Data Sheet 1_Estimated glucose disposal rate and cardiovascular disease risk: a meta-analysis of cohort studies.pdf

BackgroundInsulin resistance (IR) is a key cardiovascular disease (CVD) risk factor. The estimated glucose disposal rate (eGDR) is a reliable IR marker linked to CVD risk. This study is the first extensive meta-analysis of this correlation in a general population free from baseline CVD.
MethodsWe searched electronic databases such as PubMed, Web of Science and Embase for cohort studies reporting eGDR and CVD risk. Studies included adults without baseline CVD, measured eGDR at baseline, and reported hazard ratio (HR) [95% confidence interval (CI)]. The combined HR and its 95% CI were determined through the application of random or fixed effects models. Meta-regression with robust error was utilized to depict the nonlinear dose-response relationship.
ResultsTwelve cohort studies with 547,287 subjects were included, with follow-up durations ranging from 5.6 to 14.1 years. Participants with the highest eGDR category had a lower risk of CVD (HR: 0.58, 95% CI 0.53–0.63), stroke (HR: 0.62, 95% CI: 0.56–0.69), and coronary heart disease (HR: 0.46, 95% CI: 0.25–0.83) compared with the lowest eGDR category. This aligns with the meta-analysis results, where eGDR as a continuous variable had HRs of 0.88 (95% CI: 0.85–0.91) for CVD, 0.84 (95% CI: 0.76–0.93) for stroke, and 0.85 (95% CI: 0.83–0.87) for coronary heart disease. Subgroup analyses revealed that sex, sample size, follow-up duration, and prediabetes/diabetes status did not significantly affect the results. Dose–response analysis indicated that there was a linear negative association of the eGDR with the risk of CVD (Pnonlinear=0.120) or stroke (Pnonlinear=0.084).
ConclusionsThe higher eGDR is associated with lower risk of CVD, stroke, and coronary heart disease in individuals without baseline CVD. However, the observational design and high heterogeneity across studies prevent causal inference.

背景：胰岛素抵抗（Insulin resistance, IR）是心血管疾病（cardiovascular disease, CVD）的关键危险因素。估算葡萄糖处置率（estimated glucose disposal rate, eGDR）是与心血管疾病风险相关的可靠胰岛素抵抗标志物。本研究是首个针对无基线心血管疾病的普通人群中该相关性开展的大规模荟萃分析。
方法：我们检索了PubMed、Web of Science、Embase等电子数据库，查找报告了估算葡萄糖处置率与心血管疾病风险的队列研究。纳入研究需满足以下条件：研究对象为无基线心血管疾病的成年人，于基线时测量估算葡萄糖处置率，且报告了风险比（hazard ratio, HR）[95%置信区间（confidence interval, CI）]。通过随机效应模型或固定效应模型计算合并风险比及其95%置信区间。采用稳健误差meta回归分析刻画非线性剂量-反应关系。
结果：最终纳入12项队列研究，共涉及547287名受试者，随访时长为5.6至14.1年。与最低估算葡萄糖处置率组相比，最高估算葡萄糖处置率组受试者罹患心血管疾病（风险比：0.58，95%置信区间0.53–0.63）、脑卒中（风险比：0.62，95%置信区间0.56–0.69）及冠心病（风险比：0.46，95%置信区间0.25–0.83）的风险更低。该结果与荟萃分析整体结论一致：当估算葡萄糖处置率作为连续变量时，心血管疾病、脑卒中、冠心病的合并风险比分别为0.88（95%置信区间0.85–0.91）、0.84（95%置信区间0.76–0.93）及0.85（95%置信区间0.83–0.87）。亚组分析显示，性别、样本量、随访时长以及糖尿病前期/糖尿病状态均未对结果产生显著影响。剂量-反应分析表明，估算葡萄糖处置率与心血管疾病（P非线性=0.120）或脑卒中（P非线性=0.084）的风险呈线性负相关。
结论：在无基线心血管疾病的人群中，较高的估算葡萄糖处置率与较低的心血管疾病、脑卒中及冠心病风险相关。但由于本研究为观察性设计，且纳入研究间存在较高异质性，无法进行因果推断。