Estimated glucose disposal rate and mortality in patients with cardiovascular disease: findings from two large cohorts

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiovascular disease (n=35743). Intervention: Estimated glucose disposal rate (eGDR) vs. Lower eGDR (continuous per unit increase or lowest quartile Q1 as reference). Primary outcome: All-cause mortality (primary cohort NHANES, continuous eGDR in fully adjusted model) (HR 0.859, 95% CI 0.800 to 0.923, p=<0.001).

Q: What does this research mean for the field?

Higher estimated glucose disposal rate is independently associated with lower all-cause and cardiovascular mortality in patients with cardiovascular disease. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Lin Yang Zhao; Danni Wu; Zenglei Zhang; Tianli Li; Tong Gao; Song Wu; Baofu Wang; Mengru Liu; Peng Yang; Jiangshan Tan; 李宪伦

doi:10.1136/openhrt-2026-004434

July 1, 2026Open HeartOpen Access

Estimated glucose disposal rate and mortality in patients with cardiovascular disease: findings from two large cohorts

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Why the study?

Insulin resistance contributes to adverse cardiovascular outcomes, but conventional assessments are complex and not routinely available. This study evaluated whether the estimated glucose disposal rate (eGDR), a simple surrogate of insulin resistance, provides prognostic information in patients with established CVD.

Does a higher estimated glucose disposal rate (eGDR) predict lower all-cause and cardiovascular mortality in adults with established cardiovascular disease?

Key Points

To determine whether the estimated glucose disposal rate, a simple surrogate marker of insulin resistance, provides prognostic value for mortality in patients with established cardiovascular disease.
Analyzed adults with cardiovascular disease from the National Health and Nutrition Examination Survey (n=4283; primary cohort) and a subcohort from the UK Biobank (n=31 460; replication cohort).
Followed participants over median durations of 7.8 years (NHANES) and 14.2 years (UK Biobank).
Applied Cox proportional hazards models, restricted cubic splines, and Kaplan-Meier curves to evaluate relationships between continuous and quartile-based eGDR and mortality.
A total of 1886 deaths (634 cardiovascular) occurred in NHANES and 2218 deaths (616 cardiovascular) occurred in the UK Biobank.
In fully adjusted continuous models, higher eGDR was associated with lower all-cause mortality in NHANES (HR, 0.859; 95% CI 0.800 to 0.923; p<0.001) and the UK Biobank (HR, 0.792; 95% CI 0.743 to 0.844; p<0.001).
Higher continuous eGDR was also associated with lower cardiovascular mortality in NHANES (HR, 0.844; 95% CI 0.736 to 0.969; p=0.016) and the UK Biobank (HR, 0.737; 95% CI 0.656 to 0.828; p<0.001).

Study Design

Type

Cohort (n=35,743)

Multicenter

Yes

Structured PICO

Does a higher estimated glucose disposal rate (eGDR) predict lower all-cause and cardiovascular mortality in adults with established cardiovascular disease?

P

Population

35,743 adults with established cardiovascular disease across two cohorts: NHANES (n=4,283, mean age 65 years, 54.7% male, median follow-up 7.8 years) and UK Biobank (n=31,460, mean age 60 years, 60.7% male, median follow-up 14.2 years).

E

Exposure

Higher estimated glucose disposal rate (eGDR, calculated as 21.158 − [0.09 × waist circumference in cm] − [3.407 × hypertension (1=yes, 0=no)] − [0.551 × HbA1c in %]), evaluated as a continuous variable and across quartiles (Q1-Q4).

C

Comparator

Lower eGDR (continuous model or lowest quartile Q1 [≤4.2 in NHANES; ≤6.91 in UKB] as reference).

O

Outcome

All-cause mortality and cardiovascular mortality over median follow-up of 7.8 years (IQR 4.7–11.8) in NHANES and 14.2 years (IQR 13.5–15.0) in UK Biobank, ascertained via the National Death Index and national death registries using ICD-10 codes.hard clinical

Main Result

Hazard Ratio: 0.859 (95% CI 0.8–0.923)

p-value: p=<0.001

Limitations

eGDR was assessed only at baseline, precluding evaluation of longitudinal changes in insulin resistance.
Residual confounding (e.g., diet, medication adherence, genetics) cannot be excluded despite multivariable adjustment.
Substantial differences in mortality rates, cohort characteristics, sampling frameworks, and follow-up between NHANES and UKB limit direct quantitative comparisons.
UKB replication analysis was restricted to a predefined subcohort with available Patient Health Questionnaire-9, potentially introducing selection bias.
Mortality rates differed substantially between NHANES and UKB due to differences in cohort characteristics, sampling frameworks, and follow-up.
The UKB replication analysis was based on a predefined subcohort with available Patient Health Questionnaire-9, which may have introduced selection bias.

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Implication

Estimated glucose disposal rate (eGDR), calculated from routine clinical variables (waist circumference, hypertension status, and HbA1c), independently predicts all-cause and cardiovascular mortality in patients with established CVD across two large cohorts.

Abstract

Background Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality worldwide. Insulin resistance contributes to adverse cardiovascular outcomes but conventional assessments are complex and not routinely available. The estimated glucose disposal rate (eGDR), a simple surrogate of insulin resistance, may provide prognostic information in patients with established CVD.Methods Adults with CVD were identified from the National Health and Nutrition Examination Survey (NHANES) (n=4283) as the primary cohort and from a predefined UK Biobank (UKB) subcohort (n=31 460) as the replication cohort. Cox models, restricted cubic splines, Kaplan-Meier curves and subgroup analyses were used to evaluate associations between eGDR and mortality.Results During median follow-ups of 7.8 and 14.2 years, 1886 and 2218 deaths occurred in NHANES and the UKB, including 634 and 616 cardiovascular deaths, respectively. In fully adjusted models, higher continuous eGDR was associated with lower all-cause mortality in NHANES (HR, 0.859; 95% CI 0.800 to 0.923; p<0.001) and the UKB (HR, 0.792; 95% CI 0.743 to 0.844; p<0.001). Similar associations were observed for cardiovascular mortality in NHANES (HR, 0.844; 95% CI 0.736 to 0.969; p=0.016) and the UKB (HR, 0.737; 95% CI 0.656 to 0.828; p<0.001). Spline analyses showed non-linear inverse associations with both mortality outcomes in NHANES. In the UKB, the association with all-cause mortality became non-linear after multivariable adjustment, whereas the association with cardiovascular mortality was approximately linear.Conclusion Higher eGDR was independently associated with lower all-cause and cardiovascular mortality in patients with CVD, supporting its potential as a simple marker for mortality risk stratification.

Discussion

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Cite This Study

Zhao et al. (2026) conducted a cohort in Cardiovascular disease (n=35,743). Estimated glucose disposal rate (eGDR) vs. Lower eGDR (continuous per unit increase or lowest quartile Q1 as reference) was evaluated on All-cause mortality (primary cohort NHANES, continuous eGDR in fully adjusted model) (HR 0.859, 95% CI 0.800 to 0.923, p=<0.001).

synapsesocial.com/papers/6af0dba03c845ca7837cee10 https://doi.org/10.1136/openhrt-2026-004434

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Estimated glucose disposal rate and mortality in patients with cardiovascular disease: findings from two large cohorts

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Estimated glucose disposal rate and mortality in patients with cardiovascular disease: findings from two large cohorts

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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