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Author Spotlight: Assessing the Cardiovascular Profile of Patients with Metabolic Syndrome
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Enhancing cardiovascular risk prediction in hypertensive adults: a 3PM-based evaluation of insulin resistance and

Yulong Lan1,2, Zhaogui Wu3, Dan Wu1,2

  • 1Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong China.

The EPMA Journal
|November 28, 2025
PubMed

Insights

Insulin resistance (IR) and arterial stiffness synergistically increase atherosclerotic cardiovascular disease (ASCVD) risk in hypertension patients. Combining these biomarkers improves risk prediction and enables personalized preventive strategies.

Area of Science:

  • Cardiovascular Medicine
  • Metabolic Syndrome
  • Hypertension Research

Background:

  • Hypertension management is complicated by coexisting insulin resistance (IR) and arterial stiffness.
  • These conditions are silent, synergistic drivers of atherosclerotic cardiovascular disease (ASCVD).
  • Understanding their combined impact is crucial for effective ASCVD risk stratification.

Purpose of the Study:

  • To evaluate the joint impact of IR and arterial stiffness on ASCVD risk in hypertensive adults.
  • To assess the utility of these biomarkers in predictive, preventive, and personalized medicine (PPPM) strategies.

Main Methods:

  • Prospective cohort study of 30,094 hypertensive adults.
  • Insulin resistance assessed via triglyceride-glucose (TyG) index.
  • Arterial stiffness measured by brachial-ankle pulse wave velocity (baPWV).
  • Time-to-event analyses for ASCVD incidence.

Main Results:

  • A median 5.6-year follow-up observed 1655 ASCVD cases.
  • Elevated TyG index showed a dose-response relationship with ASCVD risk across baPWV strata.
  • Individuals with both elevated TyG and baPWV had significantly higher ASCVD risk (HR: 1.93, 95% CI: 1.66-2.25).
  • A significant additive interaction (33.4% of joint risk) was identified.
  • Combined biomarkers improved model discrimination (C-index: 0.68) and reclassification (NRI: 18.63%).

Conclusions:

  • Insulin resistance and arterial stiffness have a synergistic effect on ASCVD risk.
  • Integrating these biomarkers into predictive models enhances early identification of high-risk hypertensive patients.
  • This dual-biomarker approach supports PPPM for optimizing cardiovascular outcomes through tailored interventions.
Abstract

Keywords:
ASCVDArterial stiffnessCardiovascular riskHypertensionImproved individual outcomesInsulin resistancePredictive preventive personalized medicine (PPPM / 3PM)Prospective cohort studyTriglyceride-glucose index

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