Comparison of the predictive value of four insulin resistance surrogates for the prevalence of hypertension: a population-based study

Abstract

Background Several studies have investigated the association of insulin resistance (IR) surrogates and the risk of hypertension. However, it is unclear whether there exist differences between different IR surrogates and hypertension risk. Therefore, this study aimed to explore the association of four IR surrogates (triglyceride-glucose index (TyG index), triglyceride-glucose index with body mass index (TyG-BMI), triglycerides/high-density lipoprotein cholesterol ratio (TG/HDL-c), and metabolic score for IR (METS-IR)) with the prevalence of hypertension. Methods This is a cross-sectional study with a total of 117,056 participants. Data were extracted from a computerized database established by Rich Healthcare Group in China, which included all medical records of participants who received a health check-up from 2010 to 2016. IR surrogates were grouped into quartiles as continuous variables, and multivariate logistic regression was performed to estimate the association between different IR surrogate levels and the prevalence of hypertension. Results were expressed as odds ratios (ORs) and 95% confidence intervals (CIs). Missing data were accounted by multiple imputation. These analyses were considered as the sensitivity analysis. Meanwhile, the Bayesian network (BN) model was constructed to further evaluate the relationship between baseline characteristics and the four IR surrogates and the prevalence of hypertension, as well as the importance of every single variable for the prevalence of hypertension. Results Multivariate logistic regression analysis revealed that TyG-BMI and METS-IR were independent risk factors for the prevalence of hypertension that increased significantly with increasing TyG-BMI and METS-IR (p for trend < 0.001). The area under the TyG-BMI curve (AUC) was 0.681 [95% CI: 0.677–0.685], and the cut-off value was 199.5, with a sensitivity and specificity of 65.57% and 61.18%, respectively. While the area under the METS-IR curve (AUC) was 0.679 [95% CI: 0.674–0.683], and the cut-off value was 33.61, with a sensitivity and specificity of 69.67% and 56.67%, respectively. The BN model presented that among these four IR surrogates and related variables, TyG-BMI was the most important predictor of hypertension prevalence, with a significance of 34%. The results before and after multiple imputation were similar. Conclusion TyG-BMI and METS-IR were independent risk factors for the prevalence of hypertension. TyG-BMI and METS-IR had good predictive value for the prevalence of hypertension, and TyG-BMI was superior to METS-IR.

Association Between the Metabolic Score for Insulin Resistance and Hypertension in Adults: A Meta-Analysis

“…As shown in Table 1 , eight observational studies, including two cohort studies 21 28 and six cross-sectional studies 22 23 24 25 26 27 , were included in the meta-analysis. These studies were published between 2019 and 2022, and performed in Mexico 21 , China 22 23 24 25 , 27 28 , and Japan 26 .…”

“…As shown in Table 1 , eight observational studies, including two cohort studies 21 28 and six cross-sectional studies 22 23 24 25 26 27 , were included in the meta-analysis. These studies were published between 2019 and 2022, and performed in Mexico 21 , China 22 23 24 25 , 27 28 , and Japan 26 . Four of them included community-derived adult population 21 23 , 26 27 , and the other four included adults for routine health check 22 24 , 25 28 .…”

“…These studies were published between 2019 and 2022, and performed in Mexico 21 , China 22 23 24 25 , 27 28 , and Japan 26 . Four of them included community-derived adult population 21 23 , 26 27 , and the other four included adults for routine health check 22 24 , 25 28 . Overall, 305 341 adults were included in the meta-analysis, and 47 887 (15.7%) of them had hypertension.…”

“…For the two cohort studies 21 28 , the mean follow-up durations were 2.9 and 3 years, respectively. For all of the included studies, METS-IR was analyzed as categorized variables and compared between the fourth versus the first quartiles in seven studies 21 22 23 24 , 26 27 28 , and between the third versus the first tertiles in the other study 25 . In three of the included studies 26 27 28 , METS-IR was also analyzed as continuous variables.…”

“…Then, an additional 147 articles were excluded since the contents of the titles and abstracts indicated that they were not relevant to the aim of the meta-analysis, which made a total of 18 studies for the full-text review. Finally, after excluding ten studies through full-text review, eight studies [21][22][23][24][25][26][27][28] were included. The reasons for the removing of the ten studies are also presented in ▶Fig.…”