High triglyceride-glucose index is associated with subclinical cerebral small vessel disease in a healthy population: a cross-sectional study

The joint effect of triglyceride-glucose related indices and depression on cardio-renal-metabolic multimorbidity among middle-aged and older Chinese adults

BACKGROUND

The triglyceride-glucose (TyG) related indices, indicators for insulin resistance, and depression are both established predictors of cardiovascular diseases. However, the single and combined effect of TyG related indices and depression on cardio-renal-metabolic multimorbidity (CRMM) risk remain uncertain.

METHODS

This study included 7848 respondents aged 45 years and older, derived from the China Health and Retirement Longitudinal Study (CHARLS) 2011, 2020. Cox regression was used to determine independent and joint effect of TyG indices and depression on CRMM incidence. Restricted cubic spline (RCS) was further performed to identify associations of TyG indices with CRMM.

RESULTS

Results demonstrated that both TyG indices (including TyG-WC, TyG-WHtR, and TyG-BMI) and depression were independently linked to increased risk of CRMM. The RCS model further confirmed the significant dose-response relationships. Participants experiencing both elevated TyG indices and depression exhibited the highest CRMM risk, in contrast to those with neither condition (HR = 1.630, 95%CI: 1.467-1.811; HR = 1.631, 95%CI: 1.465-1.817; HR = 1.582, 95%CI: 1.419-1.764; HR = 1.532, 95%CI: 1.372-1.711, respectively).

LIMITATIONS

Firstly, disease diagnoses in the CHARLS were self-reported, which might cause recall bias. Then, data was specific to the population over 45 years old, so the results may not apply broadly to all populations.

CONCLUSIONS

This study revealed both the single and joint effect of TyG, TyG-WC, TyG-WHtR, as well as TyG-BMI and depression on CRMM risk. Combined evaluations of the TyG index with depression screening is crucial for identifying related risk factors and enhancing prevention strategies against CRMM.

Association between triglyceride-glucose index and Helicobacter pylori infection: a cross-sectional study

Background

Mounting research suggests that insulin resistance (IR) is associated with Helicobacter pylori (H. pylori) infection. The triglyceride-glucose (TyG) index has received widespread attention due to its high sensitivity in assessing IR. This study examined the association between H. pylori infection and TyG index.

Methods

This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) 1999 - 2000. Participants were categorized into quartile groups (Q1-Q4) based on their TyG index. Weighted multivariable-adjusted logistic regression and subgroup analysis were used to explore the correlation between TyG index and H. pylori infection. Furthermore, sensitivity analysis was conducted to assess the robustness of our findings.

Results

This study included 2,918 participants, 1,101 of whom were infected with H. pylori. The mean TyG index for all participants was 8.56 ± 0.67. Patients who were H. pylori positive had higher levels of TyG index compared with H. pylori seronegative participants (8.74 ± 0.03 vs. 8.57 ± 0.03, P < 0.05). The fourth quartile of the TyG index showed the highest odds of H. pylori infection compared to Q1 (OR = 2.37, 95%CI: 1.52 to 3.71, P  <  0.001). Sensitivity analysis indicated that the association between TyG index and H. pylori infection remained strong even after excluding participants with cardiovascular diseases or taking lipid-lowering medications, as well as patients with diabetes or taking glucose-lowering medications.

Conclusions

In this study, a stable and strong positive association was found between TyG index and H. pylori infection. IR may be significantly associated with H. pylori infection. Further studies are necessary to elucidate the underlying mechanisms and potential clinical implications of these findings.

Association between triglyceride glucose index and depression in polycystic ovary syndrome

OBJECTIVE

The relationship between the triglyceride glucose (TyG) index and the incidence of depression in populations with polycystic ovary syndrome (PCOS) remains unclear. This study aims to investigate the relationship between the TyG index and depression incidence in PCOS populations.

METHODS

We conducted a study on 725 women aged 18 to 45 who visited our hospital from January 2021 to December 2023. Demographic and anthropometric data were collected, and serum assays were performed. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess the past week's feelings and determine depression status. Statistical methods such as binary logistic regression analysis were used to analyze the relationship between the TyG index, Homeostatic model assessment insulin resistance index(HOMA-IR), and depression in PCOS patients. The TyG index, HOMA-IR, was tested for its ability to predict depression using receiver operating characteristic (ROC) curves.

RESULTS

In logistic regression models, a significant positive association was observed between the TyG index and depression after the adjusted analysis(4.552(2.975 ∼ 6.966), P<0.001). Compared to HOMA-IR(1.224(1.122 ∼ 1.336), P<0.001), the TyG index was a more significant risk factor for depression. ROC analysis showed that the AUC of the TyG index(0.724, 0.684 ∼ 0.765) was higher than the HOMA-IR(0.698,0.656~0.74).

CONCLUSIONS

A high TyG index was associated with higher odds of having depression in the population with PCOS. This indicated that the TyG index may be an independent predictor of depression development.

CLINICAL TRIAL NUMBER

Not applicable.

Correlation Between Blood Glucose Level and Cerebral Small Vessel Disease Markers in Neurologically Asymptomatic, Nondiabetic Individuals

Objectives

Cerebral small vascular disease (CSVD) is not rare in neurologically asymptomatic individuals. Glucose control and insulin resistance (IR) may be its risk factors. We aimed to explore the relationship between CSVD markers, glucose control, and IR in neurologically asymptomatic, nondiabetic individuals.

Methods

A total of 412 participants from the annual physical examinations population in our hospital who underwent brain magnetic resonance imaging from May 2019 to June 2021 were enrolled. We collected clinical data and blood test indices and calculated the triglyceride-glucose (TyG) index. CSVD markers were assessed, including lacunes, white matter hyperintensities (WMH), enlarged perivascular spaces (EPVS), cerebral microbleeds (CMBs), and the total CSVD score. Correlations between CSVD markers, clinical variables, and blood test parameters were analyzed.

Results

The median age of our group was 70.32 ± 10.27 years (45-103 years). The prevalence of asymptomatic CSVD was 43.7%. Lacunes were present in 8.3%, periventricular WMH (PVWMH) in 65.3%, deep WMH (DWMH) in 64.1%, EPVS in 87.4%, and CMBs in 31.3% of individuals. Glycated hemoglobin A1c (HbA1c) varied between PVWMH subgroups (p = 0.043). Fasting blood glucose (FBG) was higher in individuals with deep CMBs than in those without deep CMBs (p = 0.012). FBG was an independent risk factor for deep CMBs after controlling for multiple variables. However, the TyG index was not associated with CSVD markers.

Conclusions

The prevalence of neurologically asymptomatic CSVD is common in the nondiabetic population. It may be beneficial for middle-aged and elderly people to pay attention to their blood glucose levels.

Exploring the triglyceride-glucose index's role in depression and cognitive dysfunction: Evidence from NHANES with machine learning support

BACKGROUND

Depression and cognitive impairments are prevalent among older adults, with evidence suggesting potential links to obesity and lipid metabolism disturbances. This study investigates the relationships between the triglyceride-glucose (TyG) index, body mass index (BMI), depression, and cognitive dysfunction in older adults, leveraging data from the NHANES survey and employing machine learning techniques.

METHODS

We analysed 1352 participants aged 60-79 from the 2011-2014 NHANES dataset, who underwent cognitive function testing, depression assessments, and TyG index measurements. Multivariate linear regression and subgroup analyses were conducted to examine associations between the TyG index and depression/cognitive impairment. Machine learning models evaluated the importance of predictive factors for depression, while Mendelian randomization (MR) was employed to explore the causal relationship between BMI and depression/cognitive function.

RESULTS

The TyG index was negatively associated with cognitive function scores and positively associated with depression scores in adjusted models (p < 0.001). In fully adjusted subgroup analyses, among obese individuals (BMI ≥ 28), a 100-unit increase in the TyG index was linked to a 3.79-point decrease in depression scores. Machine learning models (Xgboost, AUC = 0.960) identified BMI, TyG-BMI, gender, and comorbidities (e.g., asthma, stroke, emphysema) as key determinants of depression. MR analyses revealed a negative association between BMI and depression risk [OR: 0.9934; 95 % CI (0.9901-0.9968), p = 0.0001] and cognitive dysfunction risk [OR: 0.8514; 95 % CI (0.7929-0.9143), p < 0.05]. No evidence of heterogeneity or pleiotropy was detected.

LIMITATIONS

Depression and cognitive impairments were self-reported, potentially introducing bias. The observed associations may be influenced by unmeasured confounders, necessitating further research into the underlying mechanisms.

CONCLUSIONS

Our findings reveal associations between the TyG index and psychocognitive health in older adults. While these results highlight lipid metabolism as a potential factor in depression and cognitive dysfunction, further studies are needed to validate these findings and explore underlying mechanisms.

Association of triglyceride glucose index with diabetic retinopathy in middle-aged and elderly ambulatory type 2 diabetic patients

Background

Diabetic retinopathy (DR) is a major contributor to vision loss and blindness among working-age adults worldwide. While the relationship between the triglyceride glucose (TyG) index and DR in hospitalized patients has been demonstrated, research on the correlation between the triglyceride glucose (TyG) index and DR in ambulatory type 2 diabetes mellitus (T2DM) patients is still relatively limited.

Methods

A cohort of 398 middle-aged and elderly T2DM patients who underwent outpatient physical examinations at the First People's Hospital of Hefei City between 2012 and 2017 were included in this study. They were categorized into either the nondiabetic retinopathy group (296 cases in the NDR group) or the diabetic retinopathy group (102 cases in the DR group) based on the results of dilated fundus examinations. One-way logistic regression and LR backward multifactorial logistic regression analyses were utilized to identify the risk factors associated with the development of diabetic retinopathy in T2DM patients. Furthermore, the predictive value of the TyG index for diabetic retinopathy in middle-aged and elderly ambulatory T2DM patients was evaluated through stratified regression to adjust for other factors, along with receiver operating characteristic (ROC) curve analysis.

Results

Multivariate logistic regression analysis indicated that the TyG index was identified as an independent risk factor for diabetic retinopathy (DR) in middle-aged and elderly patients with type 2 diabetes mellitus (T2DM) (P < 0.05). The receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) was 0.585 [95% CI (0.524, 0.646)] (P = 0.011), with an optimal cut-off value of 9.115, corresponding to a sensitivity of 82.4% and specificity of 36.1%.

Conclusion

The TyG index serves as an independent risk factor for diabetic retinopathy (DR) in middle-aged and elderly ambulatory type 2 diabetes mellitus (T2DM) patients, and it is recommended that this index be used as a reference index in the comprehensive assessment of DR.

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.

The association between triglyceride-glucose index and its combination with post-stroke depression: NHANES 2005-2018

BACKGROUND

Growing evidence indicates a link between insulin resistance and post-stroke depression (PSD). This study employed the triglyceride glucose (TyG) index as a measure of insulin resistance to investigate its relationship with PSD.

METHODS

This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (2005-2018). PSD was assessed using data from patient health questionnaires, while the TyG index was calculated based on fasting venous blood glucose and fasting triglyceride levels. The formula used for the TyG index is ln[triglycerides (mg/dL) × fasting blood glucose (mg/dL)/2]. Participants were categorized into four groups according to the TyG index quartiles. A weighted multivariable logistic regression model was applied to examine the relationship between the TyG index and PSD.

RESULTS

A total of 1217 patients were included in the study, of which 232 were diagnosed with PSD. The TyG index was divided into quartiles (Q1-Q4) for analysis. After adjusting for potential confounders, we found a significant positive association between the highest quartile of the TyG index (Q4: ≥9.33) and PSD (OR = 2.51, 95% CI: 1.04-6.07, p = 0.041). This suggests that in the U.S. adult stroke population, individuals with higher TyG indices are more likely to experience depressive symptoms. Subgroup analysis further confirmed a stable and independent positive association between the TyG index and PSD (all trend p > 0.05).

CONCLUSION

In this large cross-sectional study, our results suggest that among US adults who have experienced a stroke, those with higher TyG index levels are more likely to exhibit depressive symptoms. This provides a novel approach for the clinical prevention of PSD. Patients with higher TyG indices in the stroke population may require closer psychological health monitoring and timely intervention. Additionally, since the TyG index is calculated using only fasting blood glucose and triglyceride levels, it can help identify high-risk PSD patients, particularly in regions with limited healthcare resources.

Analyzing the correlation between acute ischemic stroke and triglyceride-glucose index based on ordered logistic regression

Objective

To investigate the association between insulin resistance, measured by the triglyceride-glucose (TyG) index, and clinical outcomes in patients with acute ischemic stroke who underwent intravenous thrombolysis with alteplase.

Methods

This retrospective study included 165 patients with acute ischemic stroke treated with intravenous alteplase. Insulin resistance was evaluated using the TyG index, and its relationship with the modified Rankin Scale (mRS) scores was analyzed. The analysis was conducted using R software (version R 4.1.3) to evaluate the correlation between the TyG index and functional outcomes at 14, 30, and 90 days post-stroke.

Results

The study found that each unit increase in the TyG index significantly raised the risk of poor functional outcomes at 14 days (OR 9.86; 95% CI: 3.32-32.21; P < 0.001), 30 days (OR 5.82; 95% CI: 2.08-17.45; P = 0.001), and 90 days (OR 9.79; 95% CI: 3.33-31.66; P < 0.001) following a stroke. Higher TyG index values were associated with worse neurological outcomes. Although male gender, older age, and smoking were also linked to poorer outcomes, these associations did not reach statistical significance.

Conclusion

The findings suggest that a higher TyG index, indicating greater insulin resistance, is associated with worse neurological outcomes in stroke patients. Early intervention targeting insulin resistance may improve clinical outcomes in ischemic stroke patients, and further research is needed to explore additional factors affecting neurological recovery.

Association between triglyceride-glucose (TyG) index and the incidence of depression in US adults with diabetes or pre-diabetes

BACKGROUND

The relationship between the triglyceride glucose (TyG) index and the incidence of depression in populations with diabetes or pre-diabetes remains unclear. This study aims to investigate the association between the TyG index and depression incidence in diabetic/pre-diabetic populations.

METHOD

Data from the 2005-2018 National Health and Nutrition Examination Survey (NHANES) were analyzed. After adjustment for confounders, multivariate logistic regression models were fitted to investigate the association between TyG index and depression incidence. Restricted cubic splines (RCS), subgroup analysis, interaction analysis, and mediation analysis were also constructed.

RESULTS

A total of 8,970 participants with diabetes or pre-diabetes were enrolled. The linear positive association between TyG index and the incidence of depression was observed. Insulin resistance partly mediates this association in mediation analysis. There is a U-shape association between TyG index and the incidence of depression in diabetic/pre-diabetic populations whose ethnicity is Other Hispanic (p for nonlinearity =0.0237). Subgroup analysis evaluated the robustness of our findings and interaction analysis showed that this association can be modified by race/ethnicity.

CONCLUSION

There is a linear positive association between the TyG index and the incidence of depression in populations with diabetes or pre-diabetes.

Role of Peripheral and Central Insulin Resistance in Neuropsychiatric Disorders

Insulin acts on different organs, including the brain, which helps it regulate energy metabolism. Insulin signaling plays an important role in the function of different cell types. In this review, we have summarized the key roles of insulin and insulin receptors in healthy brains and in different brain disorders. Insulin signaling, as well as insulin resistance (IR), is a major contributor in the regulation of mood, behavior, and cognition. Recent evidence showed that both peripheral and central insulin resistance play a role in the pathophysiology, clinical presentation, and management of neuropsychiatric disorders like Cognitive Impairment/Dementia, Depression, and Schizophrenia. Many human studies point out Insulin Resistance/Metabolic Syndrome can increase the risk of dementia especially Alzheimer's dementia (AD). IR has been shown to play a role in AD development but also in its progression. This review article discusses the pathophysiological pathways and mechanisms of insulin resistance in major neuropsychiatric disorders. The extent of insulin resistance can be quantified using IR biomarkers like insulin levels, HOMA-IR index, and Triglyceride glucose-body mass index (TyG-BMI) levels. IR has been shown to precede neurodegeneration. Human trials showed current treatment with certain antidiabetic drugs, as well as life style management, like weight loss and exercise for IR, have shown promise in the management of cognitive/neuropsychiatric disorders. This may pave the pathway to the development of new therapeutic approaches to these challenging disorders of dementia and psychiatric diseases. Recent clinical trials are showing some encouraging evidence for these pharmacological and nonpharmacological approaches for IR in psychiatric and cognitive disorders, even though more research is needed to apply this evidence into clinical practice. Early identification and management of IR may help as a strategy to potentially alter neuropsychiatric disorders onset as well as its progression.

Combined influence of depression symptoms and ratio of triglyceride to high-density lipoprotein cholesterol on cardiometabolic multimorbidity: Findings from the China Health and Retirement Longitudinal Study 2011-2018

BACKGROUND

Previous studies had reported depression symptoms and TG/HDLC ratio may share pathophysiological pathway. The aim was to investigate the combined effects of depression symptoms and TG/HDL-C ratio on the risk of CMM.

METHODS

This cohort study extracted data from 2011 to 2018 of CHARLS. The CMM event occurred from 2013 to 2018, defined as suffering from more than one of stroke, cardiac events, and diabetes mellitus. Cox proportional hazards regression models were used to assess the association between the baseline combined effects of depression symptoms and TG/HDL-C ratio with incidence of CMM, stroke, cardiac events, and diabetes mellitus.

RESULTS

A total of 8349 participants (3966 men and 4383 women) were included in the study, with a mean age of 58.5 years. During a 7-year follow-up survey, 370 (4.43 %) participants developed CMM. Compared to individuals with no depression symptoms and low TG/HDLC ratio, the multivariable-adjusted HRs (95%CI) for the new-onset CMM for patients with the depression symptoms alone, high TG/HDLC ratio alone, and depression symptoms and high TG/HDLC ratio were 1.37 (95 % CI = 0.95-1.98), 1.62 (95 % CI = 1.22-2.14), 1.94 (95 % CI = 1.39-2.72), respectively (P < 0.001).

LIMITATIONS

Firstly, potential confounding factors such as dietary intake and nutrition were not collected at the time of study design. Secondly, exposure to the outcome was self-reported, which may cause recall bias or misclassification. Finally, the population was aged ≥45 years, so the results cannot be generalized to all age groups.

CONCLUSION

Our findings indicated that patients with depression and high TG/HDLC ratio had a higher risk of developing CMM.

Triglyceride-glucose index's link to cardiovascular outcomes post-percutaneous coronary intervention in China: a meta-analysis

Percutaneous coronary intervention (PCI) addresses myocardial ischaemia, but a significant subset of patients encounter major adverse cardiovascular events (MACE) post-treatment. This meta-analysis investigated the relationship between the post-PCI triglyceride-glucose (TyG) index and MACE. Comprehensive searches of the Embase, PubMed, Cochrane Library, and Web of Science databases were conducted up to 3 March 2023, using relevant keywords. The effect size was determined based on I2 statistic using random-effects models. Cluster-robust standard errors crafted the dose-response curve, and the GRADE Evaluation Scale was employed to rate the quality of evidence. The group with the highest TyG index had significantly higher post-PCI MACE rates than the lowest index group, with hazard ratios (HRs) of 2.04 (95% CI 1.65-2.52; I2 = 77%). Each unit increase in TyG index corresponded to HRs of 1.82 for MACE (95% CI 1.34-2.46; I2 = 92%), 2.57 for non-fatal MI (95% CI 1.49-4.41; I2 = 63%), and 2.06 for revascularization (95% CI 1.23-3.50; I2 = 90%). A linear relationship between TyG index and MACE risk was established (R2 = 0.6114). For all-cause mortality, the HR was 1.93 (95% CI 1.35-2.75; I2 = 50%), indicating a higher mortality risk with elevated TyG index. The GRADE assessment yielded high certainty for non-fatal MI but low certainty for all-cause mortality, revascularization, and MACE. The TyG index may predict risks of post-PCI MACE, all-cause mortality, non-fatal MI, and revascularization, with varied levels of certainty. A potential linear association between the TyG index and MACE post-PCI was identified. Future research should validate these findings.

Novel inflammatory and insulin resistance indices provide a clue in cerebral amyloid angiopathy

This study investigated the correlation of newly identified inflammatory and insulin resistance indices with cerebral amyloid angiopathy (CAA), and explored their potential to differentiate CAA from hypertensive arteriopathy (HA). We retrospectively analyzed 514 consecutive patients with cerebral small vessel disease (CSVD)-related haemorrhage, comparing the differences in novel inflammatory and insulin resistance indices between patients with CAA and HA. Univariate regression, LASSO and multivariate regression were used to screen variables and construct a classification diagnosis nomogram. Additionally, these biomarkers were explored in patients with mixed haemorrhagic CSVD. Inflammatory indices were higher in CAA patients, whereas insulin resistance indices were higher in HA patients. Further analysis identified neutrophil-to-lymphocyte ratio (NLR, OR 1.17, 95% CI 1.07-1.30, P < 0.001), and triglyceride-glucose index (TyG, OR = 0.56, 95% CI 0.36-0.83, P = 0.005) as independent factors for CAA. Therefore, we constructed a CAA prediction nomogram without haemorrhagic imaging markers. The nomogram yielded an area under the curve (AUC) of 0.811 (95% CI 0.764-0.865) in the training set and 0.830 (95% CI 0.718-0.887) in the test set, indicating an ability to identify high-risk CAA patients. These results show that CSVD patients can be phenotyped using novel inflammatory and insulin resistance indices, potentially allowing identification of high-risk CAA patients without haemorrhagic imaging markers.

Associations of Serum Insulin and Related Measures With Neuropathology and Cognition in Older Persons With and Without Diabetes

OBJECTIVE

To examine associations of serum insulin and related measures with neuropathology and cognition in older persons.

METHODS

We studied 192 older persons (96 with diabetes and 96 without, matched by sex and balanced by age-at-death, education, and postmortem interval) from a community-based, clinical-pathologic study of aging, with annual evaluations including neuropsychological testing (summarized into global cognition and 5 cognitive domains) and postmortem autopsy. We assessed serum insulin, glucose, leptin, adiponectin, hemoglobin A1C, advanced glycation-end products (AGEs), and receptors for advanced glycation-end products, and calculated the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and adiponectin-to-leptin ratio. Using adjusted regression analyses, we examined the associations of serum measures with neuropathology of cerebrovascular disease and Alzheimer's disease, and with the level of cognition proximate-to-death.

RESULTS

Higher HOMA-IR was associated with the presence of brain infarcts and specifically microinfarcts, and higher HOMA-IR and leptin were each associated with subcortical infarcts. Further, higher leptin levels and lower adiponectin-to-leptin ratios were associated with the presence of moderate-to-severe atherosclerosis. Serum insulin and related measures were not associated with the level of Alzheimer's disease pathology, as assessed by global, as well as amyloid burden or tau tangle density scores. Regarding cognitive outcomes, higher insulin and leptin levels, and lower adiponectin and receptors for advanced glycation-end products levels, respectively, were each associated with lower levels of global cognition.

INTERPRETATION

Peripheral insulin resistance indicated by HOMA-IR and related serum measures was associated with a greater burden of cerebrovascular neuropathology and lower cognition. ANN NEUROL 2024;95:665-676.

Triglyceride Glucose Index as an Indicator of Cardiovascular Risk in Syrian Refugees

Background

The triglyceride glucose (TyG) index is a quick and inexpensive approach to measure insulin resistance. The aim of this study was to evaluate the TyG index's ability to predict cardiovascular risk and determine the TyG index cutoff values in Syrian refugees.

Methods

A retrospective research study was conducted with 756 Syrian refugees. Data on demographics and clinical laboratory assessments were obtained from refugee's files. The formula Ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg (dL)/2] was used to calculate the TyG index. The Framingham risk score was used to calculate ten-year cardiovascular risk. The TyG index cutoff point was determined using the receiver operating characteristic curve (ROC).

Results

Included participants had a mean age of 56.76 ± 10.78 years and a mean body mass index (BMI) of 27.42 ± 4.03 kg/m2. 28.57% of the subjects were smokers, and the majority were female (56.75%). A significant moderate correlation was observed between TyG index and Framingham score (r = 0.428, p < 0.001). ROC curve analysis for TyG index and Framingham score showed an area under the curve (AUC) of 0.741 (95% CI = 0.691-0.791; p < 0.001). The cutoff value of the TyG index to recognize intermediate/high risk Framingham risk score was 9.33, with a sensitivity of 64.3%, and specificity of 75.0%.

Conclusion

Our findings determine that, given a TyG index cutoff value of 9.33, the TyG index has a predictive ability to assess ten-year cardiovascular risk by comparison to the Framingham risk score in a high-risk group of Syrian refugees and can be used as an independent indicator of cardiovascular risk.

Blood Pressure Partially Mediated the Association of Insulin Resistance and Cerebral Small Vessel Disease: A Community-Based Study

BACKGROUND

Insulin resistance as a significant vascular risk factor has been studied in relation to cerebral small vessel disease (SVD). Evidence suggests that insulin resistance might trigger high blood pressure (BP). Therefore, we aimed to investigate whether insulin resistance impacts SVD with a mediating effect of BP in nondiabetic subjects.

METHODS AND RESULTS

PRECISE (Polyvascular Evaluation for Cognitive Impairment and Vascular Events) study participants underwent brain and vascular imaging techniques and metabolomic risk factors measurements. Insulin resistance was evaluated by the insulin sensitivity index and the Homeostatic Model Assessment for Insulin Resistance based on the standard oral glucose tolerance test. On average, 2752 nondiabetic subjects (47.1% men) aged 60.9 years were included. The multivariable logistic regression model and linear regression model tested the association of insulin resistance with BP components (including systolic BP [SBP], diastolic BP (DBP), and pulse pressure [PP]) and SVD, and of BP components with SVD. In the mediation analysis, SBP, DBP, and PP were found to partially mediate the detrimental effect of insulin resistance (assessed by the insulin sensitivity index) on lacunes (mediation percentage: SBP, 31.15%; DBP, 34.21%; PP, 10.43%), white matter hyperintensity (mediation percentage: SBP, 37.34%; DBP, 44.15%; PP, 9.80%), and SVD total burden (mediation percentage: SBP, 42.07%; DBP, 49.29%; PP, 11.71%) (all P<0.05). The mediation analysis results were not significant when using the Homeostatic Model Assessment for Insulin Resistance to assess insulin resistance.

CONCLUSIONS

Higher insulin resistance was associated with SVD in this community-dwelling population. The association of insulin resistance with lacunes, white matter hyperintensity, and SVD total burden was explained in part by BP.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03178448.

Association of Triglyceride-Glucose Index With Cognitive Function and Brain Atrophy: A Population-Based Study

OBJECTIVE

To investigate the associations of triglyceride-glucose (TyG) index, a reliable surrogate marker for insulin resistance, with the function of various cognitive domains and brain structures among older adults.

DESIGN

A population-based cross-sectional study.

SETTING

Older adults living in the rural communities in China.

PARTICIPANTS

About 4,541 rural-dwelling dementia-free participants (age ≥65 years; 56.37% women) undertook examinations in March-September 2018 for MIND-China.

MEASUREMENTS

TyG index was calculated as ln[fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. A neuropsychological test battery was used to assess memory, attention, verbal fluency, and executive function. Volumetric brain measures were assessed on magnetic resonance imaging (MRI) in a subsample (n = 1,019). Data were analyzed with restricted cubic spline and multivariable general linear models.

RESULTS

An inverted J-shaped association was observed between TyG index and z-scores of multiple cognitive domains, such that among individuals with TyG index ≥8.57 (median), a higher TyG index was significantly associated with lower z-scores of memory, attention, verbal fluency, executive function, and global cognition (all p < 0.05); among people with TyG index <8.57, a higher TyG index was significantly associated with a higher executive function z-score (p < 0.05), but not with any of the other examined cognitive domains. In the MRI subsample, a higher TyG index was significantly associated with lower volumes of total brain tissue, gray matter, and white matter as well as greater cerebrospinal fluid volume (p < 0.05), but not with white matter hyperintensity volume.

CONCLUSIONS

Insulin resistance, as indicated by a high TyG index, was associated with poor function in multiple cognitive domains and global brain atrophy.

Exploring the association between triglyceride-glucose index and thyroid function

BACKGROUND

Thyroid dysfunction is associated with abnormal glucose-insulin homeostasis, and the triglyceride-glucose (TyG) index has been recommended as a convenient surrogate of insulin resistance (IR). This study aimed to investigate the relationship between TyG and thyroid function in the US population.

METHODS

 We analyzed data from the National Health and Nutrition Examination Survey (NHANES) conducted from 2007 to 2012 in a cross-sectional manner. Aside from conventional thyroid parameters, our study evaluated the central sensitivity to thyroid hormones (THs) using the thyroid feedback quantile-based index (TFQI), thyrotropin resistance index (TT4RI), and thyrotropin index (TSHI). To evaluate peripheral sensitivity to THs, we calculated the ratio of free triiodothyronine (FT3) to free thyroxine (FT4) and the sum activity of peripheral deiodinases (SPINA-GD). In the 1848 adults, multivariable linear regression, subgroup, and interaction analyses were employed to estimate the association between TyG and thyroid parameters. The nonlinear relationship was addressed by smooth curve fittings and generalized additive models.

RESULTS

After adjusting covariates, we demonstrated a significant negative association between TyG and FT4 (β = - 0.57, p < 0.001), and a positive relationship between TyG and thyroid-stimulating hormone (β = 0.34, p = 0.037), as well as TgAb (β = 17.06, p = 0.005). Subgroup analysis indicated that the association between TyG and TgAb was more pronounced in the female subjects (β = 32.39, p < 0.001, p for interaction = 0.021). We also confirmed an inverse correlation between TyG and central sensitivity to THs, as assessed by TSHI and TT4RI (βTSHI = 0.12, p < 0.001; βTT4RI = 2.54, p = 0.023). In terms of peripheral sensitivity to THs, we found a significant positive correlation between TyG and FT3/FT4 (β = 0.03, p = 0.004), and SPINA-GD (β = 2.93, p = 0.004).

CONCLUSION

The present study established a noteworthy association between TyG and thyroid parameters, indicating a strong link between IR and thyroid dysfunction. Further investigations are warranted to validate these results.

Vascular cognitive impairment - Past, present, and future challenges

Vascular cognitive impairment (VCI) is a lifelong process encompassing a broad spectrum of cognitive disorders, ranging from subtle or mild deficits to prodromal and fully developed dementia, originating from cerebrovascular lesions such as large and small vessel disease. Genetic predisposition and environmental exposure to risk factors such as unhealthy lifestyles, hypertension, cardiovascular disease, and metabolic disorders will synergistically interact, yielding biochemical and structural brain changes, ultimately culminating in VCI. However, little is known about the pathological processes underlying VCI and the temporal dynamics between risk factors and disease mechanisms (biochemical and structural brain changes). This narrative review aims to provide an evidence-based summary of the link between individual vascular risk/disorders and cognitive dysfunction and the potential structural and biochemical pathophysiological processes. We also discuss some key challenges for future research on VCI. There is a need to shift from individual risk factors/disorders to comorbid vascular burden, identifying and integrating imaging and fluid biomarkers, implementing a life-course approach, considering possible neuroprotective influences of positive life exposures, and addressing biological sex at birth and gender differences. Finally, this review highlights the need for future researchers to leverage and integrate multidimensional data to advance our understanding of the mechanisms and pathophysiology of VCI.

Association between triglyceride glucose index and suicide attempts in patients with first-episode drug-naïve major depressive disorder

OBJECTIVE

Triglyceride glucose (TyG) index has been suggested as an alternative indicator of insulin resistance (IR); however, the association between TyG index and suicide attempts (SA) in major depressive disorder (MDD) is unclear. The aim of this study was to investigate the relationship between TyG index and SA in Chinese patients with first-episode drug-naïve (FEDN) MDD.

METHODS

This cross-sectional study enrolled 1,718 patients with FEDN MDD aged 34.9 ± 12.4 years from the First Hospital of Shanxi Medical University (Taiyuan, Shanxi Province, China) from September 2016 to December 2018. Multivariable binary logistic regression analysis was used to estimate the association between TyG index and the risk of SA. A two-piecewise linear regression model was used to investigate the threshold effects if non-linearity associations existed. Interaction and stratified analyses were performed based on sex, education, marital status, comorbid anxiety, and psychotic symptoms.

RESULTS

Multivariable logistic regression analysis revealed that TyG index was positively associated with the risk of SA after adjusting for confounders (OR = 1.35, 95% CI: 1.04-1.75, p = 0.03). Smoothing plots also showed a nonlinear relationship between TyG index and SA, with the inflection point of TyG index being 9.29. On the right of the inflection point, a positive association between TyG index and SA was detected (OR = 3.47, 95% CI: 1.81 to 6.66, p < 0.001), while no significant association was observed on the left side of the inflection point (OR = 1.14, 95% CI: 0.79 to 1.66, p = 0.476).

CONCLUSION

The relationship between TyG index and SA risk was non-linear and exhibited a threshold effect in Chinese patients with FEDN MDD. When TyG index was greater than 9.29, they showed a significant positive correlation.

Association between triglyceride-glucose index trajectories and carotid atherosclerosis progression

BACKGROUND

The triglyceride-glucose (TyG) index has been recognized as being an alternative cardiometabolic biomarker for insulin resistance associated with the development and prognosis of cardiovascular disease (CVD). However, the prospective relationship between baseline and long-term trajectories of the TyG index and carotid atherosclerosis (CAS) progression has yet to be investigated.

METHODS

This longitudinal prospective cohort study included 10,380 adults with multiple general health checks at Peking University Third Hospital from January 2011 to December 2020. The TyG index was calculated as ln (fasting triglyceride [mg/dL] × fasting glucose [mg/dL]/2). The latent class trajectory modeling method was used to analyze the TyG index trajectories over the follow-up. Based on univariate and multivariate Cox proportional hazards analyses, hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for the baseline and trajectory of the TyG index.

RESULTS

During a median follow-up period of 757 days, 1813 participants developed CAS progression. Each 1-standard deviation (SD) increase in the TyG index was associated with a 7% higher risk of CAS progression after adjusting for traditional CVD risk factors (HR = 1.067, 95% CI 1.006-1.132). Similar results were observed when the TyG index was expressed as quartiles. According to different trajectory patterns, participants were categorized into low-stable, moderate-stable, and high-increasing groups. After multivariate adjustment, the moderate-stable group had a 1.139-fold (95% CI 1.021-1.272) risk of CAS progression. The high-increasing trajectory of the TyG index tended to be associated with CAS progression (HR = 1.206, 95% CI 0.961-1.513).

CONCLUSIONS

Participants with higher baseline and moderate-stable trajectory of the TyG index were associated with CAS progression. Long-term trajectories of the TyG index can help to identify individuals at a higher risk of CAS progression who deserve specific preventive and therapeutic approaches.

Triglyceride-glucose index and short-term functional outcome and in-hospital mortality in patients with ischemic stroke

BACKGROUND AND AIMS

The triglyceride-glucose (TyG) index has been demonstrated as an independent marker of ischemic stroke. Whether TyG index predicts short-term outcomes in patients with ischemic stroke remains uncertain. The aim of the study was to investigate the early prognosis value of TyG index in ischemic stroke patients.

METHODS AND RESULTS

A total of 3216 acute ischemic stroke patients from 22 hospitals were included in this analysis. The TyG index was calculated as ln (fasting triglyceride [mg/dL] × fasting glucose [mg/dL]/2). Logistic regression model was performed to estimate the relationship between TyG index and unfavorable functional outcome of death or disability (modified Rankin Scale score of 4-6) at discharge. Risk reclassification with TyG index to predict unfavorable functional outcome was analyzed. During hospitalization, 748 patients (23.3%) experienced poor functional outcome and 105 patients (3.3%) died from all causes. The multivariable adjusted odds ratios for the highest versus lowest quartile of TyG index was 1.62 (95% CI 1.15-2.29) for unfavorable functional outcome at discharge. The addition of TyG index to the conventional model improved the risk reclassification (net reclassification improvement 10.37%; integrated discrimination improvement 0.27%; both p < 0.05) for poor functional outcome. Moreover, TyG index was associated with an odds ratio (95% CI) of 1.26 (1.02-1.55) for an ordinal shift in mRS score and 2.49 (1.21-5.12) for in-hospital mortality.

CONCLUSIONS

Higher TyG index was associated with higher risk of unfavorable functional outcome at discharge and in-hospital mortality, implicating the significant short-term prognostic effect of TyG index in patients with ischemic stroke.

Association of triglyceride-glucose index with ischemic stroke recurrence in nondiabetic patients with small vessel occlusion: a multicenter hospital-based prospective cohort study

BACKGROUND

Triglyceride-glucose (TyG) index is a simple and reliable surrogate marker of insulin resistance. Elevated TyG index was related to stroke recurrence. This study aimed to explore the associations between TyG index with ischemic stroke recurrence in nondiabetic patients with small vessel occlusion.

METHODS

From November 1, 2016 to February 28, 2021, consecutive acute ischemic stroke patients admitted within 1 week after onset were screened. The stroke mechanism was determined based on medical history, laboratory examinations, cardiac examinations, vascular examinations and neuroimaging. Nondiabetic patients with small vessel occlusion were enrolled and followed up for 1 year. The primary outcome was ischemic stroke recurrence. Logistic regression and Kaplan-Meier survival curve were used to analyze the association of the TyG index and stroke recurrence.

RESULTS

A total of 6100 acute ischemic stroke patients were screened, with 1970 nondiabetic patients with small vessel occlusion included and divided into 4 groups according to the TyG index quartiles (Q1: < 8.20; Q2: 8.20-8.53; Q3: 8.54-8.92; Q4: > 8.92). There were significant differences in age, body mass index, systolic blood pression, diastolic blood pressure, lipid-lowering agents, infarct location, fasting blood glucose, total cholesterol, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, uric acid, and stroke recurrence among the 4 groups. In the multi-adjusted models, compared to Q1 of the TyG index, the odds ratio for Q4 of the TyG index for stroke recurrence was 3.100 (1.366-8.019). The Kaplan-Meier survival (ischemic stroke-free) curves by quartiles of the TyG index also showed statistically significant differences (log-rank test, P = 0.004).

CONCLUSIONS

Our findings suggested that the TyG index was associated with ischemic stroke recurrence in nondiabetic patients with small vessel occlusion, and it could be a valuable biomarker for assessing the risk of ischemic stroke recurrence in these patients.

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.

Insulin resistance based on postglucose load measure is associated with prevalence and burden of cerebral small vessel disease

INTRODUCTION

Cerebral small vessel disease (cSVD) is highly prevalent and results in irreversible cognitive impairment and reduced quality of life. Previous studies reported controversial associations between insulin resistance and cSVD. Here, we estimated the association between insulin resistance and cSVD in non-diabetic communities in southeastern China.

RESEARCH DESIGN AND METHODS

The Polyvascular Evaluation for Cognitive Impairment and Vascular Events study (NCT03178448) recruited 3670 community-dwelling adults. We estimated the association of insulin resistance, assessed by the insulin sensitivity index (ISI_0,120) and the homeostatic model assessment for insulin resistance (HOMA-IR) based on the standard oral glucose tolerance test, with cSVD in those without a history of diabetes mellitus. cSVD was measured for both main neuroimaging manifestations of cSVD and total SVD burden scores.

RESULTS

A total of 2752 subjects were enrolled. In the multivariable logistic regression analysis, the first quartile of ISI_0,120 was found to be potentially associated with an increased risk of lacunes (OR 1.96, 95% CI 1.15 to 3.36), severe age-related white matter changes (OR 1.97, 95% CI 1.15 to 3.38), and higher total SVD burden (4-point scale: common OR (cOR) 1.34, 95% CI 1.04 to 1.72; 6-point scale: cOR 1.43, 95% CI 1.14 to 1.79). The associations between HOMA-IR and lacunes (OR 1.90, 95% CI 1.11 to 3.25) and the 4-point scale of total SVD burden (cOR 1.33, 95% CI 1.04 to 1.70) were also significant after adjustment for age, gender, medical history, and medications. However, the associations were not statistically significant after further adjustment for blood pressure/hypertension and body mass index (BMI).

CONCLUSIONS

A potential association was found between insulin resistance and cSVD, and the ISI_0,120 index presented a greater association with increased risk of cSVD as compared with the HOMA-IR. However, these associations were greatly influenced by blood pressure and BMI.

Triglyceride glucose index: A new biomarker in predicting cardiovascular risk

Introduction

Objective

Methods

Results

Conclusion

The triglyceride glucose index is associated with the cerebral small vessel disease in a memory clinic population

BACKGROUND AND OBJECTIVES

Insulin resistance (IR) has been associated with the cerebral small vessel disease (cSVD). However, as the surrogate marker of IR, there is little known about the relationship between the triglyceride glucose (TyG) index and cSVD. In this cross-sectional study, we aimed to evaluate the relationship between the TyG index and cSVD in a memory clinic population and explore the value of TyG index to improve the risk stratification of cSVD.

METHODS

We included participants who attended our memory clinic from January 2016 to December 2020. TyG index was determined as ln [fasting triglyceride (mg/dL) × fasting plasma glucose (mg/dL)/2]. We assessed lacunes, microbleeds, white matter hyperintensity (WMH) and enlarged perivascular spaces (EPVS) on MRI and calculated the total cSVD burden.

RESULTS

A total of 297 subjects were included (median age: 65 years, male sex: 64.98%). In the adjusted model, when dividing TyG index into quartiles, subjects with TyG index in the top quartile, compared with those in the bottom quartile, were more likely to have lacunes (P = 0.035), moderate-severe WMH (P = 0.001), a higher grade of deep WMH (P = 0.004), a higher grade of PVWMH (P = 0.032), a higher grade of EPVS (P = 0.002), and a higher cSVD score (P < 0.001). When introducing TyG index into traditional risk factors to predict moderate to severe cSVD, both area under the curve (0.745 vs 0.802, P = 0.003) and integrated discrimination index (0.080, 95% CI 0.050-0.110, P < 0.001) displayed an improvement from TyG index.

CONCLUSIONS

The TyG index is correlated with cSVD and may have the potential to be a surrogate marker of insulin resistance and optimize the risk stratification.

Triglyceride Glucose Index Was Associated With the Risk of Peripheral Artery Disease

This study aims to investigate the relationship between the triglyceride glucose (TyG) index and peripheral artery disease (PAD). A total of 3125 participants with completed TyG and ankle brachial pressure index (ABPI) records were enrolled from the National Health and Nutrition Examination Survey (NHANES) cycle of 1999-2004. The TyG index was calculated as ln [triglycerides (mg/dL) × glucose (mg/dL)/2], and the presence of PAD was defined as ABPI ≤.9. The participants were 59.9 ± 12.9 years old and 51.5% (1608) were male. The prevalence of PAD was 7.2% (225). Compared with the reference lowest quartile of TyG index, the highest quartile was associated with 1.27-fold increased (odds ratio [OR] 2.27, 95% confidence interval [CI] 1.53-3.41; P < .001) risk of PAD. After adjusting for sociodemographic, lifestyles, and cardiometabolic factors, the multivariate-adjusted OR and 95% CI were 1.74 (1.02-3.01; P = .044) in participants within the highest quartile. Subgroup analysis showed that the association between TyG index and the risk of PAD was still consistent across subgroups. In conclusion, higher TyG index was significantly associated with the higher risk of PAD, which could be a marker of PAD.

Insulin resistance is associated with an unfavorable outcome among non-diabetic patients with isolated moderate-to-severe traumatic brain injury – A propensity score-matched study

Background

Hyperglycemia is an independent risk factor for the poor prognosis in patients with traumatic brain injury (TBI), and stress-induced impaired insulin function is the major factor of hyperglycemia in non-diabetic patients with TBI. Several types of research suggested that insulin resistance (IR) is related to the poor prognosis of neurocritical ill patients; here we focused on the role of IR in non-diabetic patients after TBI.

Methods

We performed a prospective observational study with the approval of the Ethics Committee of our institute. IR was accessed via the update Homeostasis Model Assessment (HOMA2) of IR, a computer-calculated index by glucose and insulin level. HOMA2 ≥ 1.4 was considered as the threshold of IR according to the previous studies. The glycemic variability (GV) indices were calculated by fingertip blood glucose concentration at an interval of 2 h within 24 h to explore the relationship between IR and GV. The outcome was the 6-month neurological outcome evaluated with the Glasgow outcome scale.

Results

A total of 85 patients with isolated moderate-to-severe TBI (admission GCS ≤ 12) were finally included in our study, 34 (40%) were diagnosed with IR with HOMA2 ≥ 1.4. After propensity score matching (PSM), 22 patients in IR group were matched to 34 patients in non-IR group. Patients with IR suffered increased systemic glycemic variation after isolated moderate-to-severe TBI. IR was a significant factor for the poor prognosis after TBI (OR = 3.25, 95% CI 1.03–10.31, p = 0.041).

Conclusions

The IR estimated by HOMA2 was associated with greater GV and an unfavorable outcome after isolated moderate-to-severe TBI. Ameliorating impaired insulin sensitivity may be a potential therapeutic strategy for the management of TBI patients.

Association between triglyceride-glucose index and carotid atherosclerosis detected by ultrasonography

Background

Several previous studies have indicated that the triglyceride-glucose index (TyG) index is associated with carotid atherosclerosis (CA); however, the evidence of the association is limited and inconsistent, which may result from small sample sizes or differences in study populations. Therefore, we examined the relation between the TyG index and CA in a large general population of Chinese middle-aged and elderly population.

Methods

A total of 59,123 middle-aged and elderly participants were enrolled. The TyG index was calculated as ln[fasting triglycerides (mg/dL)×fasting glucose (mg/dL)/2]. Logistic regression models were used to analyze the relationship between the TyG index as continuous variables and quartiles and CA. The relationships between the TyG index and CA according to sex, age groups, blood pressure groups and body mass index groups were also assessed.

Results

The multivariate logistic regression analysis showed that the TyG index was significantly associated with the prevalence of CA (OR: 1.48; 95% CI 1.39–1.56), carotid intima-media thickness (CMT) (1.55; 1.45–1.67), plaques (1.38; 1.30–1.47) and stenosis severity (> 50%) (1.33; 1.14–1.56). Compared with the quartile 1, quartile 4 was significantly associated with a higher prevalence of CA (1.59; 1.45–1.75), CMT (1.93; 1.82–2.18), plaques (1.36; 1.22–1.51) and stenosis severity (> 50%) (1.56; 1.20–2.04). Subgroup analyses showed significant associations between the continuous TyG index and the prevalence of CA, CMT, plaques and stenosis severity (> 50%) according to sex, with a higher prevalence of CA, CMT, and plaques among males, while a higher prevalence of stenosis severity in females (> 50%). For participants aged < 60 years old and with hypertension, the relationship between the TyG index and stenosis severity (> 50%) was not observed (1.47; 0.97–2.22 and 1.13; 0.91–1.41). For body mass index (BMI), the association was just observed among overweight participants (1.48; 1.17–1.86). In addition, similar results were also observed when the TyG index was used as a categorical variable.

Conclusions

There is a positive association between the TyG index and CA. The association is higher in males and middle-aged individuals than those in females and elderly individuals. Besides, the relationship is stronger among individuals with normal blood pressure and underweight subjects.

Association of triglyceride glucose index with all-cause and cause-specific mortality among middle age and elderly US population

Aims

To investigate the association between the triglyceride glucose (TyG) index and all-cause and cause-specific mortality in middle age and elderly population.

Methods and results

A total of 9,254 participants with age ≥ 45 years were enrolled from the National Health and Nutrition Examination Survey cycle of 1999–2014. The TyG index was determined as ln [fasting triglycerides (mg/dL) x fasting glucose (mg/dL)/2]. Primary outcomes were all-cause mortality and cause-specific mortality (cardiovascular diseases and malignant neoplasms). The association between the levels of TyG and the risk of mortality was explored with Cox regression models. After a median follow-up of 7.6 years, 1,774 all-cause death occurred. Univariate analysis showed that the TyG was associated with all-cause mortality (hazard ratio [HR] 1.18, 95% confidence interval [CI] [1.11,1.26]; p < 0.001). Furthermore, multivariate-adjusted analysis found that the third TyG quartile (8.72 ~ 9.16) was associated with the lowest risk of all-cause mortality (HR 0.84, 95%CI [0.73, 0.98]; p < 0.05). Restricted cubic splines showed that the association between levels of TyG index and the risk of all-cause mortality was non-linear (p for nonlinearity < 0.001) and the inflection point was 9.18 using threshold effect analysis. The HR was 0.82 (95%CI [0.71,0.96]) below 9.18 while the HR was 1.32 (95%CI [1.12,1.55]) above 9.18.

Conclusion

TyG index was U-shaped associated with all-cause mortality and the TyG index associated with the lowest risk of all-cause mortality was 9.18.

Associations between the triglyceride-glucose index and cardiovascular disease in over 150,000 cancer survivors: a population-based cohort study

Background

The prevention of subsequent cardiovascular disease (CVD) is an essential part of cancer survivorship care. We conducted the present study to investigate the association between the TyG index (a surrogate marker of insulin resistance) and the risk of cardiovascular disease (CVD) events in cancer survivors.

Methods

Adult cancer patients, who underwent routine health examinations during 2009–2010 and were survived for more than 5 years as of January 1, 2011, were followed for hospitalization of CVD (either ischemic heart disease, stroke, or heart failure) until December 2020. Cox model was used to calculate hazard ratios associated with baseline TyG index (log_e [fasting triglyceride (mg) × fasting glucose (mg)/2]) for the CVD hospitalization.

Results

A total of 155,167 cancer survivors (mean age 59.9 ± 12.0 years, female 59.1%) were included in this study. A graded positive association was observed between TyG and CVD hospitalization. An 8% elevated risk for CVD hospitalization was observed for a TyG index of 8-8.4 (aHR 1.08 [95% CI 1.01–1.14]); 10% elevated risk for a TyG index of 8.5–8.9 (aHR 1.10 [95% CI 1.03–1.17]); 23% elevated risk for a TyG index of 9.0-9.4 (aHR 1.23 [95% CI 1.15–1.31]); 34% elevated risk for a TyG index of 9.5–9.9 (aHR 1.34 [95% CI 1.23–1.47]); and 55% elevated risk for a TyG index ≥ 10 compared to the reference group (TyG index < 8). Per 1-unit increase in the TyG index, a 16% increase in CVD hospitalization and a 45% increase in acute myocardial infarction hospitalization were demonstrated. Graded positive associations were evident for atherosclerotic CVD subtypes, such as ischemic heart disease, acute myocardial infarction, and ischemic stroke, but not for hemorrhagic stroke or heart failure.

Conclusions

The TyG index may serve as a simple surrogate marker for the risk stratification of future CVD events, particularly atherosclerotic subtypes, in cancer survivors.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12933-022-01490-z.

Advances in the Role of Endothelial Cells in Cerebral Small Vessel Disease

Cerebral small vessel disease (CSVD) poses a serious socio-economic burden due to its high prevalence and severe impact on the quality of life of elderly patients. Pathological changes in CSVD mainly influence small cerebral arteries, microarteries, capillaries, and small veins, which are usually caused by multiple vascular risk factors. CSVD is often identified on brain magnetic resonance imaging (MRI) by recent small subcortical infarcts, white matter hyperintensities, lacune, cerebral microbleeds (CMBs), enlarged perivascular spaces (ePVSs), and brain atrophy. Endothelial cell (EC) dysfunction is earlier than clinical symptoms. Immune activation, inflammation, and oxidative stress may be potential mechanisms of EC injury. ECs of the blood–brain–barrier (BBB) are the most important part of the neurovascular unit (NVU) that ensures constant blood flow to the brain. Impaired cerebral vascular autoregulation and disrupted BBB cause cumulative brain damage. This review will focus on the role of EC injury in CSVD. Furthermore, several specific biomarkers will be discussed, which may be useful for us to assess the endothelial dysfunction and explore new therapeutic directions.

Association between triglyceride glucose index and carotid artery plaque in different glucose metabolic states in patients with coronary heart disease: a RCSCD-TCM study in China

Background

The triglyceride glucose (TyG) index serves as a surrogate indicator of insulin resistance. However, there is limited evidence on the association between the TyG index and carotid artery plaque (CAP) in patients with coronary heart disease (CHD).

Methods

The 10,535 CHD patients were divided according to TyG index quartiles (Q1: TyG index < 8.52; Q2: 8.52 ≤ TyG index < 8.93; Q3: 8.93 ≤ TyG index ≤ 9.40; Q4: TyG index > 9.40). The presence or absence of CAP was determined by carotid ultrasonography. Logistic regression was used to analyze the relationship between the TyG index and CAP in CHD patients. The relationship between the TyG index and CAP in according to sex, age groups, and glucose metabolism states were also assessed.

Results

The baseline analysis showed that there were significant differences in related parameters among CHD patients divided into four groups according to the quartile of the TyG index. In the multi-adjusted modles, compared to Q1 of the TyG index, the odds ratios (OR) for Q4 of the TyG index for CAP were 1.37 (95% confidence interval [CI] 1.28–1.47) in CHD patients. The association between the TyG index and CAP in female (OR: 1.35; 95% CI 1.29–1.43) was higher than that in male (OR: 1.20; 95% CI 1.13–1.27). The OR value of middle-aged (≤ 60 years old) patients (OR: 1.34; 95% CI 1.26–1.42) was higher than that in elderly (> 60 years old) patients (OR: 1.16; 95% CI 1.11–1.22). In different glucose metabolism states, the TyG index of CHD patients was significantly related to the risk of CAP, with the highest OR value observed for diabetes (OR: 1.36; 95% CI 1.26–1.46).

Conclusions

The TyG index and CAP showed a significant association in CHD patients. This association between TyG index and CAP in CHD patients is higher in female than in male, and the association in middle-aged and elderly patients is higher than that in elderly patients. In the condition of DM, the association between TyG index and carotid artery plaque in CHD patients is higher.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s12933-022-01470-3.

Association Between Triglyceride-Glucose Index and 2-Year Adverse Cardiovascular and Cerebrovascular Events in Patients with Type 2 Diabetes Mellitus Who Underwent Off-Pump Coronary Artery Bypass Grafting

BACKGROUND

Data on the relationship between the triglyceride glucose (TyG) index and prognosis after off-pump coronary artery bypass grafting (OPCABG) are limited. This retrospective observational cohort study evaluated the association of the TyG index with prognosis in patients with diabetes mellitus who underwent OPCABG.

METHODS

The TyG index was calculated using the following equation: TyG index = ln (fasting triglyceride level [mg/dL] × fasting glucose level [mg/dL]/2). The primary outcomes included the occurrence of major adverse cardiovascular and cerebrovascular events (MACCEs), which were defined as all-cause death, nonfatal myocardial infarction, nonfatal stroke and symptomatic graft failure. The association between the TyG index and MACCEs was assessed by Cox proportional hazards regression analysis.

RESULTS

A total of 1578 patients with diabetes who underwent OPCABG (mean age, 62.9 ± 8.0 years; men, 72.7%) were enrolled in this study. Over the follow-up of 2 years, 176 patients (11.2%) had at least 1 primary endpoint event. The follow-up incidence of the primary endpoint rose with increasing TyG index tertiles. The multivariate Cox proportional hazards regression analysis adjusted for multiple confounders revealed a hazard ratio for the primary endpoint of 2.133 (95% CI 1.347-3.377; P for trend = 0.001) when the highest and lowest TyG index tertiles were compared.

CONCLUSION

The TyG index was significantly and positively associated with MACCEs, suggesting that the TyG index may be a valuable predictor of adverse cardiovascular and cerebrovascular outcomes after OPCABG in patients with T2DM.

Triglyceride-Glucose Index and Intravenous Thrombolysis Outcomes for Acute Ischemic Stroke: A Multicenter Prospective–Cohort Study

Background

The triglyceride-glucose (TyG) index has recently been proposed as a reliable marker of insulin resistance. There is insufficient evidence to verify that the TyG index is correlated with functional outcomes and hemorrhagic transformation and in patients with stroke treated with intravenous thrombolysis (IVT).

Methods

We designed a multicenter cohort study, which enrolled patients with acute ischemic stroke treated with IVT between December 2004 and December 2016. The TyG index was divided into tertiles and calculated on a continuous scale. Unfavorable functional outcomes were defined by the modified Rankin Scale of 3–6 at 90 days and the incident rates of symptomatic intracranial hemorrhage (SICH) within 36 h of IVT onset were surveyed. Stroke severity was defined as mild (4–8), moderate (9–15), or high (≥16) based on the National Institutes of Health Stroke Scale (NIHSS) scores.

Results

Among 914 enrolled patients, the tertiles of the TyG index were 8.48 for T1, 8.48–9.04 for T2, and 9.04 for T3. T3 showed an increased risk of unfavorable functional outcomes at 90 days [odds ratio (OR): 1.76; P = 0.0132]. The TyG index was significantly associated with unfavorable functional outcomes at 90 days (OR: 1.32; P = 0.0431 per unit increase). No association was found between the TyG index and SICH. These findings were applicable for T3 with stroke of moderate (OR, 2.35; P = 0.0465) and high severity (OR: 2.57, P = 0.0440) patients with stroke.

Conclusion

This study supports the strong association between the increased TyG index and increased unfavorable functional outcomes at 90 days in patients with acute ischemic stroke treated with IVT. These findings were found to be robust in patients with moderate and high stroke severity.

The Triglyceride Glucose Index Is a Risk Factor for Enlarged Perivascular Space

The triglyceride glucose (TyG) index is considered a simple surrogate marker for insulin resistance and has been associated with cerebrovascular diseases. However, limited information is available regarding its association with the subclinical cerebral small vessel disease (CSVD). Here, we investigated the association of TyG index with the burden and distribution of enlarged perivascular space (EPVS) in the non-diabetic population. The data of 531 non-diabetic patients from 2017 to 2020 were assessed. Participants were grouped according to the burden of EPVS. TyG index was calculated using the log scale of fasting triglycerides (mg/dl) × fasting glucose (mg/dl)/2. The association of TyG index with EPVS burden and distribution was evaluated. In the multivariable logistic regression analysis, the TyG index was associated with moderate to severe EPVS [odds ratio (OR): 2.077; 95% CI = 1.268–3.403]. The TyG index was significantly associated with an increased risk of moderate to severe EPVS in subgroups of age <65 years, male, diastolic blood pressure (DBP) <90 mmHg, low-density lipoprotein cholesterol (LDL-C) ≥2.85 mmol/L, serum homocysteine <10 μmol/L, and estimated glomerular filtration rate (eGFR) <90 ml/min/1.73 m², as well as those without smoking. Further analysis of EPVS distribution, the TyG index was found to be associated with moderate to severe EPVS in the centrum semiovale (CSO), not in the basal ganglia (BG). Conclusively, the TyG index was independently and positively associated with moderate to severe CSO EPVS. TyG index may serve as an independent risk factor for CSVD in clinical practice.

Relationship of the Triglyceride-Glucose Index with Subclinical White Matter Hypersensitivities of Presumed Vascular Origin Among Community-Dwelling Koreans

Purpose

The triglyceride-glucose (TyG) index, a widely accessible measure, has been a surrogate indicator of peripheral insulin resistance, and its clinical importance continues to grow in East Asia. We hypothesized that the TyG index is relevant to subclinical white matter hypersensitivities (WMHs) of presumed vascular origin among community-dwelling Koreans.

Methods

We investigated the relationship between the TyG index and WMHs on brain magnetic resonance imaging scans in 2417 Koreans over 45 years of age without a history of cancer, stroke, or ischemic heart disease. The study population was divided into four groups according to the TyG index quartiles. Using multiple logistic regression analysis, we assessed the odds ratios (ORs) and 95% confidence intervals (95% CIs) for WMHs across the TyG index quartiles.

Results

The prevalence of WMHs was significantly higher in the fourth TyG index quartile, with an overall rate of 9.3%. After adjusting for potential confounding variables, the ORs of WMHs for the TyG index quartiles were 1.00, 1.47 (95% CI, 0.91–2.40), 1.76 (95% CI, 1.05–2.97), and 6.79 (95% CI, 3.85–1.54), respectively.

Conclusion

We found that higher TyG index values were associated with the brain’s WMHs of presumed vascular origin. Our findings suggest that the serum TyG index could be an additional valuable biomarker for assessing the risk of cerebral small vessel disease in the preclinical stage.

The Atherogenic Index of Plasma is Associated With Cerebral Small Vessel Disease: A Cross-Sectional Study

Objective

Recently, the lipid profile of atherogenic dyslipidemia has become important in cerebrovascular diseases. Atherogenic index of plasma (AIP), an index that reflects this lipid profile as a single number, has been proposed, but there are still few related studies in cerebrovascular disease. In this study, we evaluated the relationship between AIP and cerebral small vessel disease (cSVD) in health check-up participants.

Methods

We assessed consecutive health check-ups participants between 2006 and 2013. cSVD was measured including the following three subtypes: white matter hyperintensity (WMH), lacuens, and cerebral microbleeds (CMBs). WMH quantitatively measured the volume, and lacunes and CMBs qualitatively evaluated the presence. AIP was calculated according to the following formula based on blood test results: AIP=log [triglyceride (mg/dL)/high-density lipoprotein cholesterol (mg/dL)].

Results

A total of 3,170 participants were evaluated (mean age: 56.5 years, male sex: 53.8%). In multivariable linear regression analysis, AIP (β=0.129, 95% confidence interval [CI]=0.003–0.255) was associated with WMH. Age, hypertension, diabetes, lipid-lowering agents, and intracranial atherosclerosis were also associated with WMH volume. In multivariable logistic regression analysis, AIP (adjusted odds ratio=1.72 1.79, 95% CI=1.03–2.90) showed close association with lacunes. Age and intracranial atherosclerosis were also related to lacunes. CMBs did not show a statistically significant association with AIP.

Conclusion

High AIP was associated with cSVD in health check-up participants. Since this close relationship was only seen in WMH and lacunes, these subtypes may have arisen from a more atherosclerosis-related pathology.

Correlation Between Retinal Microvascular Abnormalities and Total Magnetic Resonance Imaging Burden of Cerebral Small Vessel Disease in Patients With Type 2 Diabetes

Background and Purpose: Diabetic retinopathy (DR) is one of the common microvascular complications in diabetes. The total magnetic resonance imaging (MRI) burden of cerebral small vessel disease (CSVD) tends to be increased in diabetic patients and is a marker of microvascular disease; however, the relationship between DR and CSVD is unclear. This study aimed to explore the relationship between retinal microvascular abnormalities and the total MRI burden of CSVD in patients with type 2 diabetes.

Methods: Data were collected from patients with type 2 diabetes who were hospitalized between December 2019 and November 2020 in Changzhou Second People’s Hospital affiliated to Nanjing Medical University. All patients underwent retinal photography and cerebral MRI. The central retinal artery equivalent (CRAE), the central retinal venous equivalent (CRVE), and arteriole-to-venule ratio (AVR) were calculated using Image J software to determine the retinal vascular calibers for each patient. The total MRI burden score for CSVD was determined, and the relationship between retinal microvascular abnormalities and the total MRI burden of CSVD was analyzed.

Results: Of the 151 diabetic patients included in the study, 84 (55.6%) had no diabetic retinopathy (NDR), 27 (17.9%) had mild DR, and 40 (26.5%) had moderate, or severe non-proliferative DR (grouped together for this study as “more than mild DR”). In patients with more than mild DR, the proportion of moderate to severe burden of CSVD was 75%, which was higher than in patients with mild DR (48.1%) or NDR (26.2%). Patients with moderate to severe burden of CSVD were more likely than those with mild burden of CSVD to have narrowed retinal arterioles (105.24 ± 8.42 μm vs. 109.45 ± 7.93 μm), widened retinal venules (201.67 ± 16.25 μm vs. 193.95 ± 13.54 μm), and lower arteriole-to-venule ratio (0.52 ± 0.05 vs. 0.57 ± 0.04) (P < 0.05 for all). The degree of DR (r = 0.465, P < 0.001) and CRVE (r = 0.366, P < 0.001) were positively correlated with the total MRI burden of CSVD. Multivariate logistic regression analysis indicated that, after adjustments were made for age, smoking, alcohol consumption, hypertension, and other factors, more than mild DR (OR, 4.383; P = 0.028), CRAE (OR, 0.490; P = 0.031), and CRVE (OR, 1.475; P = 0.041) were independently associated with moderate to severe burden of CSVD.

Conclusion: Retinal microvascular abnormalities in patients with type 2 diabetes are associated with the presence of cerebral small vessel lesions. The degree of DR and retinal vessel changes can be used as predictors of intracranial microcirculation lesions.

Triglyceride glucose index is associated with cerebral small vessel disease burden and cognitive impairment in elderly patients with type 2 diabetes mellitus

OBJECTIVE

To investigate the relations of Triglyceride glucose (TyG) index with cerebral small vessel disease (CSVD) burden and cognitive function in aged patients with type 2 diabetes mellitus (T2DM).

METHODS

A total of 308 elderly patients with T2DM were included in this retrospective study. The standardized Chinese version of Mini-Mental State Examination was used to assess cognitive function. The total CSVD burden score was assessed by combining four imaging markers of CSVD, including the presence of white matter hyperintensity, cerebral microbleeds in the deep, lacunes and enlarged perivascular spaces in the basal ganglia. The TyG index was calculated as the formula of ln [fasting triglyceride (mg/dl) × fasting plasma glucose (mg/dl)/2]. We used logistic regression analysis and mediation analysis to investigate the relations of TyG index with CSVD and cognitive function.

RESULTS

Multivariate binary logistic regression analysis showed that increased TyG index (OR: 2.241; 95% Confidence Interval(CI): 1.439 to 3.490; P <0.001), or severe CSVD burden (OR: 2.198; 95% CI: 1.283 to 3.763; P = 0.004) was associated with an increased risk of cognitive impairment in elderly patients with T2DM after adjusting for potential confounders. In addition, TyG index was an independent risk factor of severe CSVD burden (OR: 1.472; 95% CI: 1.003 to 2.160; P = 0.048) after controlling for potential confounders. Compared with the lowest TyG index tertile, the multivariable-adjusted OR of the highest tertile was 3.298 (95% CI: 1.685 to 6.452; P for trend <0.001) for cognitive impairment, 1.933 (95% CI: 1.010 to 3.698; P for trend = 0.047) for severe CSVD burden. Mediation analysis found a significant moderating effect of the severe CSVD burden on the association between higher TyG index levels and cognitive impairment.

CONCLUSIONS

The increased TyG index is an independent risk factor for cognitive impairment and severe CSVD burden in clinical practice. A proportion of the effect of increased TyG index on cognitive impairment may be due to the aggravation of CSVD burden.

Association Between Triglyceride-Glucose Index and Risk of Periodontitis: A Cross-Sectional Study

Background

The purpose of this study was to investigate the TyG index in the occurrence of periodontitis among the United States (US) population.

Methods

We analyzed clinical data from 4813 participants in the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2014. the TyG index was calculated as ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Dose-response curves, univariate and multivariate logistic analyses were used to analyze the adjusted odds ratio (aOR) and 95% confidence interval (CI) between TyG index and periodontitis. In addition, we performed 1:1 propensity score matching (PSM) for periodontitis and no periodontitis participants to further explore the relationship between TyG and periodontitis.

Results

A total of 4813 participants were included in our study, of which 1353 (28.1%) reported periodontitis and 3460 (71.9%) no periodontitis. The dose-response curves showed a non-linear positive association between TyG and periodontitis, with the risk of periodontitis increased with increasing TyG. In addition, similar results were still observed after subgroup analysis and PSM analysis. After adjusting for confounding variables, multivariate logistic analysis showed that TyG was associated with an increased risk of periodontitis (aOR =1.153; 95% CI 1.006-1.322, p=0.034).

Conclusion

Elevated TyG index was significantly associated with a high risk of periodontitis, and people with a high TyG index should be aware of the risk of periodontitis progression in order to establish lifestyle changes at an early stage.

Causal effect of insulin resistance on small vessel stroke and Alzheimer's disease: A Mendelian randomization analysis

BACKGROUND AND PURPOSE

The causal effect of insulin resistance on small vessel stroke and Alzheimer's disease (AD) was controversial in previous studies. We therefore applied Mendelian randomization (MR) analyses to identify the causal effect of insulin resistance on small vessel stroke and AD.

METHODS

We selected 12 single-nucleotide polymorphisms (SNPs) associated with fasting insulin levels and five SNPs associated with "gold standard" measures of insulin resistance as instrumental variables in MR analyses. Summary statistical data on SNP-small vessel stroke and on SNP-AD associations were derived from studies by the Multi-ancestry Genome-Wide Association Study of Stroke consortium (MEGASTROKE) and the Psychiatric Genomics Consortium-Alzheimer Disease Workgroup (PGC-ALZ) in individuals of European ancestry. Two-sample MR estimates were conducted with inverse-variance-weighted, robust inverse-variance-weighted, simple median, weighted median, weighted mode-based estimator, and MR pleiotropy residual sum and outlier (MR-PRESSO) methods.

RESULTS

Genetically predicted higher insulin resistance had a higher odds ratio (OR) of small vessel stroke (OR 1.23, 95% confidence interval [CI] 1.05-1.44, p = 0.01 using fasting insulin; OR 1.25, 95% CI 1.07-1.46, p = 0.006 using gold standard measures of insulin resistance) and AD (OR 1.13, 95% CI 1.04-1.23, p = 0.004 using fasting insulin; OR 1.02, 95% CI 1.00-1.03, p = 0.03 using gold standard measures of insulin resistance) using the inverse-variance-weighted method. No evidence of pleiotropy was found using MR-Egger regression.

CONCLUSION

Our findings provide genetic support for a potential causal effect of insulin resistance on small vessel stroke and AD.

The association between triglyceride-glucose index, cardio-cerebrovascular diseases, and death in Korean adults: A retrospective study based on the NHIS-HEALS cohort

BACKGROUND

The triglyceride-glucose (TyG) index is a reliable indicator of insulin resistance. We aimed to investigate the TyG index in relation to cardio-cerebrovascular diseases (CCVDs and mortality.

METHODS

This retrospective study included 114,603 subjects. The TyG index was categorized into four quartiles by sex: Q1, <8.249 and <8.063; Q2, 8.249‒<8.614 and 8.063‒<8.403; Q3, 8.614‒< 8.998 and 8.403‒<8.752; and Q4, ≥8.998 and ≥8.752, in men and women, respectively. To calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the primary outcomes (CCVDs and all-cause mortality) and secondary outcomes (cardiovascular diseases [CVDs], cerebrovascular diseases [CbVDs], CCVD-related deaths, or all-cause deaths), Cox proportional hazards regression models were adopted.

RESULTS

Compared to Q1, the HRs (95% CIs) for the primary outcomes of Q2, Q3, and Q4 were 1.062 (0.981‒1.150), 1.110 (1.024-1.204), and 1.151 (1.058-1.252) in men and 1.099 (0.986-1.226), 1.046 (0.938-1.166), and 1.063 (0.954-1.184) in women, respectively, after adjusted for age, smoking status, drinking status, physical activity, body mass index, systolic blood pressure, low-density lipoprotein cholesterol, economic status, and anti-hypertensive medications. Fully adjusted HRs (95% CIs) for CVDs of Q2, Q3, and Q4 were 1.114 (0.969-1.282), 1.185 (1.031-1.363), and 1.232 (1.068-1.422) in men and 1.238 (1.017-1.508), 1.183 (0.971-1.440), and 1.238 (1.018-1.505) in women, respectively. The adjusted HRs (95% CIs) for ischemic CbVDs of Q2, Q3, and Q4 were 1.005 (0.850-1.187), 1.225 (1.041-1.441), and 1.232 (1.039-1.460) in men and 1.040 (0.821-1.316), 1.226 (0.981-1.532), and 1.312 (1.054-1.634) in women, respectively, while the TyG index was negatively associated with hemorrhagic CbVDs in women but not in men. The TyG index was not significantly associated with CCVD-related death or all-cause death in either sex.

CONCLUSIONS

Elevated TyG index was positively associated with the primary outcomes (CCVDs and all-cause mortality) in men and predicted higher risk of CVDs and ischemic CbVDs in both sexes.

Effects of intracranial atherosclerosis and atrial fibrillation on the prognosis of ischemic stroke with active cancer

BACKGROUND

In ischemic stroke patients with active cancer, cryptogenic stroke has worse prognosis than stroke by conventional mechanisms. However, the individual effects of intracranial atherosclerosis (ICAS) or atrial fibrillation (AF) on the prognosis of these patients have not been studied.

AIMS

Therefore, we aimed to investigate the effects of ICAS and AF on the prognosis of ischemic stroke patients with active cancer.

METHODS

We included ischemic stroke patients with active cancer between 2010 and 2020. Early neurological deterioration (END) was defined as an increase of ≥ 1 in the motor NIHSS score, or ≥ 2 in the total NIHSS score within 72 hours of admission. Unfavorable outcomes were defined as a score of ≥ 3 on the 3-month modified Rankin Scale.

RESULTS

In total, 116 ischemic stroke patients with active cancer were evaluated. In multivariable analysis, ICAS was positively associated with END (adjusted odds ratio [aOR] = 4.56, 95% confidence interval [CI]: 1.52-13.70), and this association showed a quantitative relationship according to the degree of stenosis of ICAS (stenosis group: aOR = 4.24, 95% CI: 1.31-13.72; occlusion group, aOR = 5.74, 95% CI: 1.05-31.30). ICAS was also closely related to unfavorable outcomes (aOR = 6.33, 95% CI: 1.15-34.79). In contrast, AF showed no significant association with END or unfavorable outcomes. Our data showed that patients with ICAS had larger and more severe initial stroke lesions, and poorer prognosis than those without.

CONCLUSIONS

ICAS, but not AF, was closely associated with poor prognosis in ischemic stroke patients with active cancer.

Impact of prior cerebrovascular disease and glucose status on incident cerebrovascular disease in Japanese

BACKGROUND

Although both a history of cerebrovascular disease (CVD) and glucose abnormality are risk factors for CVD, few large studies have examined their association with subsequent CVD in the same cohort. Thus, we compared the impact of prior CVD, glucose status, and their combinations on subsequent CVD using real-world data.

METHODS

This is a retrospective cohort study including 363,627 men aged 18-72 years followed for ≥ 3 years between 2008 and 2016. Participants were classified as normoglycemia, borderline glycemia, or diabetes defined by fasting plasma glucose, HbA1c, and antidiabetic drug prescription. Prior and subsequent CVD (i.e. ischemic stroke, transient ischemic attack, and non-traumatic intracerebral hemorrhage) were identified according to claims using ICD-10 codes, medical procedures, and questionnaires.

RESULTS

Participants' mean age was 46.1 ± 9.3, and median follow up was 5.2 (4.2, 6.7) years. Cox regression analysis showed that prior CVD + conferred excess risk for CVD regardless of glucose status (normoglycemia: hazard ratio (HR), 8.77; 95% CI 6.96-11.05; borderline glycemia: HR, 7.40, 95% CI 5.97-9.17; diabetes: HR, 5.73, 95% CI 4.52-7.25). Compared with normoglycemia, borderline glycemia did not influence risk of CVD, whereas diabetes affected subsequent CVD in those with CVD- (HR, 1.50, 95% CI 1.34-1.68). In CVD-/diabetes, age, current smoking, systolic blood pressure, high-density lipoprotein cholesterol, and HbA1c were associated with risk of CVD, but only systolic blood pressure was related to CVD risk in CVD + /diabetes.

CONCLUSIONS

Prior CVD had a greater impact on the risk of CVD than glucose tolerance and glycemic control. In participants with diabetes and prior CVD, systolic blood pressure was a stronger risk factor than HbA1c. Individualized treatment strategies should consider glucose tolerance status and prior CVD.

Weight gain following pancreas transplantation in type 1 diabetes is associated with a worse glycemic profile: A retrospective cohort study

AIMS

Evaluate the weight trajectories after pancreas transplantation (PT) and their relationships with pancreas graft outcomes in type 1 diabetes (T1D).

METHODS

Retrospective cohort study. T1D individuals who underwent PT were recruited (T1D-PT; n = 194) and divided into three groups according to transplantation date: 1999-2004 (n = 57), 2005-2009 (n = 79), 2010-2015 (n = 58). For weight comparisons, a random sample of T1D without renal impairment was also recruited during 2015 (n = 61; T1D-control).

RESULTS

The median follow-up for the T1D-PT group was 11.1 years. Despite significant weight loss at 6 months (65.7 ± 12.4 vs. 64.1 ± 11.4 Kg; p < 0.001), a stepped increase was seen thereafter (60 months: 68.0 ± 14.0 Kg; p < 0.001). Participants from the 2010-2015 period showed higher weight gain (p < 0.001), outweighing that observed in the T1D-control (60 months: +4.69 ± 8.49 vs. -0.97 ± 4.59 Kg; p = 0.003). Weight gain between 6 and 36 months was directly associated with fasting glucose and HbA1c at 36 months, and with HbA1c at 60 months (p < 0.05). However, in Cox-regression models adjusted for age, sex, and several recipient and PT-related variables, the third tertile of weight gain between 6 and 36 months showed a non-significant increase in the graft failure/dysfunction (HR 2.33 [0.75-7.27]).

CONCLUSIONS

Weight gain post-PT was associated with glucose-related biochemical markers of graft dysfunction, which needs confirmation in further studies.

High triglyceride-glucose index is associated with early recurrent ischemic lesion in acute ischemic stroke

The triglyceride-glucose (TyG) index has been associated with various metabolic, cardiovascular, and cerebrovascular diseases. We evaluated the association between the TyG index and early recurrent ischemic lesions (ERILs) in patients with acute ischemic stroke (AIS). We included consecutive patients diagnosed with AIS between 2010 and 2016. ERILs were defined as new diffusion-weighted imaging lesions outside the initial symptomatic lesion area. The TyG index was calculated using the following formula: log scale of fasting triglyceride × fasting glucose/2. A total of 176 patients with AIS were evaluated. In the multivariable analysis, the TyG index remained significant (adjusted odds ratio [aOR] 2.63, 95% confidence interval [CI] 1.34–5.15). This close correlation between the TyG index and ERIL was pronounced in ERIL-same group (aOR 2.84, 95% CI 1.40–5.78), but not in ERIL-different group. When comparing the relationship between the TyG index and ERIL by stroke mechanisms, only the intracranial- and extracranial-large artery atherosclerosis groups showed significantly higher TyG index values in patients with ERIL than those without. In conclusion, a higher TyG index was associated with ERIL, especially ERIL-same, in patients with AIS. The TyG index appears to be involved in ERIL occurrence by a mechanism related to atherosclerosis.

The association between triglyceride glucose index and depression: data from NHANES 2005-2018

BACKGROUND

The association between triglyceride glucose (TyG) index and depression is unclear. We conducted this analysis to explore whether higher TyG index is associated with a higher odd of depression.

METHODS

This was an observational study using data from the National Health and Nutrition Examination Survey (2005-2018), a cross-sectional and nationally representative database. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). TyG index was calculated based on the equation as follows: ln [triglyceride (mg/dL) × fasting blood glucose (mg/dL)/2], and participants were divided into quartiles based on TyG index. Weighted multivariable logistic regression models were used to explore the relationship between the TyG index and depression.

RESULTS

A total of 13,350 patients were included, involving 1001 (7.50%) individuals with depression. Higher TyG index is significantly associated with elevated depressive symptoms in U.S. adults. Multivariate-adjusted HRs for patients in the TyG index 4th quartile were higher for depression (OR = 1.46; 95% confidence interval (CI) 1.30, 1.64) compared with the 1st quartile of TyG index. Similar results were seen in men and women, across age groups, and baseline comorbidities.

CONCLUSION

In this large cross-sectional study, our result suggests that population with higher TyG index are significantly more likely to have depressive symptoms in U.S. adults.