Association between insulin resistance surrogate markers and cardiovascular disease risk in individuals with subclinical metabolic disorders: a prospective cohort study based on baseline levels, cumulative exposure, and longitudinal trajectories
Authors' conclusion
This study demonstrates that baseline IR, cuIR, and longitudinal trajectory patterns are significantly associated with CVD risk in middle-aged and older populations. These measures provide incremental predictive value beyond traditional risk factors. Early identification and long-term monitoring of IR-related surrogate markers during the subclinical metabolic stage may enhance CVD risk stratification and support precision prevention and intervention strategies.
Study context
- Population
- Middle-aged and older adults, China Health and Retirement Longitudinal Study (CHARLS) (2011–2020); external validation in English Longitudinal Study of Ageing (ELSA) (2004–2016)baseline insulin resistance (IR) analysis
- Participants
- 7,299 participants
- Exposure
- Higher vs lower IR-related surrogate markers
- Outcome
- Incidence of newly diagnosed CVD
Methodological detailsexternal validation cohort (ELSA), K-means clustering of cumulative exposure, group-based trajectory modeling
- External validation cohort (ELSA)
- K-means clustering of cumulative exposure
- Group-based trajectory modeling
Main finding
As reported in the abstract
- New cardiovascular disease (CVD) events
- 1,870
- TyG-ABSI strongest association, Model 3 fully adjusted: HR
- 4.92 (3.13-7.74) (95% CI)
- Higher quantiles associated with increased CVD risk
- P for trend < 0.05
Observational data: associations, not effects.
Further findings
External validation of baseline IR (ELSA)
- Highest quantile significantly increased risk
- P for trend < 0.05
- All IR indicators except TyG positively correlated with CVD risk in unadjusted models; after multivariable adjustment TyG-WC, TyG-BMI, TyG-BRI, TyG-WHtR, METS-IR and CTI remained independently associated
Cumulative IR (cuIR) and CVD risk (CHARLS)
- Participants developing CVD
- 773 out of 3,847
- All 11 cuIR surrogate markers significantly increased CVD risk (multivariable Cox); Q2 and Q3 elevated risk vs Q1
- P for trend < 0.05
- High-level cumulative exposure clusters had significantly higher CVD risk than low-level clusters
IR trajectories and CVD risk (ELSA)
- CTI strongest association: HR
- 1.90 (1.25-2.89) (95% CI)
- High-risk vs low-risk trajectory significantly increased CVD risk for TyG-WC, TyG-BMI, TyG-BRI, METS-IR and CTI (fully adjusted)
- TyG, TyG-WHtR, TyG-WWI and TyG-ABSI not significant after multivariable adjustment; no significant associations for AIP and CHG trajectories
Original publication
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