Objective To investigate the relationship between estimated glucose disposal rate (eGDR) and the incidence of cardiovascular disease (CVD) in individuals without diabetes and those with diabetes. Methods Participants were drawn from the China Health and Retirement Longitudinal Study from 2011 to 2018. Participants were divided into four subgroups based on quartiles of baseline eGDR. In this study, data were analyzed using Kaplan-Meier survival curves, Cox proportional hazards models, restricted cubic spline curves, subgroup analyses, and receiver operator characteristic curves. Results A total of 6 283 participants were included. Among them, 47.2% are male, with an average age of (59.6±9.5) years; 285 cases (4.5%) had diabetes; there were 1 571 cases in Q1 group, 1 572 cases in Q2 group, 1 583 cases in Q3 group, and 1 557 cases in Q4 group. A total of 761 CVD events occurred. According to the multivariate-adjusted model, baseline eGDR levels were significantly associated with the risk of CVD events (P<0.05). Baseline eGDR was associated with the risk of CVD events in individuals without diabetes (P<0.05), but the results were not entirely consistent for those with diabetes [CVD: hazard ratio (HR)=0.85, 95% confidence interval (CI) (0.75, 0.96), P=0.012; heart disease: HR=0.91, 95%CI (0.78, 1.06), P=0.211; stroke: HR=0.74, 95%CI (0.58, 0.93), P=0.012]. Restricted cubic spline curves revealed significant negative linear relationships between baseline eGDR and CVD, heart disease, and stroke. Subgroup analyses with interaction testing revealed that the association between baseline eGDR and CVD was not modified by age, sex, smoking status, alcohol consumption, or dyslipidemia. Receiver operator characteristic curves further demonstrated that baseline eGDR exhibited significantly better predictive performance than the triglyceride-glucose (TyG) index, obesity indices, and the TyG index-obesity composite. Conclusions Low level baseline eGDR is associated with an increased risk of CVD in individuals without diabetes. This finding may help improve risk stratification to guide preventive measures and enhance the prognosis of CVD.
目的 探讨大剂量西地兰联合小剂量酒石酸美托洛尔经静脉途径治疗急性左心衰伴快速心室率心房颤动的疗效与安全性。 方法 将2005年6月－2012年2月收治的76例急性左心衰伴快速心室率心房颤动患者，随机分配至对照组（39例）与治疗组（37例），对照组静脉注射西地兰，治疗组静脉注射西地兰与小剂量酒石酸美托洛尔，分别在用药开始时及用药开始后全程监测收缩压、心室率、呼吸频率、手指脉搏血氧饱和度（SpO2）、呼吸困难程度、肺部啰音与治疗2 h时尿量，记录急性左心衰改善时间。 结果 两组患者在治疗开始时心室率（P=0.246）、呼吸频率（P=0.390）、收缩压（P=0.525）与SpO2（P=0.482）均无统计学意义；在治疗整个过程中，两组患者收缩压与治疗2 h尿量均无统计学意义（P=0.264）；在治疗开始后30、60、90、120 min时治疗组患者心室率均显著低于对照组（P=0.000）。治疗组患者从在治疗开始到急性左心衰改善的时间明显短于对照组（P=0.003）。试验期间无1例患者出现病情恶化或死亡。 结论 在排除美托洛尔禁忌症的前提下，在严密监测肺部啰音及指氧饱和度的情况下，对那些平时心功能Ⅰ~Ⅱ级的急性左心衰伴快速心室率心房颤动患者，在经静脉途径给予大剂量西地兰的同时，间断多次静脉注射小剂量美托洛尔，能安全有效地控制过快心室率，缩短急性左心衰竭持续时间。