ORIGINAL RESEARCH article

Front. Nutr.

Sec. Clinical Nutrition

Volume 12 - 2025 | doi: 10.3389/fnut.2025.1601137

Stress Hyperglycemia Ratio and Risk of Incident Myocardial Infarction in the General Population: A Large-Scale Cohort Study

Provisionally accepted
Wenke ChengWenke Cheng1Xianlin ZhangXianlin Zhang1Jiqian ShiJiqian Shi1Huaiyu RuanHuaiyu Ruan1Pinfang KangPinfang Kang1Hongyan SunHongyan Sun1Meiyang XuMeiyang Xu1Zhongyan DuZhongyan Du2*Bi TangBi Tang1*
  • 1The first affiliated hospital of Bengbu medical university, Bengbu, China
  • 2Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China

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Background: Stress hyperglycemia ratio (SHR), which combines acute admission glucose with chronic glycemic indices, is a novel marker of stress hyperglycemia. Its association with acute myocardial infarction (AMI) risk in the general population remains unclear.This prospective cohort study used data from the UK Biobank and included 337,620 participants without known cardiovascular disease (CVD). SHR was calculated as admission glucose / [(28.7 × HbA1c%) -46.7], with levels categorized into quintiles. The primary outcome was incident AMI, while ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) were evaluated as secondary outcomes. Cox proportional hazards models assessed the relationship between SHR and incident AMI risk. An accelerated failure time model was used to evaluate the effect of SHR on time to AMI onset, and dynamic changes in SHR were analysed using a restricted cubic spline (RCS).Results: During a median follow-up of 164.8 months (IQR: 155.7-173.6), 10,598 AMI events, including 3,019 STEMI and 5,711 NSTEMI cases, were recorded. Compared with the fourth quintile, the first, second, and third quintiles had increased AMI risks by 19% (HR 1.19; 95% CI 1.12-1.27), 16% (HR 1.16; 95% CI 1.09-1.24), and 7% (HR 1.07; 95% CI 1.00-1.14), respectively, with no significant increase observed in the highest quintile. RCS analysis revealed a U-shaped relationship between SHR and incident AMI risk (P for nonlinearity < 0.001), with the lowest risk at an SHR of 0.966.In the general population without known CVD, SHR exhibited a U-shaped association with incident AMI risk, with the lowest risk observed at an SHR of 0.966, particularly at levels below this threshold.

Keywords: Stress hyperglycemia ratio, acute myocardial infarction, ST-segment elevation myocardial infarction, Non-ST-segment elevation myocardial infarction, UK Biobank

Received: 27 Mar 2025; Accepted: 05 Jun 2025.

Copyright: © 2025 Cheng, Zhang, Shi, Ruan, Kang, Sun, Xu, Du and Tang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Zhongyan Du, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang Province, China
Bi Tang, The first affiliated hospital of Bengbu medical university, Bengbu, China

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Supplementary Material