A comparison between lipid-based vs. glycemic-based insulin sensitivity indices for the association with abnormal ECG findings and 20-year mortality among older adults
Authors' conclusion
TyG-WTHR was the only ISI associated with ischemic changes on ECG and all-cause and cardiovascular mortality and significantly improved the predictive performance for all-cause cardiovascular mortality. While most glycemic-based and lipid-based ISIs showed similar predictive ability, TyG-WTHR stands as the preferred ISI and should be considered for screening at-risk individuals for cardiovascular morbidity and mortality.
Study context
- Population
- Community-dwelling older adults, third phase of the Glucose intolerance, Obesity, and Hypertension study (1999–2008); mean age 72.3 ± 7 years, 49% female
- Participants
- 963 adults
- Exposure
- Lipid-based vs glycemic-based insulin sensitivity indices
- Outcome
- Ischemic ECG changes
Methodological detailscommunity-based, multivariable regression, AUC and net reclassification improvement (NRI) analysis, Eleven insulin sensitivity indices (ISIs) calculated, Followed until December 2016 (CV mortality) and December 2019 (all-cause mortality)
- Community-based
- Multivariable regression
- AUC and NRI analysis
- Eleven ISIs calculated
- Followed until December 2016 (CV mortality) and December 2019 (all-cause mortality)
Main finding
As reported in the abstract
Ischemic ECG changes, all participants
107
11.2%
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| All-cause mortality per TyG-WTHR · median follow-up 13 [IQR-8] years | 1.3 (1.0–1.6) | P = 0.04 | |
| CV mortality per TyG-WTHR · median follow-up 11 [IQR-6] years | 1.7 (1.2–2.4) | P = 0.004 | |
| 0.512Hazard ratio (log scale) |
- All-cause mortality per triglyceride-glucose waist-to-height ratio (TyG-WTHR) — Deaths
- 466 (48.4%)
- CV mortality per TyG-WTHR — CV deaths
- 179 (38.4%)
All-cause mortality per TyG-WTHR · median follow-up 13 [IQR-8] years
- TyG-WTHR was the only ISI associated with both all-cause and CV mortality
Predictive ability for all-cause mortality (AUC)
- Lipid-based and glycemic ISIs showed similar predictive ability; slightly better for TyG-WTHR
- AUC 0.46 (95%CI 0.4-0.5, p = 0.02)
Net reclassification improvement (NRI)
- TyG-WTHR model correctly reclassified for CV mortality vs model without ISIs
- 19% (95%CI 0.02-0.36, p = 0.03)
- TyG-WTHR model correctly reclassified for all-cause mortality vs QUICKI-based model
- 3% (95%CI 0.003-0.05, p = 0.02)
- Better reclassification for all-cause mortality: triglyceride-HDL ratio (95%CI 0.02-0.27, p = 0.03)
- Better reclassification for all-cause mortality: TyG-WTHR (95%CI 0.0004-0.01, p = 0.03)
Original publication
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