Association of prediabetes and insulin resistance on prognosis of patients with moderate-to-severe coronary artery calcification: a prospective cohort study

作者：Enmin Xie, Huimin Cai, Zixiang Ye, Min Yang, Lei Feng, Cheng‐Gang Zhu, Jia Li, Kefei Dou · 发表于：Cardiovascular Diabetology · 年份：2025 · DOI：10.1186/s12933-025-02807-4 · 被引用次数：7 · 研究领域：Cardiac Imaging and Diagnostics、Parathyroid Disorders and Treatments、Cardiovascular Function and Risk Factors

BACKGROUND: Prediabetes and insulin resistance are linked to the presence and progression of coronary artery calcification, but their prognostic significance in individuals with moderate-to-severe coronary artery calcification (MSCAC) remains unclear. The triglyceride-glucose (TyG) index, a validated surrogate marker of insulin resistance and a reliable predictor of cardiovascular outcomes, has not been thoroughly investigated for its role in risk stratification in patients with MSCAC. This study sought to evaluate the prognostic value of different prediabetes definitions and to determine whether the TyG index enhances risk stratification in this population. METHODS: This prospective cohort study consecutively enrolled 4195 patients with angiography-detected MSCAC. Prediabetes was defined using two criteria: the American Diabetes Association (ADA) criteria (fasting plasma glucose [FPG] 5.6-6.9 mmol/L and/or hemoglobin A1c [HbA1c] 5.7-6.4%), and the World Health Organization (WHO)/International Expert Committee (IEC) criteria (FPG 6.1-6.9 mmol/L and/or HbA1c 6.0-6.4%). The primary outcome was the incidence of major adverse cardiovascular events (MACE), including cardiovascular death, nonfatal myocardial infarction, and stroke. RESULTS: The prevalence of ADA-defined prediabetes was 36.6%, nearly twice that of WHO/IEC-defined prediabetes (17.9%). Over a median follow-up of 3.1 years, WHO/IEC-defined prediabetes was significantly associated with an increased risk of MACE compared...