Predictive values of metabolic score for insulin resistance on risk of major adverse cardiovascular events and comparison with other insulin resistance indices among Chinese with and without diabetes mellitus: Results from the 4C cohort study

AIMS/INTRODUCTION: To investigate the relationship between the metabolic score for insulin resistance (METS‐IR) index and major adverse cardiac events (MACEs) and to compare its ability to predict MACEs with other IR indices including homeostatic model assessment for IR (HOMA‐IR) and triglyceride glucose (TyG) index‐related parameters. MATERIALS AND METHODS: We conducted a cohort study enrolling 7,291 participants aged ≥40 years. Binary logistic regression and restricted cubic splines were performed to determine the association between METS‐IR and MACEs, and the receiver operating curve (ROC) was utilized to compare the predictive abilities of IR indices and to determine the optimal cut‐off points. RESULTS: There were 348 (4.8%) cases of MACEs during a median follow‐up of 3.8 years. Compared with participants with a METS‐IR in the lowest quartile, the multivariate‐adjusted RRs and 95% CIs for participants with a METS‐IR in the highest quartile were 1.47 (1.05–2.77) in all participants, 1.42 (1.18–2.54) for individuals without diabetes, and 1.75 (1.11–6.46) for individuals with diabetes. Significant interactions were found between the METS‐IR and the risk of MACEs by sex in all participants and by age and sex in individuals without diabetes (all P values for interaction < 0.05). In the ROC analysis, the METS‐IR had a higher AUC value than other indices for predicting MACEs in individuals with diabetes and had a comparable or higher AUC than other indices for individuals without diabetes. CONCLUSIONS: The METS‐IR can be an effective clinical indicator for identifying MACEs, as it had superior predictive power when compared with other IR indices in individuals with diabetes.