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Changes in estimated glucose disposal rate and future stroke risk in individuals with cardiovascular-kidney-metabolic syndrome stages 0–3
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  • Published: 09 April 2026

Changes in estimated glucose disposal rate and future stroke risk in individuals with cardiovascular-kidney-metabolic syndrome stages 0–3

  • Xinran Wang1,2,3,4,
  • Sirun Qin1,5,
  • Bohao Peng6,
  • Hong Xiang2,
  • Ye Tao1,2,
  • Chengxian Guo4 &
  • …
  • Hongwei Lu1,2 

Scientific Reports , Article number:  (2026) Cite this article

We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Subjects

  • Diseases
  • Neurology
  • Neuroscience
  • Risk factors

Abstract

Previous studies have reported an association between estimated glucose disposal rate (eGDR) and stroke in individuals with cardiovascular-kidney-metabolic (CKM) syndrome stages 0–3. However, the association of changes in eGDR with the risk of incident stroke in this population remains unclear. Using data from the China Health and Retirement Longitudinal Study (CHARLS), this study included 3849 participants with CKM syndrome stages 0–3, among whom 285 (7.4%) developed stroke during follow-up from 2015 to 2020. Logistic regression was employed to evaluate the impact of cumulative eGDR (cumeGDR) and clusters of eGDR changes on stroke risk. After adjusting for potential confounders, the risk of incident stroke was significantly higher in participants with persistently moderately low eGDR (Class 2: OR 1.51, 95% CI 1.02–2.26), persistently low eGDR (Class 3: OR 2.11, 95% CI 1.36–3.26), and markedly declining eGDR (Class 4: OR 1.78, 95% CI 1.20–2.66), compared with those with persistently high eGDR (Class 1). Lower cumeGDR levels were independently associated with a higher risk of stroke events. Restricted cubic spline analysis indicated a negative linear relationship between cumeGDR and stroke risk. Receiver operating characteristic (ROC) curve analysis demonstrated that cumeGDR had greater predictive value for stroke than eGDR, and incremental predictive value analysis revealed that incorporating cumeGDR or clusters of eGDR changes into the baseline model provided incremental value for stroke risk prediction. These findings suggest that among individuals with CKM syndrome stages 0–3, persistently low eGDR or markedly declining eGDR was associated with a higher risk of stroke, underscoring the clinical value of dynamic eGDR monitoring for the early identification of individuals at high risk for stroke.

Data availability

The datasets generated and/or analyzed during this study are publicly available in the CHARLS repository, [http://charls.pku.edu.cn].

Abbreviations

eGDR:

Estimated glucose disposal rate

CKM:

Cardiovascular-kidney-metabolic

AHA:

American Heart Association

CKD:

Chronic kidney disease

CVD:

Cardiovascular disease

IR:

Insulin resistance

WC:

Waist circumference

HbA1c:

Glycated hemoglobin

CHARLS:

China Health and Retirement Longitudinal Study

cumeGDR:

Cumulative estimated glucose disposal rate

SBP:

Systolic blood pressure

DBP:

Diastolic blood pressure

BMI:

Body mass index

HDL-C:

High-density lipoprotein cholesterol

LDL-C:

Low-density lipoprotein cholesterol

TG:

Triglycerides

TC:

Total cholesterol

CRP:

C-reactive protein

UA:

Uric acid

Scr:

Serum creatinine

FBG:

Fasting blood glucose

OR:

Odds ratio

CI:

Confidence interval

ROC:

Receiver operating characteristic

AUC:

Area under the curve

RCS:

Restricted cubic spline

VIF:

Variance inflation factor

eGFR:

Estimated glomerular filtration rate

ANOVA:

Analysis of variance

C-statistic:

Concordance statistic

NRI:

Net reclassification improvement

IDI:

Integrated discrimination improvement

ROS:

Reactive oxygen species

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Acknowledgements

The authors would like to thank all members of the CHARLS working group and all of the participants who provided data.

Funding

This work was supported by the National Natural Science Foundation of China (grant numbers 82470475 and 82270519).

Author information

Authors and Affiliations

  1. Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China

    Xinran Wang, Sirun Qin, Ye Tao & Hongwei Lu

  2. Center for Experimental Medicine, The Third Xiangya Hospital, Central South University, Changsha, China

    Xinran Wang, Hong Xiang, Ye Tao & Hongwei Lu

  3. Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, China

    Xinran Wang

  4. Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China

    Xinran Wang & Chengxian Guo

  5. Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

    Sirun Qin

  6. Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Bohao Peng

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Contributions

XW, CG and HL conceived the study. XW, SQ and BP prepared and analyzed the data. XW drafted the manuscript. HX, YT, CG and HL participated in the data review and manuscript revision. All authors reviewed and approved the final manuscript.

Corresponding authors

Correspondence to Chengxian Guo or Hongwei Lu.

Ethics declarations

Ethics approval and consent to participate

The CHARLS protocol complied with the Declaration of Helsinki and received approval from the Biomedical Ethics Review Committee of Peking University (IRB 00001052–11015). All participants gave written informed consent.

Competing interests

The authors declare no competing interests.

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Cite this article

Wang, X., Qin, S., Peng, B. et al. Changes in estimated glucose disposal rate and future stroke risk in individuals with cardiovascular-kidney-metabolic syndrome stages 0–3. Sci Rep (2026). https://doi.org/10.1038/s41598-026-46225-2

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  • Received: 07 November 2025

  • Accepted: 24 March 2026

  • Published: 09 April 2026

  • DOI: https://doi.org/10.1038/s41598-026-46225-2

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Keywords

  • Stroke
  • Cardiovascular-kidney-metabolic syndrome
  • Estimated glucose disposal rate
  • Insulin resistance
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