After final adjustment for age, sex, race, education, smoking, drinking, physical activity, body mass index, total cholesterol, high density lipoprotein, albumin, alanine aminotransferase, blood urea nitrogen, blood uric acid, glucose, hypertension, diabetes mellites, and CVD (Model 3), compared to those with the first quartile of SI (< 88.41 vs. ≥125.52), participants with the highest quartile of SI were associated with reduced risk of cardiovascular death (HR: 0.41, 95% CI: 0.31–0.53, P < 0.001) and all-cause death (HR: 0.41, 95% CI: 0.35–0.49, P < 0.001). The gene discussed is GPT; the disease is diabetes mellitus.