Estimated glucose disposal rate shows the broadest associations with cardiometabolic multimorbidity progression in early cardiovascular–kidney–metabolic stages: a longitudinal cohort study
- 1Department of Neurology, The Affiliated Hospital of Qingdao University , ,
- 2Department of Gastroenterology, The Affiliated Hospital of Qingdao University , ,
Abstract
Background: Early risk stratification may help prevent cardiometabolic multimorbidity (CMM) among adults at cardiovascular–kidney–metabolic (CKM) stages 0–3. We compared the estimated glucose disposal rate (eGDR), triglyceride–glucose (TyG) index, and atherogenic index of plasma (AIP) for incident CMM, disease transitions, and incremental prediction.
Methods: This longitudinal cohort analysis included 6,407 China Health and Retirement Longitudinal Study participants aged 45–79 years at CKM stages 0–3 and free of CMM in 2011, with follow-up through 2020. CMM was defined as the coexistence of at least two of diabetes, heart disease, and stroke. Cox models estimated hazard ratios (HRs) per standard deviation in the adverse direction (lower eGDR or higher TyG or AIP). Restricted cubic-spline and multistate models assessed dose–response patterns and transitions; five repetitions of stratified fivefold out-of-fold validation evaluated incremental 9-year prediction.
Results: During a median follow-up of 9.0 years, 593 participants developed CMM. Primary-model HRs per adverse standard deviation were 1.92 (95% confidence interval [CI], 1.77–2.09) for eGDR, 1.69 (95% CI, 1.57–1.82) for TyG, and 1.51 (95% CI, 1.39–1.64) for AIP. After CKM-stage adjustment, eGDR remained associated with all three disease-accumulation transitions (false-discovery-rate-adjusted P ≤ 0.009); TyG remained associated only with the earliest transition, and no AIP transition survived correction. Among single-marker additions, eGDR yielded the largest point gain in discrimination (ΔC-index, 0.041; 95% CI, 0.027–0.055). Adding TyG to eGDR further increased the C-index by 0.012 (95% CI, 0.005–0.020), whereas adding AIP to eGDR plus TyG changed the C-index by 0.001 (95% CI, −0.003 to 0.005). Calibration slopes were 0.910–0.945. Interval-aware and competing-risk analyses were consistent.
Conclusion: All three indices were associated with incident CMM. eGDR showed the most consistent transition associations and the numerically largest single-marker gain in internally validated prediction; TyG was complementary, whereas AIP added little beyond eGDR and TyG. Independent external validation and clinical-utility assessment are needed before use in early risk stratification.
Related
- Differential associations of baseline, dynamic change, and cumulative average TyG-BMI with incident cardiometabolic multimorbidity: a longitudinal landmark analysis of CHARLS
- Associations of cumulative exposure and dynamic trajectories of the combined estimated glucose disposal rate and frailty index with incident cardiometabolic multimorbidity comprising diabetes, heart disease, and stroke: a longitudinal analysis based on the China health and retirement longitudinal study (CHARLS)
- Hemoglobin glycation index and the dynamic progression of cardiometabolic multimorbidity and mortality: a multi-state Markov analysis
- Body Roundness Index Predicts Incident Cardiometabolic-depression Multimorbidity: A Dose-response Analysis of 19,802 Adults in China Health and Retirement Longitudinal Study and English Longitudinal Study of Ageing Cohorts
- Longitudinal joint trajectories of the dietary inflammatory index and physical activity and risk of incident cardiometabolic multimorbidity among women: evidence from the China Health and Nutrition Survey
BibTeX
@article{wang2026estimated,
title = {{Estimated glucose disposal rate shows the broadest associations with cardiometabolic multimorbidity progression in early cardiovascular–kidney–metabolic stages: a longitudinal cohort study}},
author = {Zunwei Wang and Yanyan Liu and Yitong Ling and Yujie Sun},
journal = {Frontiers in endocrinology},
year = {2026},
month = sep,
doi = {10.3389/fendo.2026.1948249},
url = {https://europepmc.org/article/PMC/PMC13662789},
note = {CC BY},
}
RIS
TY - JOUR
TI - Estimated glucose disposal rate shows the broadest associations with cardiometabolic multimorbidity progression in early cardiovascular–kidney–metabolic stages: a longitudinal cohort study
AU - Zunwei Wang
AU - Yanyan Liu
AU - Yitong Ling
AU - Yujie Sun
PY - 2026
DA - 2026/09/30
JO - Frontiers in endocrinology
DO - 10.3389/fendo.2026.1948249
UR - https://europepmc.org/article/PMC/PMC13662789
AB - Background: Early risk stratification may help prevent cardiometabolic multimorbidity (CMM) among adults at cardiovascular–kidney–metabolic (CKM) stages 0–3. We compared the estimated glucose disposal rate (eGDR), triglyceride–glucose (TyG) index, and atherogenic index of plasma (AIP) for incident CMM, disease transitions, and incremental prediction. Methods: This longitudinal cohort analysis included 6,407 China Health and Retirement Longitudinal Study participants aged 45–79 years at CKM stages 0–3 and free of CMM in 2011, with follow-up through 2020. CMM was defined as the coexistence of at least two of diabetes, heart disease, and stroke. Cox models estimated hazard ratios (HRs) per standard deviation in the adverse direction (lower eGDR or higher TyG or AIP). Restricted cubic-spline and multistate models assessed dose–response patterns and transitions; five repetitions of stratified fivefold out-of-fold validation evaluated incremental 9-year prediction. Results: During a median follow-up of 9.0 years, 593 participants developed CMM. Primary-model HRs per adverse standard deviation were 1.92 (95% confidence interval [CI], 1.77–2.09) for eGDR, 1.69 (95% CI, 1.57–1.82) for TyG, and 1.51 (95% CI, 1.39–1.64) for AIP. After CKM-stage adjustment, eGDR remained associated with all three disease-accumulation transitions (false-discovery-rate-adjusted P ≤ 0.009); TyG remained associated only with the earliest transition, and no AIP transition survived correction. Among single-marker additions, eGDR yielded the largest point gain in discrimination (ΔC-index, 0.041; 95% CI, 0.027–0.055). Adding TyG to eGDR further increased the C-index by 0.012 (95% CI, 0.005–0.020), whereas adding AIP to eGDR plus TyG changed the C-index by 0.001 (95% CI, −0.003 to 0.005). Calibration slopes were 0.910–0.945. Interval-aware and competing-risk analyses were consistent. Conclusion: All three indices were associated with incident CMM. eGDR showed the most consistent transition associations and the numerically largest single-marker gain in internally validated prediction; TyG was complementary, whereas AIP added little beyond eGDR and TyG. Independent external validation and clinical-utility assessment are needed before use in early risk stratification.
SN - 1664-2392
ER -