The association of stress hyperglycemia ratio (SHR) with arterial stiffness: A cross-sectional study

Stress hyperglycemia ratio (SHR) is used to assess the relative increase in blood glucose during stress and is associated with various adverse clinical events. There is evidence suggesting that SHR may be related to an increased risk of cardiovascular mortality. Arterial stiffness is an independent predictor of cardiovascular events. However, the relationship between SHR and arterial stiffness has not been reported. This study analyzed the data from the National Health and Nutrition Examination Survey from 2005 to 2018. The calculation formula of SHR is [fasting plasma glucose (mmol/L)]/[1.59 × HbA1c (%) - 2.59]. Arterial stiffness was evaluated by estimated pulse wave velocity (ePWV). The relationship between SHR and ePWV was explored through weighted linear regression, logistic regression, and restricted cubic spline (RCS). In addition, subgroup analysis and interaction analysis were conducted. A total of 14,965 participants were included, with a mean age of 47.99 (0.27) years, including 7534 females (50.64%). When ePWV is taken as a continuous variable, weighted linear regression showed that SHR was independently positively associated with ePWV (β: 0.26; 95% CI: 0.11-0.41; P < .001). After defining ePWV ≥ 10 m/s as elevated ePWV, weighted logistic regression indicated that SHR was still independently positively associated with elevated ePWV (OR: 2.23; 95% CI: 1.05-4.75; P = .04). RCS showed that SHR had a nonlinear and linear association with continuous ePWV and elevated ePWV respectively. Subgroup and interaction analyses suggested that the association between SHR and ePWV was slightly weaker in these groups: overweight and obese individuals, diabetic patients, and cancer patients. This study suggests an independent positive association between SHR and arterial stiffness in the American adult population, which is slightly weaker in obese, diabetic, and cancer. Future prospective studies are needed to verify our findings further.