Sex differences in the association between atherogenic index of plasma and progression from normoglycemia to prediabetes: evidence from a 5-year large-scale retrospective cohort study.

OBJECTIVE

Currently, there is limited research on the relationship between the atherogenic index of plasma (AIP) and the risk of prediabetes (pre-DM). This study aims to explore the potential link between AIP and the risk of progression from normoglycemia to pre-DM.

METHODS

In this retrospective cohort analysis, a total of 8,295 individuals receiving routine medical examinations at Kuichong People's Hospital in Shenzhen between January 2018 and December 2023 were enrolled. The Cox proportional hazards regression model assessed the association between AIP and the risk of progression from normoglycemia to pre-DM, with restricted cubic splines functions used to assess non-linear relationships. Additionally, a competing risk Cox model was used, treating the progression from normoglycemia to diabetes (DM) as a competing event for pre-DM. Finally, the subgroup and sensitivity analyses confirmed the robustness of the findings.

RESULTS

After multivariable adjustment, each 0.1-unit increase in AIP was associated with an 11.5% increase in the risk of progression from normoglycemia to pre-DM [hazard ratio (HR) = 1.115; 95% confidence interval (CI): 1.065-1.167]. The competing risk Cox model showed that the sub-distribution hazard ratio for the association between AIP and the risk of pre-DM was 1.09 (95% CI: 1.04-1.14). Additionally, a non-linear association was observed in men, with an inflection point at 0.513. Below this threshold, each 0.1-unit increase in AIP was associated with an HR of 1.204 (95% CI: 1.098-1.321). In women, the relationship was linear.

CONCLUSION

This study demonstrated that elevated AIP was positively associated with the risk of progression from normoglycemia to pre-DM, with a significant sex difference in this relationship. This provides a reference for individualized risk stratification and management strategies for different sex populations and offers new perspectives for optimizing strategies to prevent pre-DM and DM.