Variations in Single-Point Insulin Sensitivity Estimator Index and the Risk of Cardiovascular Disease in Individuals With Cardiovascular-Kidney-Metabolic Syndrome Stages 0 to 3: A National Longitudinal Cohort Study.
既往研究仅关注基线单点胰岛素敏感性估计指标（SPISE指数）水平，而纵向SPISE指数轨迹对新发心血管疾病（CVD）的预后影响尚不明确，尤其是在心血管-肾脏-代谢综合征0至3期的个体中。本研究探讨了动态SPISE指数变化对该临床前人群CVD风险的预后价值。本前瞻性队列研究使用了CHARLS（中国健康与养老追踪调查）的数据。SPISE指数通过体重指数、甘油三酯和高密度脂蛋白胆固醇计算得出。我们通过比较第1波（基线）和第3波的测量数据，评估了纵向SPISE轨迹和累积SPISE指数暴露。采用多变量Cox比例风险模型评估基线、累积和动态SPISE指数特征与心血管-肾脏-代谢0至3期参与者新发CVD风险的关联。纵向队列包含7982名参与者，累积暴露亚队列包含5288名参与者。与SPISE指数持续处于高水平者相比，SPISE指数从高降至低的参与者CVD风险显著升高（风险比[HR]，1.28 [95% CI，1.06-1.53]），与SPISE指数持续处于低水平者相似（HR，1.36 [95% CI，1.18-1.56]）。基线和累积SPISE指数最高三分位组参与者的CVD风险分别降低22%和29%，且性别对效应有显著修饰作用。在心血管-肾脏-代谢综合征0至3期的个体中，基线和累积SPISE指数均与新发CVD风险独立负相关，且这种保护效应在男性中尤为显著。
Prior studies have focused exclusively on baseline single-point insulin sensitivity estimator (SPISE) index levels, and the prognostic impact of longitudinal SPISE index trajectories on incident cardiovascular disease (CVD) remains unclear, particularly among individuals with cardiovascular-kidney-metabolic syndrome stages 0 to 3. This study investigated the prognostic value of dynamic SPISE index changes for CVD risk in this preclinical population. This prospective cohort study used data from the CHARLS (China Health and Retirement Longitudinal Study). The SPISE index was calculated using body mass index, triglycerides, and high-density lipoprotein cholesterol. We assessed longitudinal SPISE trajectories and cumulative SPISE index exposure by comparing measurements from wave 1 (baseline) and wave 3. Multivariable Cox proportional hazards models were used to evaluate associations of baseline, cumulative, and dynamic SPISE index profiles with incident CVD risk among participants at cardiovascular-kidney-metabolic stages 0 to 3. The longitudinal cohort comprised 7982 participants, and the cumulative exposure subcohort included 5288 participants. Compared with those with persistently high SPISE index, participants with SPISE index deterioration from high to low had significantly elevated CVD risk (hazard ratio [HR], 1.28 [95% CI, 1.06-1.53]), similar to those with a persistently low SPISE index (HR, 1.36 [95% CI, 1.18-1.56]). Participants in the highest tertiles of baseline and cumulative SPISE index had 22% and 29% lower CVD risk, respectively, with significant effect modification by sex. Among individuals in cardiovascular-kidney-metabolic syndrome stages 0 to 3, both baseline and cumulative SPISE indices are independently and inversely associated with incident CVD risk, with this protective effect being particularly pronounced in men.
Yumeng Shi, Yunfeng Shen. Variations in Single-Point Insulin Sensitivity Estimator Index and the Risk of Cardiovascular Disease in Individuals With Cardiovascular-Kidney-Metabolic Syndrome Stages 0 to 3: A National Longitudinal Cohort Study.. Journal of the American Heart Association. 2026; doi:10.1161/JAHA.126.051048.
Yumeng Shi, Yunfeng Shen (2026). Variations in Single-Point Insulin Sensitivity Estimator Index and the Risk of Cardiovascular Disease in Individuals With Cardiovascular-Kidney-Metabolic Syndrome Stages 0 to 3: A National Longitudinal Cohort Study.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.126.051048
Yumeng Shi, Yunfeng Shen. Variations in Single-Point Insulin Sensitivity Estimator Index and the Risk of Cardiovascular Disease in Individuals With Cardiovascular-Kidney-Metabolic Syndrome Stages 0 to 3: A National Longitudinal Cohort Study.[J]. Journal of the American Heart Association, 2026 doi:10.1161/JAHA.126.051048.
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