Impact of surrogates for insulin resistance on mortality and life expectancy in primary care: a nationwide cross-sectional study with registry linkage (LIPIDOGRAM2015)

Yang Chen; Ziyi Zhong; Ying Gue; Maciej Banach; Garry McDowell; Dimitri P Mikhailidis; Peter P Toth; Peter E Penson; Tomasz Tomasik; Adam Windak; Marek Gierlotka; Tadeusz Osadnik; Agnieszka Kuras; Marcin Miga; Jacek Jozwiak; Gregory Y H Lip; LIPIDOGRAM2015 Investigators

doi:10.1016/j.lanepe.2024.101182

Impact of surrogates for insulin resistance on mortality and life expectancy in primary care: a nationwide cross-sectional study with registry linkage (LIPIDOGRAM2015)

Lancet Reg Health Eur. 2024 Dec 12:49:101182. doi: 10.1016/j.lanepe.2024.101182. eCollection 2025 Feb.

Authors

Yang Chen^{1

2}, Ziyi Zhong^{1

3}, Ying Gue¹, Maciej Banach^{4

5

6

7}, Garry McDowell^{1

8}, Dimitri P Mikhailidis⁹, Peter P Toth^{4

10}, Peter E Penson^{11

12

13}, Tomasz Tomasik¹⁴, Adam Windak¹⁴, Marek Gierlotka¹⁵, Tadeusz Osadnik¹⁶, Agnieszka Kuras¹⁷, Marcin Miga¹⁸, Jacek Jozwiak¹⁹, Gregory Y H Lip^{1

20

21}; LIPIDOGRAM2015 Investigators

Collaborators

LIPIDOGRAM2015 Investigators:
B Al-Shaer, W Andrusewicz, M Andrzejczuk-Rosa, E Anusz-Gaszewska, A Bagińska, P Balawajder, G Bańka, E Barańska-Skubisz, B Barbara Przyczyna, S Bartkowiak, J Bartodziej, M Bartosiewicz, M Basałyga, A Batyra, A Bąk, M Bednarz, K Bejnar, W Bernacki, M Betiuk-Kwiatkowska, S Biegaj, M Bień, W Bilski, M Biłogan, G Biruta-Pawłowska, A Biskup, B Błaszczyk, H Błaszczyk, T BłońskaJankowska, B Bogacka-Gancarczyk, M Bojanowska, E Bonda, J Borowik-Skwarek, J Borowska, J Bruckner, J Brzostek, M Brzuchacz, M Budzyńska, I Bulzacka-Fugiel, J Bulzak, K Bunikowski, A Cebulska, T Celka, E Cempel-Nowak, W Chechliński, A Chludzińska, D Chmiel, M Chmielewska, M Cichy, A Ciemięga, A Ciepluch, I Cieszyńska, B Czajka, B Czapla, M Czerner, B Czerwińska, W Czuryszkiewicz, E Daleka, Z Dawid, M Dąbrowska, R Dąbrowska, D Dąbrowski, M Dąbrowski, K Demczyszyn, A Dębowska-Serwińska, J Dmochowski, J Dobrzecka-Kiwior, E Dolanowska, H Dolanowski, P Dołek, M Domagała, H Domański, A Doszel, D Duda, M Dudkowska, B Dudziuk, P Dybciak, M Dymanowski, L Dziadzio-Bolek, M Eicke, H El-Hassan, A Eremus, M Fąferek-Muller, E Figura-Roguska, I Fijałkowska-Kaczmarek, M Flis, T Florczak, M Florczuk, E Foryszewska-Witan, W Frydrych, A Fugiel, E Futyma, A Gaca-Jaroszewicz, I Gajdamowicz, K Ganczarski, A Gatnar, M Gers, A Głowacki, K Głód, J Godula, J Gołąb, M Gołębiewski, E Goszczyńska, K Gościcka, A GórnaHajduga, E Górny, T Grabowska, R Grabowski, A Graczyk-Duda, A Gromow, A Grudewicz, J Gruszecka, A Gruszka, J Gryboś, J Grzebyk, A Grzechowiak, D Grzesiak, T Grześkowiak, A Guźla, G Hachuła, B Hawel, H Hiltawska, E Honkowicz, J Ignatowicz, K Imielski, A Iwaniura, A JagiełaSzymala, M Jalć-Sowała, A Janczylik, E Janisz, M Janiszek, K Jankiewicz-Ziobro, K Januszewska, A Jaremek, A Jaros-Urbaniak, J Jarosz, P Jarosz, W Jasiński, M Jezierska-Wasilewska, T Jędraszewski, A Jędrzejowska, R Józefowicz, K Juźwin, E Kacprzak, J Kaczmarek-Szewczyk, M Kaczmarzyk, R Kandziora, C Kaniewski, L Karolak-Brandt, S Kasperczyk, E Kasperek-Dyląg, I Kedziora, A Kępa, J Kiciński, J Kielak-Al-Hosam, Ł Kiełczawa, P Kilimowicz, K Kitliński, T Kiwka, U Klein, L Klichowicz, A Klimowicz, B Klonowski, B Kmolek, E Kobyłko-Klepacka, A Kocoń, A Kolenda, E Kollek, M Kopeć, B Koper-Kozikowska, J Koralewska, M Korczyńska, M T Korzeniewski, A Kosk, K Kotarski, E Kowalczyk, M Kowalczyk, I Kowalik, B Kozak-Błażkiewicz, M Kozik, D Kozłowska, E Kozłowska, M Kozłowska, T Kozubski, K Kózka, L Kraśnik, T Krężel, B Krochmal, B Król, G Król, J Król, T Królikowska, H Kruszewska, B Krygier-Potrykus, W Krystek, J Krzysztoń, T Kubicki, A Kuczmierczyk-El-Hassan, W Kuczyńska-Witek, D Kujda, A Kurowski, I Kurzelewska-Solarz, M Kwaczyńska, M Kwaśniak, P Kwaśniak, T Kwietniewska, A Łebek-Ordon, A Lebiedowicz, L Lejkowska-Olszewska, M Lentas, A Lesiewicz-Ksycińska, M Limanowski, S Łoniewski, J A Łopata, B Łubianka, I Łukasiuk, M Łużna, M Łysiak, B Łysik, Z Machowski, J Maciaczyk-Kubiak, G Mackiewicz-Zabochnicka, Z Magner-Krężel, S Majda, P Malinowski, J Mantyka, E Marchlik, G Martyna-Ordyniec, J Marzec, M Marzec, R Matejko-Wałkiewicz, M Mazur, M Michalczak, A Michalska-Żyłka, M Michniewicz, D Mika-Staniszewska, E Mikiciuk, T Mikołajczak, J Milewski, E Miller, B Misiaszek, M Mizik-Łukowska, E Młyńczyk-Pokutycka, M Mocek, M Moczała, M Morawska-Hermanowicz, P Moryc, A Moskal, S Moskal, A Moździerz, P Moździerz, M Mrozińska, K Mrozowicz, G Mróz, T Munia, A Mura, M Muras-Skudlarska, E Z Murawska, Ł Murawski, R Murawski, R Musielak, K Nadaj, W Nagarnowicz, R Napierała, M Niedźwiecka, A Niemirski, J Nikiel, M Nosal, W Nowacki, J Nowak, M Nyrka, A Obst, J Ochowicz, E Ogonowska, M Oleszczyk, A Ołdakowski, I Ołowniuk-Stefaniak, J Ordowska-Rejman, M Orliński, B Osińska, A Ostańska-Burian, A Paciorkowska, U Paczkowska, L Paluch, L Pałka, J Paszko-Wojtkowska, A Paszkowska, E PawlakGanczarska, W Pawlik, I Pawłowska, M Paździora, G Permiakow, A Petlic-Marendziak, T Piasecka, E Piaścińska, A Piktel, A Pilarska-Igielska, A Piotrkowska, K Piwowar-Klag, M Planer, J Plewa, P Płatkiewicz, B Płonczyńska, A Podgórska, M Polewska, B Porębska, P Porwoł, I Potakowska, A Prokop, J Przybylski, M Przybyła, H Psiuk, K Ptak, G Puzoń, N Rabiza, S Rachwalik, E Raczyńska, M Raniszewska, A Romanek-Kozik, A Rosa, K Rosa, A Rozewicz, J Rudzka-Kałwak, J Rusak, D Rutkowska, M Rybacki, D Rybińska, A Rycyk-Sadowska, L Rynda, B Rynkiewicz, B SadowskaKrawczyk, M Sadowska-Zarzycka, B Sarnecka, E Sawalach-Tomanik, B Sidor-Drozd, M SiemieniakDębska, A Sieroń, B Siewniak-Zalewska, A Sikora, B Sitarska-Pawlina, J Skorupski, I SkrzypińskaMansfeld, J Skubisz, R Skwarek, M Słodyczka, M Smentek, K Smolińska, B Solarz, W Sosnowska, B Sroka, H Stachura, D Stangreciak, M Staniak, Z Stańczyk, D Stańszczak-Ozga, E Startek, M Stefańczyk, R Stelmach, E Sternadel-Rączka, M Sternik, J Stępień, J Stocka, M Stokowska-Wojda, M Studler-Karpińska, W Suchorukow, W Sufryd, B Supłacz, J Sygacz, Ł Szczepański, J Szkandera, J Szłapa-Zellner, D Szydlarska, T Śliwa, J Śliwka, Ł Śmiejkowski, A Targońska, E Tesarska, M Tobiasz, J Tomaka, K Tomalska-Bywalec, E Tomiak, S Topczewski, A Trawińska, L Trela-Mucha, D Trojanowski, M Trzaskowska, B Trzcińska-Larska, A Trznadel-Mozul, K Ulanicka-Liwoch, M Urbanowicz, A Uthke-Kluzek, J Waczyński, J Walczak, L Warsz, M Wasyńczuk, U Wąchała-Jędras, D Wąsowicz, J Wczysła, F Wenda, E Werner-Kubicka, E Weryszko, B Węgrzynowska, M Wiaksa, M Wiankowski, A Wicherek, R Wieczorek, R Wiencek, G Wienzek-Tatara, B Wierzbicka, M Wierzbicki, B Wilczyńska, D Wilmańska, P Winiarski, A Wiszniewska-Pabiszczak, M B Witkowska, J Witzling, A Wlaź, I Wojtkowiak, J Woydyłło, K Woźniak, A Wójtowicz, J Wrona, M Wrońska, H Wujkowska, J Wyrąbek, O Wysokiński, R Zakrzewski, J Zaleska-Zatkalik, J Zaleski, M Zalewska-Dybciak, E Zalewska, B Zalewska-Uchimiak, J Zawadzka-Krajewska, J Zawadzki, A Zieliński, E Zubrycka, I Żybort, M Żymełka

Affiliations

¹ Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
² Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom.
³ Department of Musculoskeletal Ageing and Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom.
⁴ Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
⁵ Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Rzgowska 281/289, Lodz 93-338, Poland.
⁶ Department of Cardiology and Adult Congenital Heart Diseases, Polish Mother's Memorial Hospital Research Institute (PMMHRI), Rzgowska 281/289, Lodz 93-338, Poland.
⁷ Cardiovascular Research Centre, University of Zielona Gora, Zyty 28, Zielona Gora 65-046, Poland.
⁸ School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, United Kingdom.
⁹ Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), Pond St., London NW3 2QG, UK.
¹⁰ 14CGH Medical Center, Department of Preventive Cardiology, 101 East Miller Road, Sterling, IL 61081, USA.
¹¹ Clinical Pharmacy & Therapeutics Research Group, School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, James Parsons Building, Byrom Street, Liverpool L3 3AF, UK.
¹² Liverpool Centre for Cardiovascular Science, University of Liverpool, Brownlow Hill, Liverpool L69 7TX, UK.
¹³ Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, 6 West Derby St., Liverpool L7 8TX, UK.
¹⁴ Department of Family Medicine, Jagiellonian University Medical College, Bochenska 4 Street, Krakow 31-061, Poland.
¹⁵ Department of Cardiology, Institute of Medical Sciences, University of Opole, Oleska 48, Opole 45-052, Poland.
¹⁶ Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland, Jordana 38 Street, Zabrze 41-808, Poland.
¹⁷ Multiprofile Medical Simulation Center, University of Opole, Oleska 48 Street, Opole 45-052, Poland.
¹⁸ Clinical University Hospital, Witosa 26 Avenue, Opole 45-401, Poland.
¹⁹ Department of Family Medicine and Public Health, Institute of Medical Sciences, University of Opole, Oleska 48, Opole 45-052, Poland.
²⁰ Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
²¹ Medical University of Bialystok, Bialystok 15-089, Poland.

Abstract

Background: Insulin resistance (IR) is an important risk factor for multiple chronic diseases, increasing mortality and reducing life expectancy. The associations between emerging surrogates for IR, triglyceride-glucose index (TyG) and TyG-related indicators, with all-cause mortality and life expectancy in middle-aged and older patients in primary care are unclear.

Methods: This study originated from the Polish primary care cohort LIPIDOGRAM2015, including patients aged ≥45 years. Baseline fasting triglycerides and fasting glucose were used to derive TyG. Other TyG-related indicators included TyG-adjusted body mass index (TyG-BMI), TyG-adjusted waist circumference (TyG-WC), TyG-adjusted waist-to-hip, and TyG-adjusted waist-to-height. In this longitudinal analysis, we assessed associations between TyG-related indicators with total all-cause mortality, premature (age at death ≤75 years) all-cause mortality and years of life lost (YLL).

Findings: We included 10,688 patients (mean age 61.8 ± 9.3 years; 63.5% female). Cumulative total and premature all-cause mortality were 7.2% and 4.6%, respectively, during 5.7 years (IQR 5.6-5.7) of follow-up. Lowest (Q1) and highest quartile (Q4) of TyG-BMI and TyG-WC were associated with total all-cause mortality (second quartile [Q2]: reference; TyG-BMI: Q1: aHR 1.33, 95% CI 1.07-1.65, Q4: aHR 1.28, 95% CI 1.03-1.58; TyG-WC: Q1: aHR 1.44, 95% CI 1.14-1.82, Q4: aHR 1.29, 95% CI 1.04-1.59), similar results for premature all-cause mortality. Within age 45-80 years, compared with Q2 and third quartile, YLL were 4.49 and 5.46 years for TyG-BMI Q1 and Q4, respectively, 3.24 and 5.31 years for TyG-WC Q1 and Q4, respectively.

Interpretation: TyG-BMI and TyG-WC demonstrated a U-shaped association with total and premature all-cause mortality. Low and high levels of TyG-BMI and TyG-WC were associated with reduced life expectancy. Despite the relatively short follow-up period, significant associations were still observed, but longer follow-up studies are required to further explore these relationships.

Funding: Polish Lipid Association, College of Family Physician in Poland, Valeant in Poland.

Keywords: All-cause mortality; Insulin resistance; Premature mortality; Triglyceride-glucose index; TyG-adjusted body mass index; TyG-adjusted waist circumference; Years of life lost.