Prediction of various insulin resistance indices for the risk of hypertension among military young adults: the CHIEF cohort study, 2014-2020.
Level 3 - non-randomized controlled study
Prospective non-randomized cohort study
PubMed 38664804 · doi:10.1186/s12933-024-02229-8
What was done
The CHIEF prospective cohort study followed 2,448 military personnel in Taiwan aged 18–39 years without baseline hypertension between 2014 and 2020 (median follow-up of 6.0 years). Participants underwent annual health examinations with blood pressure (BP) measurements to detect incident hypertension, categorized as stage I isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and combined hypertension (CH), as well as stage II categories (SBP 140–159 mmHg or DBP 90–99 mmHg). Four non-insulin-based insulin resistance (NI-IR) indices were evaluated: TG/HDL-C ratio, TyG index, METS-IR, and ZJU index. Multivariable Cox proportional hazards regression models adjusted for baseline age, sex, body mass index, blood pressure, substance use, family history, LDL cholesterol, renal function, uric acid, and physical activity.
What was found
During the 6.0-year median follow-up, 920 incident hypertension events (37.6%) occurred. Higher TyG, TG/HDL-C, and METS-IR indices were associated with an increased risk of stage I IDH, with hazard ratios (HR) of 1.376 (95% CI: 1.123–1.687), 1.082 (95% CI: 1.039–1.127), and 3.455 (95% CI: 1.921–6.214), respectively. Only a higher ZJU index was associated with stage II IDH (HR: 1.011, 95% CI: 1.001–1.021) and stage II ISH (HR: 1.013, 95% CI: 1.003–1.023). A higher TyG index was associated with an increased risk of stage II CH (HR: 2.821, 95% CI: 1.244–6.395).
Why it matters
Surrogate insulin resistance markers calculated from routine fasting glucose, lipid profiles, and liver enzymes can predict incident early-stage hypertension subtypes in young adults without direct insulin measurement.
Limits
The cohort was restricted to young military personnel in Taiwan, which may limit generalizability to older, less active, or non-Asian populations. Blood pressure was measured at annual checkups rather than with ambulatory monitoring, and unmeasured lifestyle factors such as diet were not accounted for.
Cited by
- partial High diastolic blood pressure is primarily driven by insulin resistance.