Association of Insulin Resistance, Systemic Inflammation, and Atherogenic Dyslipidemia With Major Adverse Cardiovascular Events in Patients With Type 2 Diabetes Mellitus: A Prospective Cohort Study
Abstract
Background: Cardiovascular disease remains a major cause of morbidity and mortality in type 2 diabetes mellitus (T2DM), with residual risk persisting despite conventional risk-factor control.Insulin resistance, systemic inflammation, and atherogenic dyslipidemia may jointly contribute to this excess risk.Objective: To evaluate the association of insulin resistance, systemic inflammation, and atherogenic dyslipidemia with major adverse cardiovascular events (MACE) in patients with T2DM.Methods: This prospective multicenter cohort study included 200 adults with T2DM recruited from District Headquarters Hospital Sargodha/Sargodha Medical College and Bilawal Medical College, LUMHS, Jamshoro, from January 2025 to February 2026.Insulin resistance was assessed using HOMA-IR, systemic inflammation using high-sensitivity C-reactive protein (hs-CRP), and atherogenic dyslipidemia using triglyceride/HDL-C ratio and atherogenic index of plasma.The primary outcome was three-point MACE comprising cardiovascular death, nonfatal myocardial infarction, or nonfatal ischemic stroke.Results: During follow-up, 42 patients (21.0%) experienced MACE.Patients with MACE had significantly higher HOMA-IR, hs-CRP, triglycerides, triglyceride/HDL-C ratio, and atherogenic index of plasma.HOMA-IR (aHR 1.13, 95% CI 1.05-1.22),hs-CRP (aHR 1.09, 95% CI 1.03-1.15),and triglyceride/HDL-C ratio (aHR 1.11, 95% CI 1.03-1.20)independently predicted MACE.Patients with abnormalities in all three domains had a 3.27-fold greater adjusted hazard of MACE.Conclusion: Insulin resistance, systemic inflammation, and atherogenic dyslipidemia independently predicted cardiovascular events in T2DM.Combined assessment may improve cardiovascular risk stratification.
