Head-to-head comparison of fasting-insulin-based versus non-insulin-based insulin resistance surrogates for predicting all-cause and cardiovascular mortality in hypertensive adults across the glycemic continuum: a prospective cohort study
Authors' conclusion
In hypertensive adults, HOMA-IR was the only fasting-insulin-based index independently associated with ACM across all three glycemic strata. eGDR demonstrated the most consistent non-insulin-based associations with ACM and CVM, particularly in prediabetes and diabetes. TyG provided additional prognostic value for ACM and CVM, particularly in patients with diabetes. These findings support selecting IR indices based on glycemic phenotype and data availability.
Study context
- Population
- Hypertensive adults from NHANES 1999–2018
- Participants
- 7,548 adults
- Exposure
- Fasting-insulin-based vs non-insulin-based insulin resistance (IR) surrogates for predicting all-cause mortality (ACM) and cardiovascular mortality (CVM)
- Normoglycemian = 1,869
- Prediabetesn = 3,389
- Diabetesn = 2,290
- Outcome
- All-cause mortality (ACM) and cardiovascular mortality (CVM)
- Follow-up
- Mean 8.7 ± 5.3 years
Methodological detailsMortality data collected through December 31, 2019, Cox models with three levels of adjustment; restricted cubic splines for dose-response
- Mortality data collected through December 31, 2019
- Cox models with three levels of adjustment; restricted cubic splines for dose-response
Main finding
As reported in the abstract
- ACM events
- 1,752 (23.2%)
- CVM events
- 499 (6.6%)
- Homeostasis model assessment of insulin resistance (HOMA-IR), ACM per-unit HR
- 1.017
- HOMA-IR, ACM Q4 HR
- 1.165
- HOMA-IR, CVM per-unit HR
- 1.012
- Estimated glucose disposal rate (eGDR) (strongest overall associations), ACM per-unit HR
- 0.807
- eGDR, ACM Q4 HR
- 0.559
- eGDR, CVM per-unit HR
- 0.774
- eGDR, CVM Q4 HR
- 0.538
- TyG, ACM per-unit HR
- 1.158
- TyG, ACM Q4 HR
- 1.233
- TyG, CVM per-unit HR
- 1.160
Observational data: associations, not effects.
Further findings
HR
| Outcome | Normoglycemia | Prediabetes | Diabetes |
|---|---|---|---|
| HOMA-IR per-unit ACM by glycemic stratum (only index significant in all three strata) | 1.085 | 1.039 | 1.012 |
eGDR by glycemic stratum
- CVM Q4 HR, prediabetes
- 0.465
- CVM Q4 HR, diabetes
- 0.463
- Per-unit and Q4 ACM significance in prediabetes and diabetes
- Per-unit CVM associations only in diabetes
TyG in diabetes
- ACM per-unit HR
- 1.147
- ACM Q4 HR
- 1.337
- CVM Q4 HR
- 1.595
Original publication
Head-to-head comparison of fasting-insulin-based versus non-insulin-based insulin resistance surrogates for predicting all-cause and cardiovascular mortality in hypertensive adults across the glycemic continuum: a prospective cohort study. Cardiovasc Diabetol. Published 15 June 2026. doi:10.
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