Cohort of 3,050 adults: high eGDR plus high physical activity linked to CVD hazard ratio of 0.52

Researchers analysed 3,050 adults with cardiovascular-kidney-metabolic (CKM) syndrome stages 0–3 from the China Health and Retirement Longitudinal Study (CHARLS) and found that a higher estimated glucose disposal rate (eGDR) and higher physical activity were each associated with fewer cardiovascular events. The work was published in Diabetology & Metabolic Syndrome. Participants were enrolled at the 2011 baseline survey and followed through 2020. During this period 718 people (23.54%) developed cardiovascular disease (CVD) biomedcentral.comDiabetology & Metabolic Syndromebiomedcentral.comOpen source ↗.

CKM syndrome is a concept proposed by the American Heart Association to describe the links between kidney disease, heart disease and metabolic factors. Earlier studies had associated insulin resistance in stages 0–3 with CVD, but the role of physical exercise in this relationship was unclear. In this study eGDR served as the index of insulin resistance, and the metabolic equivalents (MET) score served as the index of physical activity.

Independent and joint associations

Low eGDR and low MET scores were each independently associated with a higher incidence of CVD. In model 3, the hazard ratio (HR) for the high eGDR group was 0.61 (95% CI 0.52–0.72), and for the high physical activity group 0.81 (95% CI 0.69–0.95).

Participants with both high eGDR and high physical activity had the lowest incidence of CVD. Their HR was 0.52 (95% CI 0.42–0.65) compared with those low on both measures biomedcentral.comDiabetology & Metabolic Syndromebiomedcentral.comOpen source ↗. Restricted cubic spline curves showed a negative linear correlation of both markers with CVD. No statistically significant additive or multiplicative interaction between eGDR and physical activity was observed.

Mediation and methods

The authors used Cox regression, restricted cubic spline curves, Kaplan-Meier survival curves, interaction analysis and subgroup analyses. An exploratory mediation analysis tested whether insulin resistance explained part of the link between physical activity and CVD. It found that eGDR mediated 12.72% of the total effect (P = 0.008).

The authors concluded that eGDR and physical activity showed independent and additive protective associations with CVD in CKM syndrome stages 0–3. They also reported that insulin resistance may mediate the association between physical activity and CVD, pointing to the potential importance of physical activity in reducing CVD risk. The study is observational, so the results describe associations within the cohort.