Associations of estimated glucose disposal rate with chest pain prevalence and mortality risks: a population-based study.

BACKGROUND: Estimated glucose disposal rate (eGDR), a validated surrogate for insulin resistance, is associated with cardiovascular disease, but its relationship with chest pain, which is a common presenting symptom of cardiovascular events, remains unclear. This study investigated the associations of eGDR with chest pain prevalence and all-cause mortality.

METHODS: Using cross-sectional and cohort study designs, we analyzed data from 1999 to 2018 National Health and Nutrition Examination Survey (NHANES). Survey-weighted logistic regression was used to examine the association between eGDR and chest pain prevalence, while weighted Cox model was used to evaluate the relationship between eGDR and all-cause mortality in participants with and without chest pain. Restricted cubic splines (RCS) examined potential nonlinearity, and Kaplan-Meier curves visualized survival differences by eGDR category. Mediation analysis examined whether white blood cells (WBC) count mediated the eGDR-mortality association.

RESULTS: The study included 13,161 participants, with the sample being weighted to reflect a population of 54,616,985 individuals. After full adjustment, each standard deviation (SD) increase in eGDR correlated with an 11% lower odds of chest pain (P < 0.001). Cox regression revealed each SD rise in eGDR was associated with a 7% lower risk of all-cause mortality among participants with chest pain (P = 0.004). RCS confirmed linear relationships for eGDR with both chest pain prevalence and mortality risk, irrespective of chest pain status. When eGDR was dichotomized at the population median (7.34 mg/kg/min), participants with high eGDR was significantly associated with reduced odds of chest pain (OR = 0.67, 95% CI: 0.59-0.77, P < 0.001) and lower all-cause mortality (HR = 0.85, 95% CI: 0.75-0.95, P = 0.006) compared to those with low eGDR. Kaplan-Meier curves demonstrated a clear survival advantage for participants with higher eGDR. WBC mediated 20.04% of the association between eGDR and all-cause mortality (Pindirect < 0.001).

CONCLUSION: Higher eGDR is robustly associated with lower chest pain prevalence and reduced all-cause mortality risk, irrespective of chest pain status. The partial mediation by WBC suggests a potential inflammatory pathway. These findings support the potential value of eGDR in non-invasive cardiometabolic risk stratification.