ArticlePloS one2025
L-shaped relationship between stress hyperglycemia ratio and cardiovascular disease risk in middle-aged and older adults: Insight from the China Health and Retirement Longitudinal Study.
Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Association of stress hyperglycemia ratio with malnutrition, sarcopenia, and frailty in older adults: a cross-sectional study.BMC geriatrics · 2026Article
- Stress hyperglycemia ratio and risk of incident myocardial infarction in the general population: a large-scale cohort study.Frontiers in nutrition · 2025Article
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8 authors.
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Abstract
backgroundThe stress hyperglycemia ratio (SHR) has emerged as a potential marker for predicting cardiovascular disease (CVD) and mortality. However, its relationship with CVD and all-cause mortality in middle-aged and older Chinese populations remains unclear.
methodsThis study analyzed data from the China Health and Retirement Longitudinal Study (CHARLS), including individuals aged 45 years and older. Cross-sectional analysis assessed the associations between SHR and CVD incidence, whereas longitudinal Cox regression models evaluated the relationships between SHR, CVD risk, and all-cause mortality. Restricted cubic spline analyses were employed to explore potential non-linear relationships. The predictive performance of SHR was compared with that of fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c).
resultsThe cross-sectional analysis identified an inverse association between the SHR and CVD incidence. Longitudinal analysis indicated that SHR was independently associated with an increased risk of CVD, with a significant L-shaped relationship (non-linear P = 0.001). Threshold effect analysis identified 0.985 as the inflection point for SHR, with hazard ratios (HRs) increasing sharply below this level (HR: 0.32, 95% CI: 0.17-0.61, P = 0.001). However, no significant non-linear relationship was observed between SHR and all-cause mortality (non-linear P = 0.942). FBG, HbA1c, and SHR provided similar predictive value for all-cause mortality (area under the curve: 0.526 vs. 0.535 vs. 0.513), without significant incremental predictive value.
conclusionsThe SHR is an independent predictor of CVD risk in middle-aged and older Chinese adults, with an L-shaped relationship. Future large-scale, multicenter studies are needed to validate these findings.
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