Work

Association between estimated glucose disposal rate and subclinical cerebrovascular atherosclerotic burden in non-diabetic middle-aged and older adults

Year: 2026

Type: article

Abstract: Objective To evaluate the association and dose–response relationship between estimated glucose disposal rate (eGDR), a surrogate marker of insulin resistance, and subclinical cerebrovascular atherosclerotic burden in non-diabetic middle-aged and older adults. Methods This retrospective analysis used data from a prospective registry and included 604 adults aged ≥45 years without diabetes. Participants with symptomatic cerebrovascular disease, including prior ischemic stroke or transient ischemic attack attributable to cerebrovascular stenosis, were excluded. Cerebrovascular atherosclerosis was assessed using carotid duplex ultrasonography, head and neck magnetic resonance angiography, or head and neck computed tomography angiography. Based on neuroimaging results, participants were classified into three categories: no atherosclerosis, single vascular bed involvement, and dual vascular bed involvement. Associations between eGDR and atherosclerotic burden were evaluated using ordinal logistic regression models, including unadjusted, age- and sex-adjusted, and fully adjusted models. Restricted cubic spline (RCS) analysis was performed to examine the dose–response relationship. Results All 604 participants were community-dwelling adults without symptomatic cerebrovascular disease. The mean age was 64 ± 11 years, and 220 (36.4%) were male. Participants with a higher subclinical cerebrovascular atherosclerotic burden were older, had a higher prevalence of hypertension, and had lower eGDR levels ( p < 0.001). The prevalence of single and dual vascular bed involvement decreased progressively across eGDR quartiles, from the lowest (Q1) to the highest (Q4) quartile (single bed: 33.1% vs. 19.2%; dual beds: 13.2% vs. 2.0%). In the fully adjusted ordinal logistic regression model, each 1-SD increase in eGDR was associated with lower odds of being in a higher atherosclerotic burden category (OR = 0.74, 95% CI: 0.62–0.89, p = 0.001). Compared with Q1, participants in Q4 had lower odds of being in a higher burden category (OR = 0.42, 95% CI: 0.24–0.72, p = 0.001; P for trend = 0.002). The RCS analysis showed a linear correlation between eGDR and atherosclerotic burden (overall p = 0.002, non-linear p = 0.322). Conclusion Among middle-aged and older adults without diabetes, lower eGDR was independently associated with a higher subclinical cerebrovascular atherosclerotic burden, with a linear pattern. These findings warrant further investigation in prospective studies.

Source: Frontiers in Neurology

DOI: 10.3389/fneur.2026.1946802