Association between selected anthropometric measures and insulin resistance indices in patients with chronic ischemic heart disease

Abstract

Background: Cardiovascular disease (CVD) remains the leading cause of death worldwide, accounting for approximately 19.8 million deaths in 2022, or 32% of all deaths. Insulin resistance is an important pathophysiological mechanism not only in the development of type 2 diabetes mellitus (T2DM) but also in the development and progression of cardiovascular disease. Evidence remains limited regarding the simultaneous assessment of associations between selected anthropometric measures and insulin resistance in patients with ischemic heart disease (IHD). Aim: To investigate the association between waist-to-height ratio (WHtR) and insulin resistance indices (TG/HDL and HOMA-IR) in patients with chronic ischemic heart disease. Materials and Methods: This hospital-based cross-sectional study included 274 patients aged 40–75 years. Written informed consent was obtained from all participants. Data were collected using a structured questionnaire, anthropometric measurements were performed, and peripheral blood samples were collected. Laboratory measurements included fasting lipid profile, fasting glucose, and fasting insulin levels. WHtR was calculated as waist circumference (cm) divided by height (cm). Insulin resistance was assessed using the TG/HDL ratio, calculated as TG (mmol/L) divided by HDL (mmol/L), and the HOMA-IR index. Metabolic syndrome was defined according to the Joint Interim Statement (JIS2009) criteria. Results: Among the 274 participants, 209 (76.3%) were male and 65 (23.7%) were female, with a mean age of 61.1±7.9 years. WHtR was significantly and positively correlated with HOMA-IR, with a weak-to-moderate correlation (Spearman’s ρ=0.303, p<0.001). A weak but statistically significant positive correlation was also observed between WHtR and the TG/ HDL ratio (ρ=0.136, p=0.039). The discriminative ability of WHtR for insulin resistance was moderate (AUC=0.645, 95% CI: 0.562–0.729; p=0.001). The optimal cutoff value determined using the Youden index was 0.60, with a sensitivity of 63.2% and specificity of 64.2%. Multivariable logistic regression analysis showed that WHtR ≥0.60 was independently associated with insulin resistance. Conclusion: WHtR was significantly and positively associated with HOMA-IR and the TG/HDL ratio, and WHtR ≥0.60 was independently associated with insulin resistance.