Association between estimated glucose disposal rate and cardiovascular mortality in postmenopausal women: a national cohort study

The association between estimated glucose disposal rate (eGDR) and cardiovascular mortality in postmenopausal women remains unclear. We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 1999 to 2018. Participants were stratified by eGDR levels (< 4, 4–6, 6–8, and ≥ 8 mg/kg/min). Survey-weighted Cox proportional hazards models estimated risks of cardiovascular mortality and all-cause mortality, and logistic regression was used to evaluate the risk of having a 10-year predicted cardiovascular disease (CVD) risk ≥ 20%. The study enrolled 7,788 postmenopausal women with a mean age of 60.5 years. During a median follow-up of 9.1 (IQR: 4.8–14.3) years, 414 cardiovascular deaths occurred (3.9%). Compared with the reference group (eGDR < 4 mg/kg/min), multivariable-adjusted hazard ratios (95% CIs) for cardiovascular mortality were 0.37 (0.20–0.67), 0.29 (0.12–0.67), and 0.29 (0.12–0.72) for eGDR categories of 4–6, 6–8, and ≥ 8 mg/kg/min, respectively. A negative linear dose-response relationship was observed. Similar inverse associations were found for all-cause mortality and for having a predicted 10-year CVD risk ≥ 20%, with lower eGDR consistently predicting worse outcomes. Lower eGDR, reflecting higher insulin resistance, was independently associated with increased cardiovascular mortality risk among postmenopausal women. These findings support the potential utility of eGDR as a practical biomarker for early cardiovascular mortality risk stratification.