Associations of estimated glucose disposal rate with chest pain prevalence and mortality risks: a population-based study.
- 1Department of Hand and Plastic Surgery, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China.
- 2Clinical Laboratory Center, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, NO.1111, East Section of Wenzhou Avenue, Longwan District, Wenzhou City, Zhejiang Province, 325000, China. [email protected].
Abstract
Background
Estimated glucose disposal rate (eGDR), a validated surrogate for insulin resistance, is associated with cardiovascular disease, but its relationship with chest pain, which is a common presenting symptom of cardiovascular events, remains unclear. This study investigated the associations of eGDR with chest pain prevalence and all-cause mortality.Methods
Using cross-sectional and cohort study designs, we analyzed data from 1999 to 2018 National Health and Nutrition Examination Survey (NHANES). Survey-weighted logistic regression was used to examine the association between eGDR and chest pain prevalence, while weighted Cox model was used to evaluate the relationship between eGDR and all-cause mortality in participants with and without chest pain. Restricted cubic splines (RCS) examined potential nonlinearity, and Kaplan-Meier curves visualized survival differences by eGDR category. Mediation analysis examined whether white blood cells (WBC) count mediated the eGDR-mortality association.Results
The study included 13,161 participants, with the sample being weighted to reflect a population of 54,616,985 individuals. After full adjustment, each standard deviation (SD) increase in eGDR correlated with an 11% lower odds of chest pain (P < 0.001). Cox regression revealed each SD rise in eGDR was associated with a 7% lower risk of all-cause mortality among participants with chest pain (P = 0.004). RCS confirmed linear relationships for eGDR with both chest pain prevalence and mortality risk, irrespective of chest pain status. When eGDR was dichotomized at the population median (7.34 mg/kg/min), participants with high eGDR was significantly associated with reduced odds of chest pain (OR = 0.67, 95% CI: 0.59-0.77, P < 0.001) and lower all-cause mortality (HR = 0.85, 95% CI: 0.75-0.95, P = 0.006) compared to those with low eGDR. Kaplan-Meier curves demonstrated a clear survival advantage for participants with higher eGDR. WBC mediated 20.04% of the association between eGDR and all-cause mortality (Pindirect < 0.001).Conclusion
Higher eGDR is robustly associated with lower chest pain prevalence and reduced all-cause mortality risk, irrespective of chest pain status. The partial mediation by WBC suggests a potential inflammatory pathway. These findings support the potential value of eGDR in non-invasive cardiometabolic risk stratification.
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BibTeX
@article{wang2026associations,
title = {{Associations of estimated glucose disposal rate with chest pain prevalence and mortality risks: a population-based study.}},
author = {Jieke Wang and Manli Ye},
journal = {BMC cardiovascular disorders},
year = {2026},
month = jul,
doi = {10.1186/s12872-026-06336-0},
url = {https://europepmc.org/article/MED/42902173},
note = {CC BY},
}
RIS
TY - JOUR
TI - Associations of estimated glucose disposal rate with chest pain prevalence and mortality risks: a population-based study.
AU - Jieke Wang
AU - Manli Ye
PY - 2026
DA - 2026/07/01
JO - BMC cardiovascular disorders
DO - 10.1186/s12872-026-06336-0
UR - https://europepmc.org/article/MED/42902173
AB - Background Estimated glucose disposal rate (eGDR), a validated surrogate for insulin resistance, is associated with cardiovascular disease, but its relationship with chest pain, which is a common presenting symptom of cardiovascular events, remains unclear. This study investigated the associations of eGDR with chest pain prevalence and all-cause mortality.Methods Using cross-sectional and cohort study designs, we analyzed data from 1999 to 2018 National Health and Nutrition Examination Survey (NHANES). Survey-weighted logistic regression was used to examine the association between eGDR and chest pain prevalence, while weighted Cox model was used to evaluate the relationship between eGDR and all-cause mortality in participants with and without chest pain. Restricted cubic splines (RCS) examined potential nonlinearity, and Kaplan-Meier curves visualized survival differences by eGDR category. Mediation analysis examined whether white blood cells (WBC) count mediated the eGDR-mortality association.Results The study included 13,161 participants, with the sample being weighted to reflect a population of 54,616,985 individuals. After full adjustment, each standard deviation (SD) increase in eGDR correlated with an 11% lower odds of chest pain (P < 0.001). Cox regression revealed each SD rise in eGDR was associated with a 7% lower risk of all-cause mortality among participants with chest pain (P = 0.004). RCS confirmed linear relationships for eGDR with both chest pain prevalence and mortality risk, irrespective of chest pain status. When eGDR was dichotomized at the population median (7.34 mg/kg/min), participants with high eGDR was significantly associated with reduced odds of chest pain (OR = 0.67, 95% CI: 0.59-0.77, P < 0.001) and lower all-cause mortality (HR = 0.85, 95% CI: 0.75-0.95, P = 0.006) compared to those with low eGDR. Kaplan-Meier curves demonstrated a clear survival advantage for participants with higher eGDR. WBC mediated 20.04% of the association between eGDR and all-cause mortality (Pindirect < 0.001).Conclusion Higher eGDR is robustly associated with lower chest pain prevalence and reduced all-cause mortality risk, irrespective of chest pain status. The partial mediation by WBC suggests a potential inflammatory pathway. These findings support the potential value of eGDR in non-invasive cardiometabolic risk stratification.
SN - 1471-2261
ER -