Association of insulin resistant-related indices with subclinical carotid atherosclerosis: mediation analysis of blood pressure.

BACKGROUND AND AIMS: We aimed to evaluate associations between insulin resistance (IR)-related indices and carotid atherosclerosis (CA) and the mediating role of blood pressure. METHODS AND RESULTS: A total of 59123 participants were included in our study. Five indices were used to quantify IR: TyG-body mass index (TyG-BMI), TyG-waist circumference (TyG-WC), TyG-waist-height ratio (TyG-WHtR), TyG - a body shape index (TyG -ABSI) and triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio. For CIMT, compared with Q1 group, the ORs (95% CIs) of TyG-BMI, TyG-WC, TyG-WHtR, TyG-ABSI, TG/HDL-C in Q4 were 3.11 (2.76-3.49), 2.69 (2.39-3.04), 2.67 (2.37-3.00), 1.59 (1.42-1.78), and 2.19 (1.97-2.45), respectively. For plaques, the ORs (95% CIs) for Q4 versus Q1 were 2.42 (2.18-2.67) for TyG-BMI, 2.85 (2.56-3.18) for TyG-WC, 2.87 (2.58-3.21) for TyG-WHtR, 2.07 (1.87-2.29) for TyG-ABSI, and 1.93 (1.75-2.13) for TG/HDL-C. For stenosis, the ORs (95% CIs) for Q4 versus Q1 were 3.12 (2.35-4.14) for TyG-BMI, 1.86 (1.42-2.44) for TyG-WC, 1.93 (1.47-2.53) for TyG-WHtR, 1.60 (1.21-2.10) for TyG-ABSI, and 1.70 (1.31-2.21) for TG/HDL-C. Receiver operating characteristic (ROC) curve analyses showed that TyG-BMI yielded the largest area under the curve (AUC) for CIMT: 0.823 (0.816, 0.829). TyG-WHtR exhibited the highest AUC for plaques: 0.846 (0.840, 0.851). Both systolic blood pressure (SBP) and diastolic blood pressure (DBP) mediated the associations between IR-related indices and CA. The mediating proportion of SBP ranged from 6.55% to 19.06%, and DBP ranged from 0.98% to 8.69%, respectively. CONCLUSIONS: IR-related indices are positively associated with CA. Blood pressure partially mediates the above-mentioned associations.