Arterial stiffness mediates insulin resistance-related risk of atherosclerotic cardiovascular disease: A real-life, prospective cohort study
Author Identifier
Yulong Lan: https://orcid.org/0000-0002-6143-9709
Document Type
Journal Article
Publication Title
European Journal of Preventive Cardiology
Publisher
Oxford Academic
School
Centre for Precision Health / School of Medical and Health Sciences
RAS ID
79404
Funders
Faculty Development Grants from Hubei University of Medicine (2023QDJZR16) / Faculty Development Grants of Xiangyang No.1 People’s Hospital Affiliated to Hubei University of Medicine (XYY2024D02) / Hubei Provincial Natural Science Foundation (2023AFB1102)
Abstract
Aims: The precise pathways connecting insulin resistance (IR) to atherosclerotic cardiovascular disease (ASCVD) remain undefined. The present study aimed to examine the mediating role of arterial stiffness in the association between IR and ASCVD, providing epidemiology insights into the potential mechanisms driving IR to incident ASCVD. Methods and results A total of 59 777 participants from the Kailuan Study Arterial Stiffness Subcohort who were free of ASCVD at baseline were enrolled in the present study. Arterial stiffness was assessed using brachial-ankle pulse wave velocity (baPWV), and IR was assessed by triglyceride-glucose index (TyG) or metabolic score for insulin resistance (METS-IR). Mediation analysis was adopted to explore the mediating effects of baPWV on the associations between IR and ASCVD and its subtypes. Over a median follow-up of 5.97 years, a total of 2073 cases of ASCVD were identified, with 478 cases of coronary heart disease (CHD) and 1636 cases of ischaemic stroke. Mediation analyses revealed that 11.1% of the total association (hazard ratio 1.23; 95% confidence interval 1.17–1.30) between the TyG index and ASCVD was mediated through baPWV. Specifically, 6.58% and 14.0% of the total associations of the TyG index with CHD and ischaemic stroke, respectively, were mediated through baPWV. Similar patterns were observed for METS-IR. These results remained consistent when assessed through causal mediation analysis, time-lagged mediation analysis, and various sensitivity analyses. Conclusion The association between IR indices and ASCVD was found to be partly mediated by baPWV, indicating a pathway connecting IR to ASCVD outcomes and the potential for interventions targeting arterial stiffness for ASCVD prevention.
DOI
10.1093/eurjpc/zwaf030
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Comments
Wu, Z., Lan, Y., Wu, D., Chen, S., Jiao, R., & Wu, S. (2025). Arterial stiffness mediates insulin resistance-related risk of atherosclerotic cardiovascular disease: A real-life, prospective cohort study. European Journal of Preventive Cardiology. Advance online publication. https://doi.org/10.1093/eurjpc/zwaf030