Insulin Resistance–Adiposity Burden and Incident Cardiovascular Disease Across Glycaemic Transitions in Prediabetes: Risk Stratification After Reversion to Normoglycaemia

Aims To examine whether insulin resistance (IR), assessed by cumulative triglyceride–glucose (TyG)‐derived indices and change patterns, stratifies incident cardiovascular disease (CVD) risk after glycaemic transition in adults with prediabetes. Materials and Methods Data were obtained from 1468 participants with prediabetes in the China Health and Retirement Longitudinal Study. Glycaemic transition and TyG‐derived indices were assessed from Wave 1 to Wave 3. Indices included TyG, TyG‐ABSI (a body shape index), TyG‐BRI (body roundness index), TyG‐CVAI (Chinese visceral adiposity index) and TyG‐WWI (weight‐adjusted waist index). Cumulative indices summarised measurements across Waves 1 and 3 and exploratory k ‐means clustering identified broad two‐wave exposure patterns. Incident CVD was assessed from Waves 3 to 5. Cox models estimated hazard ratios (HRs) and 95% confidence intervals (CIs). Results During a median 5.0‐year follow‐up, 294 CVD events occurred. Compared with persistent prediabetes, reversion to normoglycaemia was not associated with lower CVD risk (HR 0.97, 95% CI 0.72–1.31), whereas progression to diabetes was associated with higher risk (HR 1.53, 95% CI 1.14–2.07). In joint analyses, reversion with low cumulative indices was not associated with increased CVD risk, whereas reversion with high indices was significantly associated with elevated risk for most indices (HRs 1.55–2.05). Among participants who reverted to normoglycaemia, high cumulative TyG‐derived indices were significantly associated with higher CVD risk (adjusted HRs 1.89–2.52; all p < 0.05). Change‐pattern analyses were concordant. Conclusions Glycaemic transition status did not fully stratify subsequent CVD risk. Cumulative TyG‐related measures further stratified CVD risk across glycaemic transition groups, including among participants who reverted to normoglycaemia.