Triglyceride-glucose index predicts major adverse cardiovascular events in patients with chronic kidney disease

Inter-organ communication: pathways and targets to cardioprotection and neuro-protection. A report from the 12th Hatter Cardiovascular Institute workshop

A long-standing aim in the setting of various pathologies including acute myocardial infarction, chronic kidney disease (CKD), and ischaemic stroke, has been to identify successful approaches to augment cellular and organ protection. Although the continual evolution and refinement of ideas over the past few decades has allowed the field to progress, we are yet to realise successful clinical translation of this concept. The 12th Hatter Cardiovascular Workshop identified a number of important points and key questions for future research relating to cardio- and neuro-protection and interorgan communication. Specific topics that were discussed include the 'cardio-metabolic-renal' axis of organ protection, the parasympathetic signalling hypothesis, the role of the coronary microvasculature in myocardial infarction, the RISK pathway of cardioprotection, extracellular vesicles and the way forward, the future for clinical studies of remote ischaemic conditioning, and new experimental models for cardio-oncology investigations.

Prognostic Value of the Triglyceride-Glucose Index Combined with Non-HDL-C/HDL-C Ratio for Predicting Coronary Microvascular Dysfunction in ACS Patients Post-PCI

Background

Coronary microvascular dysfunction (CMD) after percutaneous coronary intervention (PCI) is a critical prognostic factor in acute coronary syndrome (ACS). This study aimed to evaluate the combined predictive value of the triglyceride-glucose index (TyG) and non-HDL-C/HDL-C ratio (NHHR) for CMD in ACS patients post-PCI.

Methods

A retrospective analysis of 542 ACS patients undergoing PCI (2021-2023) was conducted. Patients were classified into CMD (n=273) and non-CMD (n=269) groups based on CMD presence post-PCI. Baseline characteristics and biochemical markers were analyzed. TyG index and NHHR were calculated, and univariate and multivariate analyses were performed to identify predictors of CMD. ROC curves evaluated the predictive value of TyG combined with NHHR, while net reclassification index (NRI) and integrated discrimination improvement (IDI) assessed incremental predictive value.

Results

CMD patients exhibited significantly higher levels of TyG and NHHR compared to non-CMD patients. Multivariate logistic regression indicated that TyG (OR = 1.89, 95% CI: 1.24-2.88, P = 0.003) and NHHR (OR = 1.34, 95% CI: 1.11-1.62, P = 0.011) were independent predictors of CMD. The combined model showed significant improvement in discrimination (C-statistic increased from 0.750 to 0.782, P < 0.001) and reclassification (NRI = 0.458, IDI = 0.051, both P < 0.001).

Conclusion

TyG and NHHR are novel predictors of CMD post-PCI, with combined use improving risk stratification. Given the retrospective nature of the study, further multicenter prospective research is required to validate these findings.

Association between triglyceride-glucose index and clinical outcomes among patients with chronic kidney disease: a meta-analysis

PURPOSE

To identify the relationship of triglyceride-glucose (TyG) index with clinical outcomes in chronic kidney disease (CKD) patients based on current available evidence.

METHODS

PubMed, EMBASE, Web of Science and CNKI databases were searched up to August 31, 2024. Primary outcome was the all-cause mortality. Secondary outcomes included the coronary artery disease (CAD) mortality, CKD progression, risk of severe coronary artery stenosis (SCAS), major adverse cardiovascular event (MACE), coronary artery calcification (CAC) progression, end-stage renal disease (ESRD), and nonalcoholic fatty liver disease (NAFLD). The hazard ratio (HR) and odds ratio (OR) with 95% confidence interval (CI) were combined to assess the predictive role of TyG index for above clinical outcomes among CKD patients. All statistical analysis was performed by STATA 15.0 version.

RESULTS

Twelve studies with 26,530 cases were included. Pooled results indicated that elevated TyG index was significantly related to increased risk for all-cause mortality (HR = 1.22, 95% CI: 1.13-1.31, P<0.001). Besides, high TyG index was also associated with the CAD mortality (HR = 1.19, 95% CI: 1.04-1.36, P = 0.011), occurrence of CKD progression (HR = 1.52, 95% CI: 1.36-1.70, P<0.001), SCAS (OR = 1.79, 95% CI: 1.13-2.83, P = 0.013), MACE (OR = 1.68, 95% CI: 1.11-2.54, P = 0.014), CAC progression (OR = 1.55, 95% CI: 1.06-1.76, P = 0.02), CAD (OR = 2.865, 95% CI: 1.681-4.885, P<0.001), ESRD (OR = 1.49, 95% CI: 1.12-1.99, P = 0.006) and NAFLD (OR = 4.903, 95% CI: 3.046-7.893, P<0.001).

CONCLUSION

High TyG index predicts poor clinical outcomes and might serve as a novel prognostic indicator among CKD patients. However, more studies are still needed to verify above findings.

Association between triglyceride-glucose index and cardiovascular disease in US adults with chronic kidney disease: a population-based study

OBJECTIVES

Triglyceride-glucose (TyG) index, which is a valuable measure of insulin resistance, has been found to have predictive value for cardiovascular disease (CVD). However, its relationship with CVD among individuals with chronic kidney disease (CKD) has not been thoroughly investigated. This study focused on examining the relationship of the TyG index and CVD among CKD patients in United States.

METHODS

3507 eligible participants from the National Health and Nutrition Examination Survey (2003-2018) were surveyed in this study. Methods such as multivariable logistic regression analysis and smooth curve fitting were employed to estimate how the TyG index is linked to CVD in CKD populations. Subgroup and interaction analyses were conducted in order to figure out potential moderating effects of various factors.

RESULTS

In this cross-sectional study which based on a population with CKD, 29.5% of patients also had CVD. An independent and positive link of TyG and CVD was revealed (OR 1.213, 95% CI 1.059, 1.389). This association was nonlinear, with a threshold effect observed at a TyG index of 8.98. The results of subgroup analysis suggested that the relationships of TyG and CVD differed according to CKD stage: (OR 1.048, 95% CI 0.857, 1.282) in CKD stages 1-2; (OR 1.267, 95% CI 1.030-1.560) in stage 3; and (OR 2.131, 95% CI 1.224-3.709) in stages 4-5. Interaction analyses further suggested the potential moderating effects of CKD stage. Additionally, among specific CVD types, only coronary heart disease (CHD) had a significant and positive relationship with TyG (OR 1.617, 95% CI 1.123, 2.327).

CONCLUSIONS

TyG index was identified to be independently and positively related to the likelihood of CVD, specifically in populations with an eGFR < 60 mL/min/1.73 m². The association had a threshold effect. The results highlight the potential of the TyG index as a tool for screening and risk assessment of CVD in populations suffering from CKD, warranting further investigation.

The U-shape relationship between insulin resistance-related indexes and chronic kidney disease: a retrospective cohort study from National Health and Nutrition Examination Survey 2007-2016

BACKGROUND

There is ongoing debate on the correlation between chronic kidney disease (CKD) and insulin resistance (IR)-related indices. Our objective was to explore the prognostic ability of IR-related indexes for the prevalence of CKD, as well as the mortality from all causes and cardiovascular disease (CVD) in CKD patients.

METHODS

The data used in this study came from the National Health and Nutrition Examination Survey (NHANES). Binary logistic regression analysis, Cox proportional hazards model, and restricted cubic spline (RCS) were used to analyze the relationship between IR-related indexes, including metabolic score of IR (METS-IR), homeostatic model assessment for IR (HOMA-IR), triglyceride glucose index (TyG), triglyceride glucose-waist-to-height ratio (TyG-WHtR), triglyceride glucose-body mass index (TyG-BMI), with CKD and its all-cause mortality and CVD mortality. Subgroup analysis was performed to test the stability of the results. Finally, the predictive power of IR-related indexes for CKD was tested by the receiver operating characteristic (ROC) curve.

RESULTS

Among the recruited 10,660 participants, 15.42% were CKD patients. All IR-related indexes were found to be nonlinearly correlated to the prevalence of CKD in the study. When the TyG index was higher than 9.05, it was positively associated with CKD (OR: 1.77, 95% CI 1.44-2.18). Moreover, increased TyG-WHtR level was correlated with a greater prevalence of CKD when it was higher than 4.3 (OR: 1.31, 95% CI 1.19-1.45). Other IR-related indexes (METS-IR, HOMA-IR, and TyG-BMI) showed fewer notable correlations with CKD. The association of IR-related indexes and the prevalence of CKD remained consistent in most subgroups (P for interactions > 0.05). TyG-WHtR was also the predictor of all-cause mortality in CKD patients (HR: 1.34, 95% CI 1.14-1.58), while other IR-related indexes were not correlated with the all-cause mortality or CVD mortality in CKD patients (P > 0.05). Otherwise, ROC curves showed that TyG-WHtR had more robust diagnostic efficacy than other IR-related indexes (METS-IR, HOMA-IR, TyG, and TyG-BMI) in predicting CKD (area under the curve: 0.630, 95% CI 0.615-0.644).

CONCLUSIONS

IR-related biomarkers (METS-IR, HOMA-IR, TyG, and TyG-BMI) were positively correlated with the prevalence of CKD. Moreover, TyG-WHtR enhanced CKD and its all-cause mortality prediction. In patients with elevated levels of IR-related indexes, the early detection and intervention of IR may reduce the occurrence of CKD and the prognosis of CKD patients.