Cross-sectional association of the metabolic score for insulin resistance with hypertension in multi-ethnic patients with premature coronary artery disease: the IPAD study

Abstract

Purpose The relationship between the metabolic score for insulin resistance (METS-IR) and cardiometabolic risk factors in premature coronary artery disease (PCAD) is unclear. This study aimed to investigate the association between METS-IR and hypertension, as well as systolic blood pressure (SBP) and diastolic blood pressure (DBP), in patients with PCAD. Methods This cross-sectional analysis of the Iran Premature Coronary Artery Disease (IPAD) study included women aged <= 70 and men aged <= 60 with PCAD. Associations between METS-IR and hypertension were examined using logistic regression, and those with SBP and DBP were examined using generalized linear models. METS-IR was modeled per 1-unit increase and quartiles. Ethnicity-stratified analyses were performed in quartiles. Results are reported as odds ratios (ORs), beta coefficients, and 95 confidence intervals (CIs). Results Overall, 1,688 patients were analyzed, with a mean age of 55.0 +/- 7.1 years. SBP and DBP increased across the METS-IR levels (P for trend < 0.001). Continuous METS-IR was associated with a higher odds of hypertension (OR: 1.03; 95 CI: 1.02-1.05). Compared with Q1, the highest quartile had a higher odds of hypertension (OR: 2.70; 95 CI: 1.96-3.72; P for trend < 0.001). In ethnicity-stratified analyses, the associations were significant in the Fars (P < 0.001), Azari (P = 0.005), and Bakhtiari (P = 0.040) populations. Other ethnic groups showed imprecise estimates, owing to the small sample sizes. Conclusions METS-IR was positively associated with hypertension and higher SBP and DBP in patients with PCAD. Associations varied across ethnic groups, underscoring the need for prospective studies to define population-specific thresholds and prognostic implications.