Association of triglyceride-glucose index and high-sensitivity C-reactive protein with asymptomatic intracranial arterial stenosis: A cross-sectional study

The comprehensive effects of high-sensitivity C-reactive protein and triglyceride glucose index on cardiometabolic multimorbidity

Background

The triglyceride-glucose index (TyG index) is one of the surrogate markers of insulin resistance, and high-sensitivity C-reactive protein (hsCRP) reflects systemic inflammation. Existing studies suggest that insulin resistance or systemic inflammation may be indicative of cardiometabolic disease, but few of the existing studies have combined the TyG index and inflammation levels before assessing cardiometabolic multimorbidity. Our study data came from the China Health and Retirement Longitudinal Study (CHARLS). Participants in this data were followed for 9 years, and we used these data to conduct a long-term analysis to assess the combined effects of the TyG index and hsCRP on cardiometabolic multimorbidity in Chinese adults over 45 years of age.

Purpose

To study the combined effect of TyG index and hsCRP on cardiometabolic multimorbidity in middle-aged as well as elderly Chinese.

Method

The study data came from the China Health and Retirement Longitudinal Study (CHARLS), which included a total of 4,483 middle-aged and elderly participants who did not have cardiovascular metabolic diseases at baseline, which was from CHARLS 2011, and the last survey was in 2020. A total of five cardiometabolic diseases were considered in this study: diabetes, hypertension, hyperlipidemia, heart disease and stroke. A person was defined as having cardiometabolic multimorbidity when he/she had two or more cardiometabolic diseases at the same time. TyG index (median as cut-off) and hsCRP (1mg/L as cut-off) were each divided into two groups and combined into four groups (Group L-L: TyG index=median & hsCRP<1mg/L; Group L-H: TyG index=1mg/L; Group H-H: TyG index>=median & hsCRP>=1mg/L). Multiple regression equations were fitted to analyse the combined influence of TyG index and hsCRP on cardiometabolic multimorbidity.

Results

TyG index increases the risk of CMM events independently of hsCRP, as does the reverse. When the TyG index is elevated and hsCRP is also elevated, this condition significantly increases the danger of cardiometabolic multimorbidity in middle-aged and elderly Chinese.

Conclusion

High levels of TyG index and hsCRP can enhance the danger of cardiometabolic multimorbidity in Chinese middle-aged and elderly people, and the joint use of hsCRP and TyG index assessment may be a better way to achieve primary prevention of cardiometabolic multimorbidity in Chinese middle-aged and elderly people.

Association between triglyceride-glucose index and the risk of stroke among moyamoya patients: a single-center retrospective study

Background

Moyamoya disease increases the risk of strokes by impairing cerebral circulation, significantly affecting patients' quality of life. Despite the profound implications of this condition, there is a limited body of research exploring the factors that contribute to strokes in patients with Moyamoya disease. This study aims to evaluate the predictive value of the triglyceride-glucose index (TyG index) in forecasting stroke events among individuals diagnosed with moyamoya disease.

Methods

A total of 84 patients diagnosed with Moyamoya disease were treated at Changshu First People's Hospital from 01 January 2019 to 31 October 2024 were included in this study. We systematically collected and analyzed their clinical histories, laboratory test results, and baseline data. The patients were classified into two groups based on their history of cerebral stroke. Subsequently, we conducted a comparison and analysis of the TyG index between these two groups.

Results

The TyG index observed in patients with moyamoya disease who have a history of cerebral stroke was significantly elevated compared to that of patients without such a history. This difference was found to be statistically significant (p < 0.05). Furthermore, regression cubic splines analysis indicated a noteworthy linear relationship between the TyG index and the occurrence of cerebral stroke events.

Conclusion

In individuals diagnosed with Moyamoya disease, the TyG index has been shown to have a significant correlation with the risk of cerebral stroke. Furthermore, it has the potential to serve as an effective predictor for the occurrence of stroke.

Diagnostic value of C-reactive protein/ albumin ratio and TMTC1 in intracranial atherosclerotic stenosis in patients with acute cerebral infarction

We retrospectively analyzed the degree of stenosis in patients with acute cerebral infarction (CI) to investigate the correlation between C-reactive protein (CRP)/ albumin ratio and intracranial atherosclerotic stenosis (ICAS). Meanwhile, the differentially expressed genes (DEGs) in CI were identified through two Microarray profile GSE202518 and GSE180470. The receiver operating characteristics (ROC) curve analysis were performed to evaluate the sensitivity and specificity of CRP/ albumin ratio for the diagnosis of ICAS. Binary logistic regression models were used to examine the relationship between these biomarkers and the degree of ICAS, adjusting for potential confounders. The level of CRP/ albumin ratio in high group was significantly higher than that in low group. The area under the curve (AUC) of CRP/ albumin ratio for the diagnosis of ICAS was 0.6526 (95% CI, 0.5737 to 0.7316) in serum. TMTC1 was found to be highly expressed in high group, and the AUC of TMTC1 for the diagnosis of ICAS was 0.6853 (95% CI, 0.6085 to 0.7622) in serum. Moreover, the combination of CRP/ albumin ratio and TMTC1 enhanced the diagnosis of ICAS with AUC of 0.708 (95% CI, 0.633 to 0.783). High levels of CRP/ albumin ratio and TMTC1 expression were associated with the degree of ICAS, and may be potential diagnostic and prognostic markers for the ICAS.

Interaction of Triglyceride-Glucose Index and Metabolic Syndrome with Risk of Incident Stroke Among Middle-Aged and Older Chinese Adults

Objective

The triglyceride-glucose (TyG) index, a reliable surrogate marker of insulin resistance, has been shown as an independent risk factor for stroke. Still, the interaction between metabolic syndrome (MetS) and the TyG index in determining stroke risk remains to be clarified, which may help optimize stroke prevention strategies. This study aims to explore whether metabolic syndrome (MetS) influences the association between the TyG index and the risk of stroke.

Methods

A total of 7770 middle-aged and older participants free of stroke at baseline were enrolled from the China Health and Retirement Longitudinal Study. The TyG index was calculated as ln (triglyceride [mg/dL] × fasting glucose [mg/dL]/2). MetS was defined following the modified International Diabetes Federation criteria. The outcome was self-reported, physician-diagnosed, incident stroke during follow-up. Cox proportional hazard models were used to examine whether MetS influences the associations between the TyG index and the risk of incident stroke.

Results

A total of 568 (7.3%) incident stroke cases occurred after a median observation time of 7.0 years. After adjusting for potential confounders, a higher TyG level was associated with an increased risk of incident stroke (hazard ratio (HR) 1.19, 95% CI 1.05-1.33, P = 0.016). The association was significant in participants without MetS (HR 1.69, 95% CI 1.40-1.97, P < 0.001), but not in those with MetS (HR 1.05, 95% CI 0.88-1.21, P = 0.599). The interaction between the TyG index and MetS on the risk of incident stroke was significant (P = 0.004).

Conclusion

MetS influenced the association of the TyG index with the risk of incident stroke among middle-aged and older Chinese adults. The TyG index may be more effective for stroke risk stratification in populations without MetS compared to those with MetS.

Estimated glucose disposal rate, high sensitivity C-reactive protein and cardiometabolic multimorbidity in middle-aged and older Chinese adults: A nationwide prospective cohort study

AIM

To explore the separate and joint association of estimated glucose disposal rate (eGDR) and high-sensitivity C-reactive protein (hsCRP) with cardiometabolic multimorbidity (CMM).

METHODS

A total of 6900 participants aged 45 years or older with available data on eGDR and hsCRP and without cardiometabolic diseases at baseline from the China Health and Retirement Longitudinal Study were included. CMM was defined as the coexistence of two or more cardiometabolic diseases, including heart diseases, stroke, and diabetes.

RESULTS

During a median follow-up of 9.0 years, 464 (6.7 %) participants developed CMM. Low eGDR and high hsCRP separately and jointly increased the risk of CMM. The adjusted hazard ratio (HR) was 1.67 (95 % confidence interval [CI] 1.33-2.09) for low eGDR versus high eGDR, 1.43 (95 % CI 1.12-1.82) for high hsCRP versus low hsCRP) and 2.40 (95 % CI 1.77-3.27) for low eGDR plus high hsCRP versus high eGDR plus low hsCRP. The C-statistic, discriminatory power and risk reclassification significantly improved with the addition of combined eGDR and hsCRP for CMM (P < 0.001).

CONCLUSIONS

Low eGDR and high hsCRP were individually and jointly associated with increased risk of incident CMM. The findings highlighted the importance of joint evaluation of eGDR and hsCRP for primary prevention of CMM.

The effect of hsCRP on TyG index-associated cardiovascular risk in patients with acute coronary syndrome undergoing PCI

The effect of systemic inflammation, represented by high-sensitivity C-reactive protein (hsCRP), on triglyceride glucose (TyG) index-associated cardiovascular risk in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) has not yet been determined. This study was a retrospective analysis of a single-center prospective registry and finally included 1701 patients (age, 60 ± 10 years; male, 76.7%). The primary endpoint was defined as major adverse cardiovascular events (MACE), including cardiovascular mortality, non-fatal stroke, and non-fatal myocardial infarction. In the multivariate COX regression model that included the GRACE risk score, higher TyG index was significantly associated with a greater incidence of MACE in patients with hsCRP levels less than 2 mg/L but not 2 mg/L or more (P for interaction = 0.039). Each unit increase in the TyG index was independently associated with a 52% increased risk of MACE only in patients with hsCRP levels less than 2 mg/L (P = 0.021). After adjustment for other confounding factors, including the GRACE risk score, compared with those in the group of TyG index < 8.62 and hsCRP < 2 mg/L, patients in the group of TyG index ≥ 8.62 and hsCRP ≥ 2 mg/L had a 3.9 times higher hazard ratio for developing MACE. The addition of both TyG index and hsCRP had an incremental effect on the predictive ability of the GRACE risk score-based prognostic model for MACE (C-statistic: increased from 0.631 to 0.661; cNRI: 0.146, P = 0.012; IDI: 0.009, P < 0.001). In conclusion, there was a significant interaction between the TyG index and hsCRP for the risk of MACE, and the TyG index was reliably and independently associated with MACE only when hsCRP levels were less than 2 mg/L. Furthermore, high TyG index and high hsCRP levels synergistically increased the risk of MACE, suggesting that the prognostic value of TyG index combined with hsCRP might be promising in patients with ACS undergoing PCI.

The combined effect of triglyceride-glucose index and high-sensitivity C-reactive protein on cardiovascular outcomes in patients with chronic coronary syndrome: A multicenter cohort study

BACKGROUND

The triglyceride-glucose (TyG) index and high-sensitivity C-reactive protein (hsCRP) are the commonly used biomarkers for insulin resistance and systemic inflammation, respectively. We aimed to investigate the combined association of TyG and hsCRP with the major adverse cardiovascular events (MACE) in patients with chronic coronary syndrome (CCS).

METHODS

A total of 9421 patients with CCS were included in this study. The primary endpoint was defined as a composite of MACE covering all-cause death, nonfatal myocardial infarction, and revascularization.

RESULTS

During the 2-year follow-up period, 660 (7.0%) cases of MACE were recorded. Participants were divided equally into three groups according to TyG levels. Compared with the TyG T1 group, the risk of MACE was significantly higher in the TyG T3 group. It is noteworthy that among patients in the highest tertile of TyG, hsCRP >3 mg/L was significantly associated with an increased risk of MACE, whereas the results were not significant in the medium to low TyG groups. When patients were divided into six groups according to hsCRP and TyG, the Cox regression analysis showed that patients in the TyG T3 and hsCRP >3 mg/L group had a significantly higher risk of MACE than those in the TyG T1 and hsCRP ≤3 mg/L group. However, no significant interaction was found between TyG and hsCRP on the risk of MACE.

CONCLUSION

Our study suggests that the concurrent assessment of TyG and hsCRP may be valuable in identifying high-risk populations and guiding management strategies among CCS patients.

Proinflammatory interleukins 2, 6 and tumor necrosis factor alpha in patients with hypertension and diabetes mellitus depending on the presence of metabolic-associated liver steatosis

Background. Lack of information about proinflammatory interleukins (IL) and tumor necrosis factor alpha (TNFα) levels in case of metabolic-associated liver steatosis (MALS) and their roles in its progression to steatohepatitis are key reasons for the relevance and actuality of our study. The purpose: to evaluate proinflammatory interleukins 2, 6, and TNFα levels in concomitant liver steatosis. Materials and methods. Thirty-five patients with hypertension stage II–III, type 2 diabetes mellitus were examined. All of them were treated on an outpatient basis according to the guidelines of the Ministry of Health of Ukraine and the Declaration of Helsinki. Participants were divided into the main group with MALS (n = 24, males 45.8 %, females 54.2 %; average age 55.83 ± 0.89 years) and the control group without steatosis (n = 11, males 54.5 %, females 45.5 %; average age 53.00 ± 1.55 years). In addition to standard parameters, levels of IL6, IL2, TNFα, selectin, resistin, insulin, C-peptide, glycated hemoglobin, non-esterified fatty acids were evaluated, and some indexes were calculated, including triglyceride-glucose index and Castelli indexes I and II. Results were processed statistically, with significance level of р < 0.05. Results. Although MALS is not followed by qualitative differences in proinflammatory IL2, IL6 and TNFα compared to no steatosis, the risk of TNFα elevation was 5 times higher in patients with MALS (odds ratio 5.08; 95% confidence interval 1.02–25.17). An increase in IL2 and TNFα is unfavorable for patients with MALS, it can be considered as a marker of steatosis progression to steatohepatitis, as it is associated with transaminase activation, endogenous intoxication, lipid distress and glucose intolerance. IL6 was rather lower in patients with MALS compared to those without steatosis, but its growth was exponential and proceeded simultaneously to IL2 and TNFα. Conclusions. MALS was not associated with significant changes in IL2, IL6 and TNFα compared to no steatosis, but their elevation can be criteria for transformation into steatohepatitis due to the activation of transaminases, inflammation, endogenous intoxication, lipid distress, glucose intolerance.

Joint association of TyG index and high sensitivity C-reactive protein with cardiovascular disease: a national cohort study

BACKGROUND

Both the triglyceride-glucose (TyG) index, as a surrogate marker of insulin resistance, and systemic inflammation are predictors of cardiovascular diseases; however, little is known about the coexposures and relative contributions of TyG index and inflammation to cardiovascular diseases. Using the nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS), we conducted longitudinal analyses to evaluate the joint and mutual associations of the TyG index and high-sensitivity C-reactive protein (hsCRP) with cardiovascular events in middle-aged and older Chinese population.

METHODS

This study comprised 8 658 participants aged at least 45 years from the CHARLS 2011 who are free of cardiovascular diseases at baseline. The TyG index was calculated as Ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. Cardiovascular events were defined as the presence of physician-diagnosed heart disease and/or stroke followed until 2018.We performed adjusted Cox proportional hazards regression and mediation analyses.

RESULTS

The mean age of the participants was 58.6 ± 9.0 years, and 3988 (46.1%) were females. During a maximum follow-up of 7.0 years, 2606 (30.1%) people developed cardiovascular diseases, including 2012 (23.2%) cases of heart diseases and 848 (9.8%) cases of stroke. Compared with people with a lower TyG index (< 8.6 [median level]) and hsCRP < 1 mg/L, those concurrently with a higher TyG and hsCRP had the highest risk of overall cardiovascular disease (adjusted hazard ratio [aHR], 1.300; 95% CI 1.155-1.462), coronary heart disease (aHR, 1.294; 95% CI 1.130-1.481) and stroke (aHR, 1.333; 95% CI 1.093-1.628), which were predominant among those aged 70 years or below. High hsCRP significantly mediated 13.4% of the association between the TyG index and cardiovascular disease, while TyG simultaneously mediated 7.9% of the association between hsCRP and cardiovascular risk.

CONCLUSIONS

The findings highlight the coexposure effects and mutual mediation between the TyG index and hsCRP on cardiovascular diseases. Joint assessments of the TyG index and hsCRP should be underlined for the residual risk stratification and primary prevention of cardiovascular diseases, especially for middle-aged adults.

Triglyceride-Related Parameters and Symptomatic Atherosclerotic Lesions in Patients With Ischemic Stroke

Objective

Recently, evidence has suggested that the pathophysiology and risk factors of intracranial atherosclerosis (ICAS) differs from those of extracranial atherosclerosis (ECAS). In addition, novel parameters reflecting metabolic conditions, such as insulin resistance or atherogenic dyslipidemia, based on triglycerides (TG) and other biomarkers, have emerged. In this study, we evaluated the association between TG-related parameters and symptomatic cerebral atherosclerosis in patients with acute ischemic stroke resulting from large artery atherosclerosis (LAA).

Methods

We assessed consecutive acute LAA-stroke patients between January 2010 and December 2020. Based on the radiological findings, we classified the relevant symptomatic arteries that caused the index stroke into LAA-ICAS and LAA-ECAS. As TG-related parameters, the atherogenic index of plasma (AIP) and TG-glucose (TyG) index were calculated according to the following formulas: AIP = log10 (TG Level/High-density Lipoprotein Cholesterol Level), TyG Index = Ln (TG Level × Glucose Level/2).

Results

A total of 519 patients with LAA-stroke were evaluated. In multivariable logistic regression analysis to identify predictors of LAA-ICAS, AIP was significantly associated with LAA-ICAS (adjusted odds ratio [aOR], 3.60; 95% confidence interval [CI], 1.60-8.06). TyG index also showed a statistically significant relationship with LAA-ICAS (aOR, 1.60; 95% CI, 1.11-2.32). However, TG per se did not show a statistical association with LAA-ECAS.

Conclusion

TG-related parameters were more closely associated with stroke by ICAS than by ECAS. The metabolic conditions reflected by the AIP or TyG index, rather than hypertriglyceridemia itself, may play a greater role in determining the relevant vessel causally involved in a stroke.

Immune Markers Are Associated With Asymptomatic Intracranial Large Artery Stenosis and Future Vascular Events in NOMAS

BACKGROUND

Inflammation contributes to atherosclerosis but is incompletely characterized in intracranial large artery stenosis (ICAS). We hypothesized that immune markers would be associated with ICAS and modify the risk ICAS confers on future vascular events.

METHODS

This study included a subsample of stroke-free participants in the prospective NOMAS (Northern Manhattan Study), who had blood samples analyzed with a 60-plex immunoassay (collected from 1993 to 2001) and ICAS assessment with time-of-flight magnetic resonance angiography (obtained from 2003 to 2008). We dichotomized ICAS as either ≥50% stenosis or not (including no ICAS). We ascertained post-magnetic resonance imaging vascular events. We used least absolute shrinkage and selection operator procedures to select immune markers independently associated with ICAS. Then, we grouped selected immune markers into a derived composite Z score. Using proportional odds regression, we quantified the association of the composite immune marker Z score, ICAS, and risk of vascular events.

RESULTS

Among 1211 participants (mean age, 71±9 years; 59% women; 65% Hispanic participants), 8% had ≥50% ICAS. Using least absolute shrinkage and selection operator regression, we identified CXCL9 (C-X-C motif chemokine ligand 9), HGF (hepatocyte growth factor), resistin, SCF (stem cell factor), and VEGF-A(vascular endothelial growth factor A) to have the strongest positive relationships with ≥50% ICAS in fully adjusted models. Selected markers were used to derive a composite immune marker Z score. Over an average follow-up of 12 years, we found that each unit increase in immune marker Z scores was associated with an 8% (95% CI, 1.05-1.11), 11% (95% CI, 1.06-1.16), and 5% (95% CI, 1.01-1.09) increased hazard of death, vascular death, and any vascular event, respectively, in adjusted models. We did not find a significant interaction between immune marker Z scores and ICAS in their relationship with any longitudinal outcome.

CONCLUSIONS

Among a diverse stroke-free population, selected serum immune markers were associated with ICAS and future vascular events. Further study is needed to better understand their role in the pathogenesis of ICAS and as a potential therapeutic target in stroke prevention.

Association of insulin resistance with intra- and extra-cranial atherosclerotic burden in the nondiabetic community population

AIMS

Few population-based studies have investigated the association between insulin resistance and atherosclerotic burden in intra- and extra-cranial arteries. The purpose of this study is to explore the relationship between insulin resistance and intra- and extra-cranial atherosclerotic burden in community-based nondiabetic participants.

METHODS

This is a cross-sectional analysis from a population-based prospective cohort-PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events (PRECISE) study in China. The homeostasis model assessment of insulin resistance (HOMA-IR) and insulin sensitivity indices (ISI0-120) were stratified by the quartiles, respectively. The atherosclerotic presence of plaques and burden was evaluated by high-resolution MRI. Binary or ordinal logistic regression was performed to assess the association between HOMA-IR or ISI0-120 and the presence and burden of atherosclerosis.

RESULTS

Among the 2754 participants, the mean age was 60.9 ± 6.6 years, and 1296 (47.1%) were males. Compared with the lowest quartile of HOMR-IR, the highest quartile of HOMA-IR (indicating a higher level of insulin resistance) was associated with an increased presence of plaques (OR:1.54, 95% CI:1.14-2.08), and atherosclerotic burden (OR:1.53, 95%CI:1.14-2.07) in intracranial arteries. Meanwhile, we observed a similar relationship between HOMA-IR and the presence or burden in extracranial atherosclerosis. The first (indicating a higher level of insulin resistance) quartiles of ISI0-120 were associated with the intracranial plaques (Q1, OR:1.56, 95%CI:1.16-2.11) and atherosclerotic burden (Q1, OR:1.57, 95%CI:1.17-2.12), but not extracranial plaques or atherosclerotic burden, compared with the fourth quartile of ISI0-120.

CONCLUSIONS

Insulin resistance was associated with an increased intra-and extra-cranial atherosclerotic burden in the nondiabetic elderly Chinese population.

Combined effects of high sensitivity C-reactive protein and triglyceride-glucose index on risk of cardiovascular disease among middle-aged and older Chinese: Evidence from the China Health and Retirement Longitudinal Study

BACKGROUND AND AIMS

High sensitivity C-reactive protein (hsCRP) and triglyceride glucose (TyG) index were proved to be independent risk factors of cardiovascular disease (CVD). However, individual hsCRP or TyG index might not provide sufficient predictive value on CVD risk. The current study aimed to evaluate the cumulative effect of hsCRP and TyG index on CVD risk prospectively.

METHODS AND RESULTS

A total of 9626 participants were enrolled in the analysis. The TyG index was calculated as ln(triglyceride [mg/dL] × fasting glucose [mg/dL]/2). The primary outcome was new-onset CVD events (cardiac events or stroke), and the secondary outcomes were new-onset cardiac events and stroke, separately. Participants were divided into 4 groups through the median of hsCRP and TyG index. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox proportion hazard models. From 2013 to 2018, 1730 participants experienced CVD (570 stroke and 1306 cardiac events). Linear associations were found between hsCRP, TyG index, hsCRP/TyG ratio and CVD (all p < 0.05). Compared to participants with low hsCRP/low TyG index, multivariable adjusted HRs (95% CIs) for those with high hsCRP/high TyG index were 1.17 (1.03-1.37) for CVD. No interaction of hsCRP and TyG index was found on CVD (p_-interaction ≥0.05). Furthermore, adding hsCRP and TyG index simultaneously to conventional risk model improved risk reclassification for CVD, stroke and cardiac events (all p < 0.05).

CONCLUSION

The present study suggested combination of hsCRP and TyG index might better improved the ability for risk stratification of CVD among middle-aged and older Chinese.

Associations of hematological and biochemical markers with intracranial atherosclerotic stenosis in stroke-free populations: A systematic review and meta-analysis of observational studies

BACKGROUND AND AIMS

Intracranial atherosclerotic stenosis (ICAS) is an important cause of ischemic stroke and transient ischemic attack. We aimed to synthesize relevant evidence on the associations of hematological and biochemical markers with ICAS in stroke-free populations.

METHODS AND RESULTS

We searched MEDLINE and EMBASE for articles reporting associations of hematological and biochemical markers with ICAS presence in stroke-free populations. Weighted mean difference (WMD) and 95% confidence interval (CI) for each biomarker were pooled using fixed- or random-effects models. Among 32 studies included in the systematic review, 23 studies (48,326 subjects) with 22 biomarkers were meta-analyzed. Compared with subjects without ICAS, those with ICAS had significantly higher white blood cell (4118 subjects, WMD 0.28 per 10⁹/L, 95% CI 0.01-0.56), neutrophil (4326 subjects, WMD 0.24 per 10⁹/L, 0.10-0.38), neutrophil/lymphocyte ratio (4326 subjects, WMD 0.16, 0.07-0.26), low-density lipoprotein (28,606 subjects, WMD 0.12 mmol/L, 0.05-0.19), non-high-density lipoprotein (3671 subjects, WMD 0.17 mmol/L, 0.08-0.25), C-reactive protein (CRP; 5355 subjects, WMD 0.06 mg/dL, 0.04-0.07), high-sensitivity CRP (9383 subjects, WMD 0.07 mg/dL, 0.01-0.13), uric acid (5966 subjects, WMD 17.91 μmol/L, 11.16-24.66), creatinine (5731 subjects, WMD 4.03 μmol/L, 0.77-7.29), and homocysteine (7053 subjects, WMD 2.25 μmol/L, 1.02-3.48), but lower lymphocyte (4326 subjects, WMD -0.12 per 10⁹/L, -0.19--0.04). Sensitivity analyses showed similar results.

CONCLUSIONS

Several hematological and biochemical markers easily accessible were associated with ICAS presence in stroke-free populations. This can facilitate early identification of subjects at a high risk of ICAS, who may benefit from ICAS screening and prevention.

PROSPERO REGISTRATION NUMBER

CRD42021247990.

Association between triglyceride glucose index and risk of cerebrovascular disease: systematic review and meta-analysis

BACKGROUND

The triglyceride glucose (TyG) index, which is a new surrogate indicator of insulin resistance (IR), is thought to be associated with many diseases, such as cardiovascular disease, but its relationship with cerebrovascular disease is still controversial.

METHODS

The PubMed, EMBASE, Cochrane Library, Web of Science and Medline databases were searched until March 2022 to evaluate the association between the TyG index and cerebrovascular disease risk. A random‒effects model was used to calculate the effect estimates and 95% confidence intervals (CIs).

RESULTS

A total of 19 cohort studies and 10 case‒control/cross‒sectional studies were included in our study, which included 11,944,688 participants. Compared with a low TyG index, a higher TyG index increased the risk of cerebrovascular disease (RR/HR = 1.22, 95% CI [1.14, 1.30], P&lt;  0.001; OR = 1.15, 95% CI [1.07, 1.23], P&lt;  0.001). Furthermore, the results of the dose-response analysis of the cohort study demonstrated that the risk of cerebrovascular disease increased by 1.19 times per 1 mg/dl increment of the TyG index (relative risk = 1.19, 95% CI [1.13,1.25], P&lt;  0.001).

CONCLUSION

TyG index is related to cerebrovascular disease. More data and basic research are needed to confirm the association.

Triglyceride-Glucose Index and the Risk of Stroke: A Systematic Review and Dose-Response Meta-Analysis

Insulin resistance (IR) is an independent risk factor of cardiovascular disease. Recent research has proposed a new inexpensive and reliable indicator of IR: triglyceride glucose index (TyG index). We aim to evaluate the dose-response association between the TyG index and stroke through meta-analysis. Literature published from inception until October 2021 were searched in PubMed, Embase, Cochrane Library and Web of science. Cohort studies published in English and focusing on the association between the TyG index and stroke were included in our meta-analysis. I² statistic and Chi-square were used to assess the heterogeneity. When I²≥30% or p≤0.10, the random-effect model was used to pool the effect; otherwise, we chose the fixed-effect model. Eleven cohort studies, including 5 721 077 subjects and 95 490 stroke patients, were included in our study. After pooling the effect adjusted by multiple confounders, we found that compared with the lowest baseline TyG index group, the highest one was independently associated with increased stroke risk (RR: 1.27; 95% CI, 1.24 to 1.29; I²=6%). Dose-response meta-analysis showed that the association between the two variables had a non-linear trend (p-nonlinearity<0.0001; p-heterogeneity=0.28). Subgroup analysis showed that the risk of ischemic stroke was positively correlated with TyG index (RR: 1.48; 95% CI, 1.34 to 1.62; I²=15%), while we did not observe this correlation in hemorrhagic stroke patients. In patients with type 2 diabetes and acute coronary syndrome, the TyG index was linearly correlated with incident strokes. In conclusion, elevated TyG index is the independent risk factor for incident strokes (especially ischemic stroke).