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Insulin Resistance Markers and Cardiovascular Mortality: A Comparative Study in a Portuguese Population
Session:
Sessão de Comunicações Orais 05 – Para além do LDL: determinantes metabólicos do risco cardiovascular
Speaker:
Gonçalo Bettencourt Abreu
Congress:
CPC 2026
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.3 Secondary Prevention
Session Type:
Comunicações Orais
FP Number:
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Authors:
Gonçalo Bettencourt Abreu; Maria Isabel Mendonça; Matilde Ferreira; Francisco Sousa; Filipa Escórcio Silva; Eva Henriques; Sónia Freitas; Mariana Rodrigues; Sofia Borges; António Drumond; Ana Célia Sousa; Roberto Palma Dos Reis
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> Cardiovascular diseases with cardiometabolic conditions have a high prevalence of comorbidities and an elevated mortality risk. Insulin resistance (IR) is a significant contributor to their pathogenesis. Several assessors for IR are employed in clinical evaluations; however, their relationship with mortality is imprecise.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Objective:</strong> This study aimed to investigate the association between various markers of IR and all-cause and cardiovascular (CV) mortality in patients with cardiometabolic diseases.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: This cohort study included 1,720 cardiovascular patients with cardiometabolic conditions (78.8% male; mean age, 53.3±7.9 years) with extended follow-up (average, 7.6±6.7 years). The IR levels were assessed using four surrogate markers, such as: triglyceride-glucose (TyG) index, TyG-waist circumference (TyG-WC), TyG-waist-to-height ratio (TyG-WHtR), and metabolic score for insulin resistance (METS-IR)=[ln(2xfasting plasma glucose +triglycerides)xBMI]/ln(HDL-C)<span style="background-color:white"><span style="color:black">.</span></span> To investigate the associations between different IR surrogates and both all-cause and CV mortalities, Cox proportional hazard models were applied. We employed restricted cubic splines (RCS) to examine nonlinear associations.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> Among 1,720 patients, 361 (21.0%) died from CV causes. In bivariate analysis, the four surrogate markers were significantly correlated with CV mortality (all with p<0.0001). However, Cox regression analyses of the four surrogate markers showed that only the TyG index and METS-IR were significantly and independently associated with CV mortality. The optimal threshold values for CV mortality for TyG and METS-IR were 9.3 and 48.9, respectively. Above their respective inflexion points, both markers demonstrated a positive correlation with CV mortality (HR 1.27; 95%CI: 1.01–1.61; p=0.044 and HR=1.29; 95%CI: 1.04-1.61;p=0.023, respectively). RCS analysis revealed a nonlinear relationship for both TyG and METS-IR, and CV mortality, with little risk change in at low–moderate TyG levels but a steep, progressive increase in risk at higher TyG and METS-IR values. Overall, elevated TyG and METS-IR are associated with substantially higher CV mortality. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:</strong> TyG and METS-IR are significantly associated with CV mortality. This study highlights the prognostic significance of these two markers, particularly in predicting CV mortality, helping guide early intervention strategies (lifestyle changes and therapeutic interventions).</span></span></p>
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