Association of insulin resistance-related indexes with atherosclerotic cardiovascular disease: A crosss-sectional study

Insulin resistance (IR) is linked to atherosclerotic cardiovascular disease(ASCVD). This study analyzed data from the National Health and Nutrition Examination Survey to reveal the association of IR-related indexes with ASCVD in adults, aiming to improve risk assessment and early intervention. The study included adults from the National Health and Nutrition Examination Survey between 2007 and 2016. We used multivariable logistic regression to assess the link between IR-related indexes and ASCVD. Nonlinear associations were identified using restricted cubic splines and threshold effect analyses. Subgroup analysis confirmed result stability, while receiver operating characteristic curves compared the predictive performance of the indexes. Among 11,687 participants, 9.40% had ASCVD. A linear association between the metabolic score for IR (METS-IR) and ASCVD. The triglyceride-glucose index (TyG), homeostasis model assessment of IR (HOMA-IR), and triglyceride glucose-waist height ratio (TyG-WHtR) had nonlinear correlations with ASCVD prevalence. When TyG > 9.03, it was positively correlated with ASCVD (OR: 1.31, 95% CI: 1.07-1.60). An increase in HOMA-IR < 6.79 correlated with ASCVD risk (OR: 1.08, 95% CI: 1.04-1.12), but when HOMA-IR > 6.79, the increasing trend slowed down. When TyG-WHtR > 5.82, ASCVD risk was increased markedly with increasing values (OR: 1.32, 95% CI: 1.15-1.52), subgroup analysis showed a significant interaction between diabetes status and physical activity. Additionally, TyG-WHtR demonstrated superior predictive capacity for ASCVD (AUC = 0.644) compared to other indexes. Elevated IR levels are independently associated with increased ASCVD risk in American adults, with TyG-WHtR being the strongest predictor.