L-shaped relationship between stress hyperglycemia ratio and cardiovascular disease risk in middle-aged and older adults: Insight from the China Health and Retirement Longitudinal Study.
<h4>Background</h4>The stress hyperglycemia ratio (SHR) has emerged as a potential marker for predicting cardiovascular disease (CVD) and mortality. However, its relationship with CVD and all-cause mortality in middle-aged and older Chinese populations remains unclear.<h4>Methods&l...
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Public Library of Science (PLoS)
2025-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0324978 |
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| author | Zixi Zhang Jiabao Zhou Cancan Wang Kang Wang Yongguo Dai Qiuzhen Lin Yichao Xiao Qiming Liu |
| author_facet | Zixi Zhang Jiabao Zhou Cancan Wang Kang Wang Yongguo Dai Qiuzhen Lin Yichao Xiao Qiming Liu |
| author_sort | Zixi Zhang |
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| description | <h4>Background</h4>The stress hyperglycemia ratio (SHR) has emerged as a potential marker for predicting cardiovascular disease (CVD) and mortality. However, its relationship with CVD and all-cause mortality in middle-aged and older Chinese populations remains unclear.<h4>Methods</h4>This study analyzed data from the China Health and Retirement Longitudinal Study (CHARLS), including individuals aged 45 years and older. Cross-sectional analysis assessed the associations between SHR and CVD incidence, whereas longitudinal Cox regression models evaluated the relationships between SHR, CVD risk, and all-cause mortality. Restricted cubic spline analyses were employed to explore potential non-linear relationships. The predictive performance of SHR was compared with that of fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c).<h4>Results</h4>The cross-sectional analysis identified an inverse association between the SHR and CVD incidence. Longitudinal analysis indicated that SHR was independently associated with an increased risk of CVD, with a significant L-shaped relationship (non-linear P = 0.001). Threshold effect analysis identified 0.985 as the inflection point for SHR, with hazard ratios (HRs) increasing sharply below this level (HR: 0.32, 95% CI: 0.17-0.61, P = 0.001). However, no significant non-linear relationship was observed between SHR and all-cause mortality (non-linear P = 0.942). FBG, HbA1c, and SHR provided similar predictive value for all-cause mortality (area under the curve: 0.526 vs. 0.535 vs. 0.513), without significant incremental predictive value.<h4>Conclusions</h4>The SHR is an independent predictor of CVD risk in middle-aged and older Chinese adults, with an L-shaped relationship. Future large-scale, multicenter studies are needed to validate these findings. |
| format | Article |
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| institution | OA Journals |
| issn | 1932-6203 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj-art-57459dbc94ed4cdeb8bfd410403b96cd2025-08-20T02:26:10ZengPublic Library of Science (PLoS)PLoS ONE1932-62032025-01-01205e032497810.1371/journal.pone.0324978L-shaped relationship between stress hyperglycemia ratio and cardiovascular disease risk in middle-aged and older adults: Insight from the China Health and Retirement Longitudinal Study.Zixi ZhangJiabao ZhouCancan WangKang WangYongguo DaiQiuzhen LinYichao XiaoQiming Liu<h4>Background</h4>The stress hyperglycemia ratio (SHR) has emerged as a potential marker for predicting cardiovascular disease (CVD) and mortality. However, its relationship with CVD and all-cause mortality in middle-aged and older Chinese populations remains unclear.<h4>Methods</h4>This study analyzed data from the China Health and Retirement Longitudinal Study (CHARLS), including individuals aged 45 years and older. Cross-sectional analysis assessed the associations between SHR and CVD incidence, whereas longitudinal Cox regression models evaluated the relationships between SHR, CVD risk, and all-cause mortality. Restricted cubic spline analyses were employed to explore potential non-linear relationships. The predictive performance of SHR was compared with that of fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c).<h4>Results</h4>The cross-sectional analysis identified an inverse association between the SHR and CVD incidence. Longitudinal analysis indicated that SHR was independently associated with an increased risk of CVD, with a significant L-shaped relationship (non-linear P = 0.001). Threshold effect analysis identified 0.985 as the inflection point for SHR, with hazard ratios (HRs) increasing sharply below this level (HR: 0.32, 95% CI: 0.17-0.61, P = 0.001). However, no significant non-linear relationship was observed between SHR and all-cause mortality (non-linear P = 0.942). FBG, HbA1c, and SHR provided similar predictive value for all-cause mortality (area under the curve: 0.526 vs. 0.535 vs. 0.513), without significant incremental predictive value.<h4>Conclusions</h4>The SHR is an independent predictor of CVD risk in middle-aged and older Chinese adults, with an L-shaped relationship. Future large-scale, multicenter studies are needed to validate these findings.https://doi.org/10.1371/journal.pone.0324978 |
| spellingShingle | Zixi Zhang Jiabao Zhou Cancan Wang Kang Wang Yongguo Dai Qiuzhen Lin Yichao Xiao Qiming Liu L-shaped relationship between stress hyperglycemia ratio and cardiovascular disease risk in middle-aged and older adults: Insight from the China Health and Retirement Longitudinal Study. PLoS ONE |
| title | L-shaped relationship between stress hyperglycemia ratio and cardiovascular disease risk in middle-aged and older adults: Insight from the China Health and Retirement Longitudinal Study. |
| title_full | L-shaped relationship between stress hyperglycemia ratio and cardiovascular disease risk in middle-aged and older adults: Insight from the China Health and Retirement Longitudinal Study. |
| title_fullStr | L-shaped relationship between stress hyperglycemia ratio and cardiovascular disease risk in middle-aged and older adults: Insight from the China Health and Retirement Longitudinal Study. |
| title_full_unstemmed | L-shaped relationship between stress hyperglycemia ratio and cardiovascular disease risk in middle-aged and older adults: Insight from the China Health and Retirement Longitudinal Study. |
| title_short | L-shaped relationship between stress hyperglycemia ratio and cardiovascular disease risk in middle-aged and older adults: Insight from the China Health and Retirement Longitudinal Study. |
| title_sort | l shaped relationship between stress hyperglycemia ratio and cardiovascular disease risk in middle aged and older adults insight from the china health and retirement longitudinal study |
| url | https://doi.org/10.1371/journal.pone.0324978 |
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