Association between stress hyperglycemic ratio and stroke in older people with metabolic syndrome: a prospective cohort study from UK Biobank

Background: The association between disorders of glucose metabolism and cerebrovascular disease has received increasing attention, but the association between stress hyperglycemic ratios (SHR) and stroke in older people with metabolic syndrome is still unclear; therefore, we used a large-sample cohort study to explore their association. Methods: 60,931 participants aged ≥60 years were included in this cohort. SHR is a new composite indicator that combines fasting blood glucose and glycated hemoglobin. The definition of metabolic syndrome encompasses abdominal obesity, hyperlipidemia, hypertension, and hyperglycemia. The association between SHR and stroke in older people with metabolic syndrome was explored using Cox proportional hazards models. Restricted cubic spline plots were used to explore the presence of nonlinear associations. Inflection points were calculated with recursive methods. KM survival curves were performed to investigate the risk of stroke for different SHR levels over time. Results: After controlling the confounding of all covariates, we found no significant association between SHR and stroke and its subtypes in older people with metabolic syndrome. Further RCS revealed a nonlinear association only among stroke and ischemic stroke. An inflection point of 0.87 was found, and the association of SHR with stroke and ischemic stroke before and after the inflection point was opposite and both statistically significant. Subgroup analyses did not reveal significant differences. Conclusion: This prospective cohort study revealed a nonlinear association of SHR with stroke and ischemic stroke in older people with metabolic syndrome, which provides a reference for exploring disorders of glucose metabolism and stroke risk.