Association of estimated glucose disposal rate trajectory with the incidence of cardiovascular disease over a 12-year follow-up: findings from the ELSA cohort study
X Li, L Lu, M Li, B Liu, R Guo, W He, W OuAbstract
Background
Estimated glucose disposal rate (eGDR) in baseline had been associated with an increased risk of cardiovascular disease (CVD) and mortality, demonstrating predictive value superior to other metabolic indices such as the triglyceride-glucose index and its derived parameters. However, the relationship between long-term trajectories of eGDR levels and the incidence of CVD remained unclear.
Purpose
This study aimed to move beyond traditional single-point baseline assessments to investigate the impact of dynamic eGDR trajectory patterns on incident CVD in a middle-aged and older British population.
Methods
This prospective cohort study utilized data from the English Longitudinal Study of Ageing (ELSA) spanning 2004 to 2017. eGDR was calculated as a composite measure based on waist circumference, hypertension status, and glycated hemoglobin A1c (HbA1c). Group-based trajectory modeling (GBTM) was employed to identify heterogeneous eGDR trajectory subgroups. Subsequently, multivariable Cox proportional hazards models were used to assess the associations between different eGDR trajectories and incident CVD. Subgroup and sensitivity analyses were conducted to test the robustness of the findings.
Results
Among 1,770 participants from the ELSA cohort who had eGDR measurements at Wave 2 and at least two additional measurements between Waves 2 and 6, GBTM identified four distinct trajectory patterns: low group (n=154), moderate-low group (n=663), moderate-high group (n=479), and high group (n=474). Over 12 years of follow-up, 370 incident CVD cases were recorded. The Kaplan-Meier cumulative incidence was significantly higher in the low group and moderate-low group compared to the high group (log-rank P<0.05). After full adjustment for potential confounders, compared to the high group, the low group had a significantly increased risk of incident CVD (HR 1.73, 95% CI 1.01–2.97, P=0.046), and the moderate-low group showed an even stronger association (HR 1.82, 95% CI 1.27–2.72, P=0.002). Results from subgroup and sensitivity analyses (excluding users of antihypertensive/hypoglycemic agents and smokers) were consistent with the primary findings.
Conclusions
Trajectories of persistently low eGDR levels were significantly associated with an increased risk of incident CVD. Trajectory analysis captures the cumulative effect of long-term insulin sensitivity changes more effectively than a single baseline measurement, better reflecting the dynamic impact of metabolic abnormalities on cardiovascular health. This supports the need for earlier, more precise monitoring and intervention targeting individuals with high-risk, persistently low eGDR trajectories to enable early prevention of CVD.Trajectory of eGDR trajectories over 12 yearsAssociation of eGDR trajectories with CVD