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The Prognostic Value of Insulin Resistance Indices for Major Adverse Cardiovascular Events in Young and Middle-Aged
Xi Chen1,2,3, Wei Meng1,2,3, Bin Zhu1,2,3
1Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
Insights
The metabolic score for insulin resistance (METS-IR) effectively predicts long-term cardiovascular events in younger adults with hypertension. This practical marker aids in identifying high-risk individuals for better clinical management.
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Metabolic Syndrome
Background:
- Hypertension in young and middle-aged adults leads to earlier disease onset and prolonged elevated blood pressure exposure, increasing lifetime cardiovascular risk.
- Identifying reliable predictors for major adverse cardiovascular events (MACEs) in this demographic is crucial but remains challenging.
- Insulin resistance (IR) is integral to hypertension pathophysiology, yet direct measurement is often impractical.
Purpose of the Study:
- To evaluate the prognostic value of three laboratory-derived insulin resistance indices—triglyceride-glucose (TyG) index, triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio (TG/HDL-C), and metabolic score for IR (METS-IR)—in predicting MACEs.
- To assess the comparative performance of these indices in a cohort of hypertensive patients aged 18-65 years.
Main Methods:
- A retrospective cohort study involving 4861 patients with primary hypertension (aged 18-65 years).
- Baseline calculation of TyG index, TG/HDL-C ratio, and METS-IR, with classification into tertiles.
- Follow-up for a median of 73 months to record MACEs, analyzed using multivariable Cox regression.
Main Results:
- Higher baseline levels of TyG, TG/HDL-C, and METS-IR were independently associated with an increased risk of MACEs.
- Each standard deviation increase in METS-IR significantly elevated MACEs risk by 55.7% (fully adjusted model).
- METS-IR demonstrated superior predictive discrimination (AUC=0.803) and significant improvements in reclassification (NRI, IDI), while TyG showed borderline benefit and TG/HDL-C provided no incremental value.
Conclusions:
- The METS-IR index serves as a pragmatic and effective predictor of long-term cardiovascular risk in younger hypertensive patients.
- These findings support the integration of METS-IR into routine clinical practice for enhanced cardiovascular risk stratification in this population.
- METS-IR offers a valuable, accessible tool for identifying individuals at higher risk of MACEs, guiding preventative strategies.
Abstract:
Young and middle-aged adults with hypertension develop the disease earlier and accrue longer exposure to elevated blood pressure, conferring higher lifetime cardiovascular risk. However, reliable markers predicting long-term major adverse cardiovascular events (MACEs) in this group remain unclear. Insulin resistance (IR) is crucial to hypertensive pathophysiology, but direct measurement is impractical. We evaluated the prognostic value of three laboratory-derived IR indices, the triglyceride-glucose (TyG) index, the triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio (TG/HDL-C), and the metabolic score for IR (METS-IR), in predicting MACEs. In this retrospective cohort of 4861 patients aged 18-65 years with primary hypertension, baseline indices were calculated and classified into tertiles. Patients were followed for a median of 73 months, during which 372 MACEs occurred. Multivariable Cox regression showed that higher TyG, TG/HDL-C, and METS-IR were independently associated with increased MACEs risk. In fully adjusted models, each standard deviation increase in METS-IR conferred a 55.7% higher risk (HR = 1.557, 95% CI: 1.154-2.101, p < 0.01), and patients in the highest tertile had more than double the risk vs. the lowest. METS-IR showed superior discrimination (AUC = 0.803, 95% CI: 0.774-0.886) and significant net reclassification improvement (NRI = 0.147, 95% CI: 0.073-0.239, p = 0.001) and integrated discrimination improvement (IDI = 0.006, 95% CI: 0.002-0.010, p = 0.002), whereas TyG showed borderline benefit and TG/HDL-C offered no incremental value. These findings highlight METS-IR as a pragmatic predictor of long-term cardiovascular risk in younger hypertensive patients, supporting its integration into clinical risk stratification.
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