals with abnormal glucose metabolism. This study aimed to investigate the relationships between six IR surrogate indexes and stroke risk in individuals with abnormal glucose metabolism, evaluate their predictive abilities for stroke risk.

Methods: Data from the China Health and Retirement Longitudinal Study (CHARLS) were analysed in this study. Multivariate logistic regression models were applied to analyse the relationships of IR surrogate indexes with stroke risk. The dose-response relationships between IR surrogate indexes and stroke risk were explored using restricted cubic splines. The areas under the curve (AUCs) of IR surrogate indexes were calculated by receiver operating characteristic (ROC) analysis.

Results: After adjusting for potential confounders, we observed that each standard deviation (SD) increase in eGDR was associated with a reduced risk of stroke, with an adjusted odds ratio (OR) of 0.746 [95% confidence interval (CI): 0.661-0.842]. In contrast, each SD increase in CVAI, TyG, TyG-BMI, METS-IR, and AIP were associated with an increased risk of stroke, with adjusted ORs (95% CIs) of 1.232 (1.106-1.373), 1.246 (1.050-1.479), 1.186 (1.022-1.376), 1.222 (1.069-1.396), and 1.193 (1.050-1.355), respectively. Dose-response analyses showed that eGDR, CVAI, TyG-BMI and METS-IR were linearly associated with stroke risk (P_nonlinear ≥ 0.05), whereas TyG and AIP were nonlinearly associated with stroke risk (P_nonlinear < 0.05). According to ROC analysis, The AUC of eGDR for predicting stroke risk in the overall population with abnormal glucose metabolism (AUC: 0.612, 95% CI: 0.584-0.640) was significantly higher than that of other indexes.

Conclusion: The six IR surrogate indexes were closely associated with high risk of stroke in individuals with abnormal glucose metabolism. The eGDR showed promising potential in predicting stroke risk in Chinese middle-aged and elderly populations with abnormal glucose metabolism.

Keywords: Abnormal glucose metabolism; CHARLS; Insulin resistance surrogate index; Stroke.

Fig. 1

Flowchart of participant selection

Fig. 2

Dose-response relationships between IR surrogate indexes and stroke risk. We adjusted the model fully for sex, age, education level, marital status, smoking status, alcohol consumption, BMI, WC, TC, HDL-C, LDL-C, Scr, SUA, BUN, CRP, hypertension, and heart diseases. CI, confidence interval; eGDR, estimated glucose disposal rate; CVAI, Chinese visceral adiposity index; TyG, triglyceride-glucose; TyG-BMI, TyG-body mass index; METS-IR, metabolic score for insulin resistance; AIP, atherogenic index of plasma; WC, waist circumference; TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; Scr, serum creatinine; SUA, serum uric acid; BUN, blood urea nitrogen; CRP, C-reactive protein.

Fig. 3

Subgroup analyses of the associations between IR surrogate indexes and stroke risk. Each subgroup was adjusted for sex, age, education level, marital status, smoking status, alcohol consumption, BMI, WC, TC, HDL-C, LDL-C, Scr, SUA, BUN, CRP, hypertension, and heart diseases, except for stratification variables. ORs are presented as per 1 SD increase in the IR surrogate indexes for stroke risk. OR, odds ratio; CI, confidence interval; eGDR, estimated glucose disposal rate; CVAI, Chinese visceral adiposity index; TyG, triglyceride-glucose; TyG-BMI, TyG-body mass index; METS-IR, metabolic score for insulin resistance; AIP, atherogenic index of plasma; WC, waist circumference; TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; Scr, serum creatinine; SUA, serum uric acid; BUN, blood urea nitrogen; CRP, C-reactive protein.

Fig. 4

The ROC curves of IR surrogates and stroke risk in different sex and age groups. ROC, receiver operating characteristic; AUC, area under the curve; eGDR, estimated glucose disposal rate; CVAI, Chinese visceral adiposity index; TyG, triglyceride-glucose; TyG-BMI, TyG-body mass index; METS-IR, metabolic score for insulin resistance; AIP, atherogenic index of plasma.