Associations of metabolic score for insulin resistance and new-onset stroke in middle-aged and older adults: a national cohort study
Main finding · Incident stroke by cumMETS-IRResult — go to the resultAdjusted hazard ratio 1.72 95% CI 1.22–2.42Authors' conclusion
Both cumMETS-IR and METS-IR change were associated with increased incidence of stroke in middle-aged and older Chinese adults. Monitoring changes in METS-IR over time may help characterize metabolic status more comprehensively and offer supportive information for stroke-related health assessment.
Study context
- Population
- Middle-aged and older adults from the China Health and Retirement Longitudinal Study (CHARLS), follow-up until 2020CHARLS
- Participants
- 4,344 participants
- Exposure
- Highest vs lowest quartile of cumulative metabolic score for insulin resistance (METS-IR); METS-IR change patterns vs low-stable
- Outcome
- New-onset stroke
- Follow-up
- 5-years median
Methodological detailsnational cohort, K-means clustering, Cox proportional hazards models, restricted cubic splines, mediation analysis
- National cohort
- K-means clustering
- Cox proportional hazards models
- Restricted cubic splines
- Mediation analysis
Main finding
Incident stroke by cumMETS-IR
Adjusted hazard ratio
1.72
95% CI 1.22–2.42
P = 0.002
Q4 cumMETS-IRvs Q1 cumMETS-IR
aHR 1.72 (95% CI 1.22–2.42); P = 0.002
As reported in the abstract
- New stroke events (overall)
- 385 (8.86%)
- Restricted cubic splines (RCS): Cumulative METS-IR (cumMETS-IR) positively correlated with incident stroke
- P-overall = 0.013, P-nonlinear = 0.252
Observational data: associations, not effects.
Further findings
Incident stroke by METS-IR change pattern — High-decreasing vs Low-stable
aHR 1.61 (1.08–2.42) · P = 0.021
- Incident stroke by METS-IR change pattern: per_group values are the share of participants in each pattern
Mediation by diastolic blood pressure (DBP)
- DBP partially explained the association; mediation proportion
- 9.6%
Sensitivity analyses
- Core findings remained robust across a series of sensitivity analyses
Original publication
Associations of metabolic score for insulin resistance and new-onset stroke in middle-aged and older adults: a national cohort study. Cardiovasc Diabetol. Published 11 June 2026. doi:10.
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