Studies on the relationship between insulin resistance (IR) surrogates and long-term all-cause mortality in patients with coronary heart disease (CHD) and hypertension are lacking. This study aimed to explore the relationship between different IR surrogates and all-cause mortality and identify valuable predictors of survival status in this population. The data came from the National Health and Nutrition Examination Survey (NHANES 2001–2018) and National Death Index (NDI). Multivariate Cox regression and restricted cubic splines (RCS) were performed to evaluate the relationship between homeostatic model assessment of IR (HOMA-IR), triglyceride glucose index (TyG index), triglyceride glucose-body mass index (TyG-BMI index) and all-cause mortality. The recursive algorithm was conducted to calculate inflection points when segmenting effects were found. Then, segmented Kaplan–Meier analysis, LogRank tests, and multivariable Cox regression were carried out. Receiver operating characteristic (ROC) and calibration curves were drawn to evaluate the differentiation and accuracy of IR surrogates in predicting the all-cause mortality. Stratified analysis and interaction tests were conducted according to age, gender, diabetes, cancer, hypoglycemic and lipid-lowering drug use. 1126 participants were included in the study. During the median follow-up of 76 months, 455 participants died. RCS showed that HOMA-IR had a segmented effect on all-cause mortality. 3.59 was a statistically significant inflection point. When the HOMA-IR was less than 3.59, it was negatively associated with all-cause mortality [HR = 0.87,95%CI (0.78, 0.97)]. Conversely, when the HOMA-IR was greater than 3.59, it was positively associated with all-cause mortality [HR = 1.03,95%CI (1.00, 1.05)]. ROC and calibration curves indicated that HOMA-IR was a reliable predictor of survival status (area under curve = 0,812). No interactions between HOMA-IR and stratified variables were found. The relationship between HOMA-IR and all-cause mortality was U-shaped in patients with CHD and hypertension. HOMA-IR was a reliable predictor of all-cause mortality in this population.

中文翻译：

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不同胰岛素抵抗替代指标与冠心病和高血压患者全因死亡率之间的关联：NHANES 纵向队列研究

目前缺乏关于胰岛素抵抗（IR）替代指标与冠心病（CHD）和高血压患者长期全因死亡率之间关系的研究。本研究旨在探讨不同 IR 替代指标与全因死亡率之间的关系，并确定该人群生存状态的有价值的预测因子。数据来自国家健康和营养检查调查（NHANES 2001-2018）和国家死亡指数（NDI）。采用多变量 Cox 回归和限制三次样条 (RCS) 来评估 IR 稳态模型评估 (HOMA-IR)、甘油三酯葡萄糖指数 (TyG 指数)、甘油三酯葡萄糖体重指数 (TyG-BMI 指数) 和所有指标之间的关系。 -导致死亡。当发现分段效应时，采用递归算法计算拐点。然后，进行分段Kaplan-Meier分析、LogRank检验和多变量Cox回归。绘制受试者工作特征 (ROC) 和校准曲线，以评估 IR 替代指标在预测全因死亡率方面的差异性和准确性。根据年龄、性别、糖尿病、癌症、降糖降脂药物使用情况进行分层分析和交互作用检验。该研究共有 1126 名参与者。在 76 个月的中位随访期间，455 名参与者死亡。RCS 显示 HOMA-IR 对全因死亡率具有分段效应。3.59是一个具有统计学意义的拐点。当HOMA-IR小于3.59时，与全因死亡率呈负相关[HR=0.87，95%CI(0.78，0.97)]。相反，当HOMA-IR大于3.59时，与全因死亡率呈正相关[HR=1.03，95%CI(1.00，1.05)]。ROC 和校准曲线表明 HOMA-IR 是生存状态的可靠预测因子（曲线下面积 = 0,812）。没有发现 HOMA-IR 和分层变量之间存在交互作用。在患有 CHD 和高血压的患者中，HOMA-IR 与全因死亡率之间的关系呈 U 形。HOMA-IR 是该人群全因死亡率的可靠预测指标。