Cumulative eGDR and cumulative AIP were both associated with incident cardiometabolic multimorbidity after mutual adjustment and provided complementary risk information, with the highest risk in participants with low cumulative eGDR and high cumulative AIP.
Over a median 5.0-year follow-up of 4,215 CHARLS participants, 452 developed incident cardiometabolic multimorbidity (CMM).
Higher cumulative eGDR was independently associated with a lower risk of incident CMM in the mutually adjusted model.
Higher cumulative AIP was independently associated with a higher risk of incident CMM in the mutually adjusted model.
Joint analysis showed a graded CMM risk, with the highest risk in participants with low cumulative eGDR and high cumulative AIP.
A positive additive interaction between cumulative eGDR and cumulative AIP was observed, but the multiplicative interaction was not statistically significant.
The two indices contributed unequally to prognostic performance: adding eGDR to AIP improved reclassification more than adding AIP to eGDR.
The model combining cumulative eGDR and cumulative AIP had better prognostic performance than the corresponding cumulative TyG-AIP model.
Findings were consistent across subgroup and sensitivity analyses.
This study followed 4,215 middle-aged and older adults in China for about five years to see who developed cardiometabolic multimorbidity, meaning two or more conditions such as heart disease, stroke, and diabetes. The researchers looked at two markers measured at two time points: estimated glucose disposal rate (eGDR), a measure of insulin sensitivity, and the atherogenic index of plasma (AIP), a blood-fat ratio linked to artery-clogging cholesterol patterns. In total, 452 people developed multimorbidity. Higher eGDR (better insulin sensitivity) over time was linked to lower risk, and higher AIP over time was linked to higher risk, with each marker remaining associated after accounting for the other. People with low eGDR and high AIP had the highest risk, about 3.8 times that of people with high eGDR and low AIP. The combination appeared to raise risk more than the two factors would be expected to add up to separately. Of the two markers, eGDR added more predictive information than AIP. This research suggests that insulin resistance and unhealthy blood fats each carry their own information about future risk and that looking at both together may help identify people at higher risk. As an observational study, it cannot show that changing these markers prevents multimorbidity, and the findings are from a Chinese cohort of middle-aged and older adults.
Cai H, Fu Y, Zhu F, Qiu J, Ye H, Xie E. (2026). Cumulative estimated glucose disposal rate, atherogenic index of plasma, and incident cardiometabolic multimorbidity: a prospective cohort study.. BMC cardiovascular disorders. https://doi.org/10.1186/s12872-026-06822-5