Estimated glucose disposal rate and risk of arterial stiffness and long-term all-cause mortality: a 10-year prospective study

Background To assess the applicability of the association between estimated glucose disposal rate (eGDR) and all-cause mortality in the elderly population, and the mediating role of brachial-ankle pulse wave velocity (baPWV). Methods This was a follow-up cohort study based on the cross-sectional survey of community-dwelling elderly. All participants in the study were included between September 2009 and June 2010, and the follow-up time was December 2020. Participants included 1862 Chinese community-dwelling elderly aged 60 years and above. Insulin resistance assessed by eGDR and arterial stiffness assessed by baPWV were the primary exposures of interest. Mortality, which was followed up until December 2020, was the primary outcome. Cox proportional hazards regression models were used to estimate the association of eGDR with mortality. The mediating effect of baPWV in this association was assessed by mediation analysis. Results A total of 1826 participants with a mean age of 71.03 years old were included in the study. During the median follow-up of 10.75 years, 334 participants died. The adjusted HR comparing the highest versus the lowest eGDR quartile was 0.22 (95% CI 0.09 to 0.54; p<0.001) in the Cox proportional hazards model. The results of mediation analysis showed that baPWV had a significant mediation impact on the link between eGDR and all-cause mortality both as continuous or categorical variables. Conclusion eGDR is an independent predictor of all-cause mortality in the elderly population. baPWV partially mediated the association of eGDR and long-term all-cause mortality as a mediator factor.