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 探討大劑量西地蘭聯合小劑量酒石酸美托洛爾經靜脈途徑治療急性左心衰伴快速心室率心房顫動的療效與安全性。 方法 將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顫動患者，隨機分配至對照組（39例）與治療組（37例），對照組靜脈注射西地蘭，治療組靜脈注射西地蘭與小劑量酒石酸美托洛爾，分別在用藥開始時及用藥開始后全程監測收縮壓、心室率、呼吸頻率、手指脈搏血氧飽和度（SpO2）、呼吸困難程度、肺部啰音與治療2 h時尿量，記錄急性左心衰改善時間。 結果 兩組患者在治療開始時心室率（P=0.246）、呼吸頻率（P=0.390）、收縮壓（P=0.525）與SpO2（P=0.482）均無統計學意義；在治療整個過程中，兩組患者收縮壓與治療2 h尿量均無統計學意義（P=0.264）；在治療開始后30、60、90、120 min時治療組患者心室率均顯著低于對照組（P=0.000）。治療組患者從在治療開始到急性左心衰改善的時間明顯短于對照組（P=0.003）。試驗期間無1例患者出現病情惡化或死亡。 結論 在排除美托洛爾禁忌癥的前提下，在嚴密監測肺部啰音及指氧飽和度的情況下，對那些平時心功能Ⅰ~Ⅱ級的急性左心衰伴快速心室率心房顫動患者，在經靜脈途徑給予大劑量西地蘭的同時，間斷多次靜脈注射小劑量美托洛爾，能安全有效地控制過快心室率，縮短急性左心衰竭持續時間。