ArticleCardiovascular diabetology2025
Can cardiovascular health and its modifiable healthy lifestyle offset the increased risk of all-cause and cardiovascular deaths associated with insulin resistance?
Article in Cardiovascular diabetology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Associations of triglyceride-glucose-related composite obesity indices with cardiovascular diseases and mortality: a systematic review and meta-analysis.Cardiovascular diabetology · 2026Pooled it
- Metabolomic and lifestyle profiles refine BMI-metabolic phenotypes in older adults.Cell reports. Medicine · 2026Article
- The Role of Exercise in Cardiovascular Metabolism and Its Importance for Adolescent Metabolic Health.Advances in experimental medicine and biology · 2026Review
- TyG Index and Obesity-Related Measures in Relation to All-Cause Mortality Among HSV-Positive Adults.International journal of endocrinology · 2026Article
- Article
- Association of triglyceride glucose index with cardiovascular autonomic neuropathy in type 2 diabetes mellitus.Frontiers in cardiovascular medicine · 2026Article
- Urinary Albumin-to-Creatinine Ratio, Cardiovascular Health, and All-Cause Mortality in Hypertension: A Nationwide Cohort Analysis.Journal of clinical hypertension (Greenwich, Conn.) · 2025Article
- Triglyceride glucose-weight-adjusted waist index as a cardiovascular mortality predictor: incremental value beyond the establishment of TyG-related indices.Cardiovascular diabetology · 2025Article
- Impact of the triglyceride-glucose-neutrophil-to-lymphocyte ratio and the C-reactive protein-TyG index on cardio-renal disease in patients with type 2 diabetes.Frontiers in endocrinology · 2025Article
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Abstract
backgroundInsulin resistance(IR) is associated with an increased risk of all-cause and cardiovascular death, and modifiable healthy lifestyles play an active role in the improvement of IR and the reduction of all-cause and cardiovascular death. Whether cardiovascular health (CVH) and modifiable healthy lifestyles within it can attenuate or even offset the heightened perils of both all-cause and cardiovascular deaths associated with insulin resistance remains unclear.
methodsThe study encompassed 14,172 healthy participants from the 2005-2018 NHANES programme. Insulin resistance was evaluated using the TyG index, TyG-WC, and TyG-WHtR, while CVH was assessed employing the LE8 score, in addition to the LE4 index redefined according to four health behaviours. Weighted multifactor Cox regression models were used to assess the association of IR and CVH with all-cause and cardiovascular mortality, and dose-response relationships were assessed using restricted cubic spline. Furthermore, subjects were grouped according to IR and CVH scores, and generalised linear models were used to estimate the weighted mortality and risk of death for each group and to calculate the absolute risk difference. Finally, the predicted probability of all-cause and cardiovascular mortality risk as a function of IR was computed, and the complex relationship between the three was visualised using two-dimensional grouped scatter plots and three-dimensional surface plots.
resultsAmong the 14,172 healthy participants included in the study, 1534 deaths occurred over a mean follow-up period of 7.6 years (382 of these deaths were due to cardiovascular causes). The weighted Cox regression analysis indicated that elevated TyG-WC and TyG-WHtR correlated with a greater likelihood of mortality from all causes and cardiovascular events, whereas cardiovascular health was inversely associated with these risks. Additional stratification revealed a notable reduction in the likelihood of mortality from all causes and cardiovascular events as cardiovascular health improved, irrespective of the presence of insulin resistance. Additionally, participants with high insulin resistance but moderate or high cardiovascular health did not have significantly increased risks compared with those with low insulin resistance. Stratified scatter plots and 3D surface plots revealed that cardiovascular health and modifiable healthy lifestyles significantly reduced the risk of insulin resistance-related death, with greater reductions observed at higher insulin resistance levels.
conclusionsIn this cohort study, improving cardiovascular health and modifiable health behaviors significantly reduced the risk of insulin resistance-related all-cause and cardiovascular deaths. Maintaining cardiovascular health at moderate or high levels (LE8 ≥ 50) could offset the increased risks caused by insulin resistance.
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