Relationship of the metabolic score for insulin resistance and the risk of stroke in patients with hypertension: A cohort study

Cai, Xintian; Hu, Junli; Zhu, Qing; Wang, Mengru; Li, Shasha; Dang, Yujie; Hong, Jing; Li, Nanfang

doi:10.3389/fendo.2022.1049211

Cited by 27 publications

(13 citation statements)

References 50 publications

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“…A study of 18,609 hypertensive patients found a nearly J-shaped association between METS-IR and the risk of stroke. 49 In our cohort study, our results are consistent with previous studies: METS-IR has a good predictive value for CVD, but we extend the previous research results and provide new evidence. First of all, our results show that METS-IR has a good predictive value not only for the risk of ischemic heart disease or stroke but also for CVD, including ischemic heart disease and stroke.…”

Section: Discussionsupporting

confidence: 92%

The Metabolic Score for Insulin Resistance (METS-IR) Predicts Cardiovascular Disease and Its Subtypes in Patients with Hypertension and Obstructive Sleep Apnea

Yang¹,

Cai²,

Hu³

et al. 2023

CLEP

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Objective We aimed to evaluate the METS-IR (metabolic score for insulin resistance) index for the prediction of incident cardiovascular disease (CVD) and its subtypes (coronary artery disease and stroke) in patients with hypertension and obstructive sleep apnea (OSA). Methods A retrospective cohort study was conducted with 2031 adults with hypertension and OSA, participants from the Urumqi Research on Sleep Apnea and Hypertension study (UROSAH). The hazard ratios and 95% CIs (credibility interval) for CVD and its subtypes were estimated using multivariate Cox proportional hazards regression models. Results After a median follow-up of 6.80 years (interquartile range: 5.90–8.00 years), a total of 317 (15.61%) participants developed new-onset CVD, including 198 (9.75%) incident coronary heart disease (CHD) and 119 (5.86%) incident stroke. After adjusting for as many relevant confounding factors as possible, each SD increase in METS-IR was associated with a 30% increased risk of new onset overall CVD events, a 32% increased risk of new onset CHD, and a 27% increased risk of new onset stroke. When METS-IR was assessed as tertiles, after adjustment for fully confounding factors, the highest tertiles versus the lowest tertiles were associated with a greater hazard of CVD (HR 2.05; 95% CI 1.52,-2.77), CHD (HR 1.96; 95% CI 1.35–2.84), and stroke (HR 2.24; 95% CI 1.35–3.72). The results of various subgroups and sensitivity analyses were similar. When METS-IR was added, CVD predictions were reclassified and identified more accurately than baseline models for the C-index, continuous net reclassification improvement, and integrated discrimination index. CHD and stroke showed similar results. Conclusion METS-IR is a powerful predictor of CVD and its subtypes in patients with hypertension and OSA, which can facilitate the identification of high-risk individuals and provide individualized CVD prevention.

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Section: Discussionsupporting

confidence: 92%

The Metabolic Score for Insulin Resistance (METS-IR) Predicts Cardiovascular Disease and Its Subtypes in Patients with Hypertension and Obstructive Sleep Apnea

Yang¹,

Cai²,

Hu³

et al. 2023

CLEP

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“…A retrospective cohort study with 2031 patients from the Urumqi Research on Sleep Apnea and Hypertension study showed that METS-IR was a powerful predictor of CVD and its subtypes in patients with hypertension and OSA [ 27 ]. Consistently, another study found a significant relationship between METS-IR with the risk of stroke among 14,032 hospitalized patients with hypertension [ 28 ]. Although the above studies indicated that METS-IR may help identify subjects at high risk of cardiovascular events, the studies are limited by the relatively small sample sizes, a single measurement of METS-IR, and the evident differences in study design and population characteristics, the results warrant confirmation in larger study with repeated measurements.…”

Section: Discussionsupporting

confidence: 58%

Magnitude and time course of insulin resistance accumulation with the risk of cardiovascular disease: an 11-years cohort study

Tian,

Chen,

et al. 2023

Cardiovasc Diabetol

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Background The risk of cardiovascular disease (CVD) depended on the magnitude and exposure duration of insulin resistance (IR). This study aimed to investigate the associations of cumulative metabolic score for IR (cumMETS-IR) with incident CVD, and to further explore the modulated effects of time course of METS-IR accumulation. Methods We enrolled 47,270 participants without CVD and underwent three examinations during 2006–2010 from the Kailuan study. CumMETS-IR from 2006 to 2010 were calculated as the mean values of METS-IR between consecutive examinations multiplying by time intervals between visits. Time course of METS-IR accumulation was calculated as the slope of METS-IR versus time. Hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD risk were calculated with multivariable-adjusted Cox regressions. Results During a median follow-up of 10.99 years, we identified 3184 cases of incident CVD. The risk of incident CVD increased with increasing cumMETS-IR (HR, 1.77; 95% CI 1.58–1.98 for the Q4 versus Q1 group), exposure duration (HR, 1.60; 95% CI 1.45–1.77 for 6 years versus 0 years), and cumulative burden (HR, 1.49; 95% CI 1.37–1.61 for burden ≥ 0 versus < 0). A positive slope was associated with 14% higher risk of CVD (HR, 1.14; 95% CI 1.07–1.22). When combining cumMETS-IR and slope, those with cumMETS-IR ≥ median (142.78) and slope ≥ 0 had the highest risk of CVD (HR,1.38; 95% CI 1.25–1.53). Conclusions The risk of CVD increased with elevated cumMETS-IR and an increasing trend over time, emphasizing the importance of maintaining optimal METS-IR levels across life span.

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“…discovered that METS-IR served as a potent predictor of CVD and its subtypes among patients with hypertension and obstructive sleep apnea, thereby aiding in the identification of high-risk individuals and offering personalized CVD prevention strategies ( 15 ). In another study conducted by the same researchers, it was suggested that there exists an association between METS-IR and the risk of both overall stroke and ischemic stroke specifically among patients with hypertension ( 16 ). These two studies primarily concentrated on assessing the cardiovascular and cerebrovascular risks associated with METS-IR among patients with hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…However, there are only few studies on the association between the METS-IR index and hypertension, with studies limited only to China, Mexico and Japan ( 15 , 16 , 18 – 22 ). The association between METS-IR and hypertension in the US population remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Association between a metabolic score for insulin resistance and hypertension: results from National Health and Nutrition Examination Survey 2007–2016 analyses

Zeng,

Zhang,

Yang

et al. 2024

Front. Endocrinol.

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BackgroundThe Metabolic Score for Insulin Resistance (METS-IR) offers a promising and reliable non-insulin-based approach to assess insulin resistance and evaluate cardiometabolic risk. However, evidence for the association between METS-IR and hypertension was still limited.MethodsParticipants from the National Health and Nutrition Examination Survey (NHANES) database from 2007-2016 were selected for weighted multivariable regression analyses, subgroup analyses and restricted cubic spline (RCS) modeling to assess the association between the METS-IR and hypertension, as well as systolic blood pressure (SBP) and diastolic blood pressure (DBP).ResultsThis study enrolled 7,721 adults aged ≥20 years, 2,926 (34.03%) of whom was diagnosed as hypertension. After adjusting for all potential covariates, an increased METS-IR (log2 conversion, denoted as log2METS-IR) was independently associated with a higher prevalence of hypertension (odd ratio [OR] 3.99, 95% confidence interval [CI] 3.19~5.01). The OR for hypertension in subjects with the highest quartile of METS-IR was 3.89-fold (OR 3.89, 95% CI 3.06~4.94) higher than that in those with the lowest quartile of METS-IR. This positive correlation became more significant as METS-IR increased (p for trend < 0.001). Log2METS-IR was significantly correlated with increase in SBP (β 6.75, 95% CI 5.65~7.85) and DBP (β 5.59, 95% CI 4.75~6.43) in a fully adjusted model. Consistent results were obtained in subgroup analyses. Hypertension, SBP and DBP all exhibited a non-linear increase with the rise in METS-IR. The minimal threshold for the beneficial association of METS-IR with hypertension, SBP and DBP were all identified to be 46.88.ConclusionThe findings of this study revealed a significant positive association between METS-IR and hypertension among US adults, suggesting METS-IR as a potential tool for assessing hypertension risk.

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Relationship of the metabolic score for insulin resistance and the risk of stroke in patients with hypertension: A cohort study

Cited by 27 publications

References 50 publications

The Metabolic Score for Insulin Resistance (METS-IR) Predicts Cardiovascular Disease and Its Subtypes in Patients with Hypertension and Obstructive Sleep Apnea

The Metabolic Score for Insulin Resistance (METS-IR) Predicts Cardiovascular Disease and Its Subtypes in Patients with Hypertension and Obstructive Sleep Apnea

Magnitude and time course of insulin resistance accumulation with the risk of cardiovascular disease: an 11-years cohort study

Association between a metabolic score for insulin resistance and hypertension: results from National Health and Nutrition Examination Survey 2007–2016 analyses

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