Association between estimated glucose disposal rate and cardiovascular mortality across the spectrum of glucose tolerance in the US population

Abstract Aims To determine if estimated glucose disposal rate (eGDR) can predict cardiovascular disease mortality risk at different levels of glycaemic tolerance. Materials and Methods The eGDR levels of 11 656 individuals aged 45–79 years from the National Health and Nutrition Examination Survey cycles 1999 to 2010 were analysed. Associations between eGDR levels and all‐cause and cardiovascular mortality were examined using Cox proportional hazards and Fine and Gray models, respectively. Results After a median follow‐up of 12.8 years, a total of 2852 participants died, with 777 of those deaths attributed to cardiovascular causes. When comparing participants with eGDR values of ≤4 mg/kg/min to those with eGDR values falling within the ranges of 4–6, 6–8 and >8 mg/kg/min, it was found that the latter groups exhibited lower hazard ratios for both all‐cause mortality (0.61 [0.52–0.72], 0.61 [0.52–0.72] and 0.46 [0.39–0.55]) and cardiovascular mortality (0.44 [0.33–0.57], 0.45 [0.34–0.59] and 0.30 [0.23–0.40]). A U‐shaped relationship between eGDR and all‐cause mortality was observed, with an inflection point at an eGDR of 9.54 mg/kg/min. Conclusions In the general population, the association between reduced eGDR and all‐cause and cardiovascular mortality was independently significant, contributing to the identification of individuals at high risk for different levels of glucose tolerances.