Changes in estimated glucose disposal rate and incident heart disease: A prospective cohort study from CHARLS and ELSA

Previous studies have shown that estimated glucose disposal rate (eGDR) is an important risk factor for heart disease. However, previous studies did not consider changes in eGDR during follow-up. This study aimed to investigate associations of changes in eGDR with incident heart disease. This study used data from 2 prospective cohorts: the China Health and Retirement Longitudinal Study (CHARLS) and the English Longitudinal Study of Ageing (ELSA). Changes in eGDR were assessed by eGDR at baseline and at the second survey using K-means clustering analysis, and the total eGDR was also calculated. Heart disease was assessed by self-reported physician-diagnosed heart disease (including angina, heart attack, congestive heart failure, and other heart problems). Cox proportional hazards models were used to calculate the hazard ratio (HR) and 95% confidence interval (95% CI) after adjustment for potential confounders. A total of 4929 participants from CHARLS (mean age: 58.6 years, male: 47.1%) and 2404 from ELSA (mean age: 63.3 years, male: 42.7%) were included for the main analyses. The median follow-up was 5.0 years in the CHARLS and 9.9 years in the ELSA. In the CHARLS, the HRs and 95% CIs for incident heart disease were 1.65 (1.29-2.11) for class 2 (high decreasing class), 1.39 (1.09-1.77) for class 3 (consistently moderate class), and 1.86 (1.49-2.31) for class 4 (consistently low class) compared with class 1 (consistently high class). In the ELSA, the HRs and 95% CIs for incident heart disease were 1.46 (1.12-1.91) for class 2, 1.45 (1.15-1.82) for class 3, and 1.68 (1.32-2.15) for class 4, compared to class 1. For total eGDR, lower levels of total eGDR were associated with an increased risk of incident heart disease in CHARLS and ELSA. A negative linear relationship between total eGDR and the risk of incident heart disease was observed using the multivariable adjusted restricted cubic spine models. Different changes in eGDR are associated with different risks of incident heart disease. Future research is needed to develop precise prevention strategies to maintain high levels of eGDR as well as tailored interventions to improve eGDR levels in cardiovascular practice.