Triglyceride-glucose index is associated with the risk of myocardial infarction: an 11-year prospective study in the Kailuan cohort

The triglyceride-glucose index and acute kidney injury risk in critically ill patients with coronary artery disease

BACKGROUND

The triglyceride-glucose (TyG) index, proven a reliable and simple surrogate of insulin resistance, has shown potential associations with cardiovascular outcomes and renal diseases. This research delved into the utility of the TyG index in predicting the risk of acute kidney injury (AKI) in patients with coronary artery disease (CAD), an area not extensively covered in existing literature.

METHODS

A cohort of patients with CAD was recruited from the Medical Information Mart for Intensive Care-IV database, and categorized into quartiles based on their TyG index. The primary outcome was AKI incidence, and the secondary outcome was renal replacement therapy (RRT). Scatterplot histograms, cox proportional hazards models, Kaplan-Meier survival curves, and restricted cubic splines were employed to investigate the association between the TyG index and the risk of AKI in patients with CAD.

RESULTS

A total of 1,501 patients were enrolled in this study, predominantly male (61.56%), with a median age of 69.80 years. The AKI incidence was 67.22% among all patients, with the AKI stages increased with higher TyG levels (P for trend <0.001). The Kaplan-Meier survival analyses demonstrated statistically significant differences in AKI incidence and RRT application throughout the entire cohort, stratified by the TyG index quartiles (p < 0.001). Additionally, the restricted cubic spline analysis revealed a non-linear association between the TyG index and the risk of AKI (P for non-linear =0.637). Both multivariate Cox proportional hazards analyses (HR 1.62; 95% CI 1.15-2.27; p = 0.005) and multivariate logistic regression analyses (OR 2.16; 95% CI 1.18-3.94; p = 0.012) showed that the elevated TyG index was significantly related to AKI incidence. The association between TyG index and the risk of AKI is more significant in patients without diabetes (HR 1.27; 95% CI 1.14-1.42; p < 0.001), compared to patients with diabetes (P for interaction =0.013).

CONCLUSIONS

In summary, the TyG index emerged as a reliable predictor for the occurrence of AKI in CAD patients during ICU stay. Furthermore, it is also anticipated to serve as a valuable indicator for non-diabetic patients in predicting the incidence of AKI.

Association between triglyceride-glucose index and phenotypic age acceleration: a cross-sectional study based on NHANES database

Objective

To investigate the association between triglyceride-glucose (TyG) index and phenotypic age acceleration (PhenoAgeAccel), given the emerging importance of biological aging as a health determinant and the role of insulin resistance in aging-related processes.

Methods

This cross-sectional study analyzed data from 13,291 adults aged ≥20 years in the National Health and Nutrition Examination Survey (1999-2010). The TyG index served as the exposure variable, calculated from fasting triglycerides and glucose levels. PhenoAgeAccel, derived from clinical biomarkers, was the outcome variable. Analyses adjusted for demographic, socioeconomic, and health-related covariates.

Results

A significant non-linear relationship was observed between TyG index and PhenoAgeAccel, with an inflection point at 9.60. In the fully adjusted model, each unit increase in TyG index was associated with 2.21 years increase in PhenoAgeAccel (95% CI: 1.99, 2.43). The association was stronger above the inflection point (β = 8.21, 95% CI: 7.59, 8.82) compared to below it (β = 0.56, 95% CI: 0.29, 0.83).

Conclusion

Higher TyG index levels are significantly associated with accelerated biological aging, particularly above a threshold of 9.60. These findings suggest the importance of metabolic health in biological aging processes and potential interventional strategies.

Association of the triglyceride glucose index with sudden cardiac death in the patients with diabetic foot ulcer

BACKGROUND

This study examines the relationship between the TyG index and the risk of sudden cardiac death (SCD) in the patients with diabetic foot ulcer (DFU).

METHODS

688 type 2 diabetes mellitus (T2DM) inpatients with DFU between January 2010 and December 2023 was included in this retrospective study. The 1:1 propensity score matching (PSM) method was applied. The relationship between TyG index and SCD risk was analyzed using the Kaplan-Meier (K-M) survival curve analysis, multivariate Cox proportional hazard regression model, Restricted cubic spline (RCS) model analysis and subgroup analyses.

RESULTS

Over a median follow-up period of 61 months, 38 cases of SCD were recorded. After PSM, 71 pairs of score-matched patients according to TyG index were generated. K-M survival curves revealed higher SCD rates in patients with TyG index ≥9.65. The Cox proportional hazard model, independently associated with the risk of SCD (HR: 75.98; 95 % CI: 9.16 ∼ 630.40; P < 0.001). RCS model showed that SCD risk was non-linearly correlated with gradual increases in TyG index levels. Stratified analyses indicated a consistent relationship between increasing TyG index and SCD risk across all subgroups.

CONCLUSIONS

Elevated TyG index independently confers an increased risk for SCD in individuals with DFU.

Association Between Triglyceride Glucose Index and All-Cause Mortality in the Psoriasis Patients

Triglyceride glucose (TyG) index has been discovered to be significantly associated with a higher risk of mortality. However, the specific association between the TyG index and all-cause mortality in psoriasis patients remains unclear. Data of this study came from the National Health and Nutrition Examination Survey (NHANES). The weighted multivariable Cox regression models and restricted cubic spline (RCS) models were applied to assess the association between the TyG index as continuous variables and tertiles and the risk of mortality. Kaplan-Meier (KM) methods were used to plot survival curves to describe the survival of participants. Additionally, sensitivity and subgroup analyses were conducted to test the robustness of the results. Psoriasis participants who died had substantially higher TyG index than those survived (9.00 ± 0.68 vs. 8.64 ± 0.60, P = 0.008). Multivariable Cox regression showed that TyG index was positively associated to the risk of all-cause mortality (hazard ratios (HR) 1.78, 95% confidence intervals (CI): 1.13-2.81; P = 0.012) after fully adjustment. After converting TyG index from a continuous variable to a categorical variable by tertiles, the unadjusted, partly-adjusted and fully adjusted HR for risk of all-cause mortality were 3.96 (95% CI: 1.47-10.7; P = 0.007), 3.10 (95% CI: 1.20-7.99; P = 0.019) and 3.05 (95% CI: 1.14-8.16; P = 0.027) in participants in tertile 3 of TyG index, compared with tertile 1. The significance of the association persisted across sensitivity and subgroup analysis. The TyG index was positively correlated with the risk of all-cause mortality among psoriasis. These findings suggest that TyG index may be a promising predictor of all-cause mortality for the psoriasis patients during the long-term follow-up.

Temporal relationship between chronic inflammation and insulin resistance and their combined cumulative effect on cancer risk: a longitudinal cohort study

BACKGROUND

Cancer, a chronic and dangerous disease, poses a major public health burden. Inflammation and insulin resistance promote tumorigenesis. However, the temporal relationship between the two and their relationship with cancer risk must be elucidated.

OBJECTIVE

This study aimed to investigate the association between chronic inflammation, insulin resistance, and the propensity for cancer incidence.

METHODS

We explored the temporal relationship between triglyceride index (TyG) and high-sensitivity C-reactive protein (hsCRP) levels using cross-lagged modeling. We used COX proportional risk regression modeling to explore the association between high cumulative triglyceride and glucose index (CumTyG) and high cumulative high-sensitivity C-reactive Protein (CumhsCRP) and cancer risk. We further stratified CumTyG according to tertiles to explore the association of CumhsCRP with cancer risk at different insulin resistance levels and vice versa. We analyzed the association of combined chronic inflammation with insulin resistance, risk of different cancer types, and all-cause mortality. Finally, we performed two sensitivity analyses, excluding patients who developed cancer within the first year of follow-up and those with hsCRP levels > 10 mg/L.

RESULTS

The results of the study showed that the standardized correlation coefficient (β1) between hsCRP_2006/2007 and TyG_2010/2011 was 0.02306, which was significantly higher than the correlation (β2) between TyG_2006/2007 and hsCRP_2010/2011, suggesting that inflammation played a more prominent role in future changes in insulin resistance. Chronic inflammation and insulin resistance are positively and synergistically associated with cancer risk, with high chronic inflammation and high insulin levels increasing the risk of carcinogenesis by 71%. Although CumTyG in different CumhsCRP strata and CumhsCRP in different CumTyG strata promoted carcinogenesis, there were differences in the extent of carcinogenesis. High inflammation and insulin resistance, which promote cancer onset, are closely associated with digestive system cancers. The sensitivity analysis was consistent with the primary results and verified their reliability.

CONCLUSIONS

This study revealed the potential impact of inflammation on future changes in insulin resistance. There is a synergy and interaction between chronic inflammation and insulin resistance, which promotes the risk of cancer.

TRIAL REGISTRATION NUMBER

ChiCTR2000029767 ( https://www.chictr.org.cn/showproj.html?proj=48316 ).

TRIAL REGISTRATION DATE

February 13, 2020.

Association between triglyceride glucose index and all-cause mortality in patients with critical atrial fibrillation in the MIMIC-IV database

Although several studies have demonstrated the relationship between the triglyceride glucose (TyG) index and the prevalence of atrial fibrillation (AF), more attention needs to be paid to patients with AF in intensive care units because the prevalence of AF is as high as one-third of the population. This study investigated the relationship between the TyG index and short-term prognosis in patients with critical care AF. We selected critically ill patients with AF from the MIMIC-IV database and categorized them into quartiles based on their TyG index levels. The primary outcome assessed was 30-day all-cause mortality, with secondary outcomes of 7-day and 15-day all-cause mortality. We utilized Kaplan-Meier survival curves, restricted cubic spline, and Cox proportional hazards regression models to illustrate the relationship between the TyG index and clinical outcomes in critically ill patients with AF. 1,146 critically ill patients with AF were included in this study, with a mean age of 75.90. The female population accounted for 48.43% of the total. Kaplan-Meier survival curves demonstrated a significant association between the TyG index and all-cause mortality at 7, 15, and 30 days. Cox proportional hazards analysis, after adjusting for multiple confounders, revealed a substantial increase in all-cause mortality in the fourth quartile of the TyG index compared to the first quartile (HR = 1.71, 95% CI: 1.17-2.49). Restricted cubic spline further illustrated that higher TyG index were associated with an elevated risk of all-cause mortality in critically ill patients with AF. The stratified analysis provided additional support for the robustness of this association. The TyG index demonstrated a significant association with 7-day, 15-day, and 30-day all-cause mortality in critically ill patients with AF. These findings suggest that the TyG index may serve as a useful tool in identifying AF patients at a higher risk of all-cause mortality, enabling early and effective intervention strategies.

Triglycerides to high density lipoprotein cholesterol ratio (TG/HDL), but not triglycerides and glucose product (TyG) index, is associated with arterial stiffness in prediabetes

AIMS

Prediabetes (preD) carries increased risk of cardiovascular (CV) events than normal-glucose-tolerance (NGT). Insulin resistance, a hallmark of preD, is closely linked to CV-risk, making its assessment crucial. Triglycerides-to-high-density-lipoprotein-cholesterol-ratio (TG/HDL) and triglycerides-and-glucose-product (TyG) have emerged as surrogate of insulin resistance. We aimed to evaluate the association of these indexes with CV-risk assessed through arterial stiffness in preD.

METHODS

377 individuals without diagnosis of diabetes underwent: (1) complete biochemistry and oral-glucose-tolerance-test; (2) CV-risk assessment through arterial stiffness (pulsed-wave-velocity - PWV - and augmentation-index - AugI) and intima-media-thickness (IMT). Participants were split according to current guidelines: NGT (n = 100), preD (n = 216), and newly-diagnosed-type-2-diabetes (ND-T2D) (n = 61).

RESULTS

TG/HDL and TyG were higher in preD than NGT, with no difference between preD and ND-T2D regarding TG/HDL. PreD showed higher PWV, AugI, and IMT than NGT. In preD group, after adjusting for major confounders, PWV was correlated with TG/HDL (β = 0.16; P = 0.03), but not with TyG, and there was a trend of association with HOMA-IR (β = 0.19, P = 0.07). In logistic regression, being in the higher tertile of TG/HDL was associated with higher PWV (odds-ratio 2.51, 95 %CI 1.01-6.29, P = 0.048).

CONCLUSIONS

In preD, TG/HDL was independently associated with PWV, suggesting its possible role as a simple, cost-effective tool for assessing CV risk.

The Association Between Preoperative Triglyceride Glucose Index and Postoperative Adverse Cardiovascular Events in Non-Cardiac Surgery: A Single-Center Study From China

Background

The incidence of postoperative adverse cardiovascular events (PACE) in non-cardiac surgery has significantly increased, severely affecting surgical outcomes and patient prognosis. This study investigates the relationship between preoperative triglyceride-glucose (TyG) index and PACE in patients who underwent non-cardiac surgery.

Methods

We conducted a single-center retrospective study, including adult patients (age ≥18 years) who underwent non-cardiac surgery. Univariate and multivariate logistic regression analyses assessed the relationship between the TyG index and PACE. Nonlinear correlations were investigated using restricted cubic splines (RCS). Additionally, subgroup analysis was performed to evaluate the relationship between the TyG index and PACE in different subsamples.

Results

16,066 patients were studied, among which 1505 cases (9.37%) developed PACE, with a median TyG index of 8.61 (8.22, 9.07). Using the lowest quartile of the TyG index as a reference, the fully adjusted (ORs) (95% CIs) for PACE in the second, third, and fourth quartiles of the TyG index were 1.78 (1.49~2.11), 2.16 (1.81~2.59), and 2.30 (1.88~2.83), respectively. After adjusting for all confounding factors, we found that patients with the highest TyG index had a 68% increased risk of PACE (OR 1.68, 95% CI 1.50~1.90). The results of the subgroup analysis were similar to those of the primary analysis. The RCS model suggests a linear positive correlation between the TyG index and the risk of PACE occurrence. (P for overall < 0.001, P for nonlinear = 0.547).

Conclusion

This cohort study indicates that preoperative TyG index is linearly and positively correlated with an increased incidence of PACE in the non-cardiac surgery population. This finding suggests that intensifying the evaluation of the TyG index may provide a more convenient and effective tool for identifying individuals at risk of PACE during non-cardiac surgeries.

Interactive effects of abdominal obesity and insulin resistance on cardiometabolic risk

INTRODUCTION AND OBJECTIVES

Both abdominal obesity (AO) and insulin resistance (IR) are predictors of cardiometabolic disease (CMD). We aimed to evaluate the temporal relationship between AO and IR and their combined effect on CMD risk.

METHODS

A nationally representative cohort of 9234 participants was included, with a maximum follow-up of 9 years. The triglyceride-glucose (TyG) index was calculated as an indicator of IR, and AO was measured by waist circumference (WC). Cox regression was applied to evaluate the combined effect of AO and TyG on CMD risk, including hypertension, diabetes, heart disease, and stroke. A cross-lagged panel model was used to examine the temporal relationship. Multiplicative and additive interactions between AO and insulin resistance, as well as the mediating effect of TyG, were assessed.

RESULTS

Individuals concurrently with AO and higher TyG (≥8.6 [median]) had the highest risk of hypertension (HR,1.46; 95%CI, 1.25-1.69), diabetes (HR, 1.99; 95%CI, 1.65-2.41), and stroke (HR, 1.76; 95%CI, 1.22-1.94). A biological interaction between AO and IR on diabetes was observed, with the attributable proportion due to interaction being 29%. There was a bidirectional temporal relationship between WC and TyG, and the effect of WC on TyG was more prominent than vice versa. High TyG had a mediating effect on the association of AO with hypertension (19%), diabetes (25%), and stroke (24%).

CONCLUSIONS

The findings reveal a temporal relationship between AO and IR, their combined effect on hypertension, diabetes, and stroke, and the mediating role of IR. Strategies simultaneously targeting both factors should be emphasized for the primary prevention of CMD.

Predictive Capability of Dual Trajectories of Central Adiposity Indices Combined With Glucose for Cardiovascular Diseases

BACKGROUND

This aimed to quantify the association between dual trajectory patterns combining seven central adiposity (CA) indices and fasting plasma glucose (FPG) with cardiovascular disease (CVD) risk in adults, and to compare their predictive performance.

METHODS

The Kailuan Study, a prospective study initiated in June 2006, included 39 772 adults without pre-existing CVD as of 2010. Dual trajectories of seven CA indices combined with FPG were recorded from 2006 to 2010 to predict CVD risk from 2010 to 2021. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident CVD.

RESULTS

During a median follow-up of 11.0 years, 2715 incident CVD events were recorded. Four distinct patterns of CA indices (waist circumference, waist-to-height ratio, abdominal volume index, body roundness index) and three distinct patterns of other CA indices (waist-to-hip ratio, conicity index, A body shape index) combined with FPG were identified. Compared with the lowest-risk group, the highest-risk group exhibited a significantly higher CVD risk (adjusted HRs [95% CIs]: 2.41 [2.02-2.86], 2.57 [2.18-3.05], 2.25 [1.92-2.63], 2.35 [2.01-2.73], 2.08 [1.74-2.49], 1.97 [1.72-2.26], 1.81 [1.58-2.07], respectively). Overall, the predictive capabilities were generally similar, with the combination of waist circumference and FPG showing a slightly better predictive performance compared with other patterns.

CONCLUSIONS

Distinct patterns of dual trajectories involving seven CA indices combined with FPG were associated with CVD risk. The results suggest that the combination of waist circumference and FPG may have greater clinical significance in predicting CVD risk.

Non-linear relationship between triglyceride glucose index and new-onset diabetes among individuals with non-alcoholic fatty liver disease: a cohort study

BACKGROUND

The relationship between the triglyceride glucose (TyG) values and the development of diabetes in non-alcoholic fatty liver disease (NAFLD) patients is not yet well researched. This study aims to examine how the baseline TyG levels correlate with the incidence of new-onset diabetes in this specific cohort.

METHODS

This cohort included 2,506 normoglycemic Japanese adults with NAFLD who underwent routine health check-ups at Murakami Memorial Hospital between 2004 and 2015. Several statistical approaches, including restricted cubic splines and two-piecewise linear regression, were utilized to assess the relation between the TyG levels and diabetes risk.

RESULTS

Among the 2,506 participants (mean age: 44.78 ± 8.32 years; 81.09% male), 203 individuals (8.10%) developed diabetes over the course of the 11-year follow-up period. A U-shaped relationship was observed between the levels of TyG and the onset of diabetes, with an inflection point identified at a TyG value of 7.82 (95% CI: 7.72-8.00). Below this threshold, each one-unit elevation in TyG values reduced the probability of diabetes by 93% (HR = 0.07, 95% CI: 0.01-0.32, P = 0.001). Conversely, above this threshold, each one-unit elevation increased the probability of diabetes by 70% (HR = 1.70, 95% CI: 1.19-2.44, P = 0.004).

CONCLUSIONS

The findings validate a U-shaped association between TyG levels and new-onset diabetes in adults with NAFLD. Both low and high TyG levels increase diabetes probability in such a group.

Application of TyG index and carotid ultrasound parameters in the prediction of ischemic stroke

Objective

The triglyceride - glucose (TyG) index has been confirmed as an independent risk factor for ischemic stroke (IS) in numerous studies. In terms of the role of carotid ultrasound in the risk assessment of IS, the focus has shifted from merely concentrating on the degree of stenosis to paying more attention to the status of carotid plaques. However, there are limited studies on combining clinical indicators such as the TyG index with carotid ultrasound parameters to assess the risk of IS. Through a retrospective study, we aim to explore the role of combining these two types of indicators in the risk assessment of IS.

Methods

This study included 145 patients with IS and 99 no ischemic stroke (NIS) patients diagnosed by magnetic resonance imaging (MRI) from January 2020 to June 2024. The TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting blood glucose (mg/dL)/2]. The carotid ultrasound parameters integrated were as follows: the presence or absence of carotid plaques, the location of the largest carotid plaque, carotid intima - media thickness (CIMT), the lengthness and thickness diameters of the largest carotid plaque, and the degree of carotid stenosis. Univariate (multivariate) logistic regression analysis, ROC curve analysis, etc. were conducted on the data using SPSS 26 and MATLAB Online. These were aimed at assessing the effectiveness of integrating clinical indicators with carotid ultrasound parameters in predicting the risk of IS.

Results

The univariate logistic regression analysis (ULR) demonstrated that age, gender, TyG index, history of diabetes, history of hypertension, fasting blood glucose (FBG), systolic blood pressure(SBP), diastolic blood pressure(DBP), low-density lipoprotein cholesterol(LDL-C), cystatin C(Cys C), the presence or absence of carotid plaques, plaque location, carotid intima-media thickness(CIMT), the length and thickness of the largest plaque were significantly associated with IS (P < 0.05), while the P-values of triglycerides(TG), total cholesterol(TC), uric acid(UA) and carotid stenosis rate were greater than 0.05. The area under the ROC curve (AUC) of the TyG index for predicting IS was 0.645 (P < 0.001), indicating a certain predictive ability but relatively limited. The optimal cut-off value was 8.28, with a sensitivity of 0.83 and a specificity of 0.63 at this cut-off value. The stratified analysis based on quartiles of the TyG index revealed that as the TyG index increased, the prevalence of hypertension and diabetes, as well as multiple lipid and metabolic indicators, increased, and the characteristics of carotid plaques also changed. Multiple risk prediction models were constructed and analyzed by ROC curves. Model 1, which integrated traditional clinical indicators, TyG index and carotid ultrasound parameters, performed best (AUC = 0.932) (P < 0.001), while Model 16, which only included some carotid ultrasound indicators, had relatively low predictive efficacy (AUC = 0.750) (P < 0.001).

Conclusion

This study confirms that the combination of TyG index and carotid ultrasound parameters is of great significance in predicting the risk of IS. The predictive ability of TyG index alone is limited, and Model 1 integrating multiple indicators has the best predictive effect and can provide a reference for clinical practice. However, due to the retrospective nature of this study and the limitations such as selection bias, small sample size and single-center, there are some discrepancies between some results and those of previous studies. Future studies need to conduct multi-center, large-sample studies and incorporate more factors to improve the model.

The triglyceride-glucose index is associated with a higher risk of hypertension: evidence from a cross-sectional study of Chinese adults and meta-analysis of epidemiology studies

Background

The results of population-based studies show a diverse association between the triglyceride-glucose (TyG) index and hypertension. The present study aimed to investigate this association based on a cross-sectional study on Chinese adults and meta-analysis of epidemiology studies.

Methods

The cross-sectional analysis used the baseline data from the on-going REACTION study in China. The TyG index was calculated as Ln [triglyceride(mg/dl)×fasting plasma glucose(mg/dl)/2]. A multivariate-adjusted logistic regression model was used to calculate the odds ratio (OR) with a 95% confidence interval (CIs) for the prevalence of hypertension, with the lowest TyG quartile as a reference.

Results

A total of 4,177 participants aged 58.62 ± 8.40 years were included. TyG was significantly associated with higher odds of hypertension (OR:1.273, 95% CI:1.171-1.384), and the association remained pronounced with isolated systolic hypertension (OR:1.161, 95% CI:1.045-1.289) and systolic-diastolic hypertension (OR:1.313, 95% CI:1.163-1.483) but not with isolated diastolic hypertension (OR:1.164, 95% CI:0.929-1.460). In the present meta-analysis, 34 relevant studies were included through systematic searches of PUBMED, Embase, and the Cochrane Library. A positive association between the TyG index and hypertension was revealed in the meta-analysis of cohort studies (HR:1.57, 95% CI:1.25-1.96) and cross-sectional studies (OR:2.01, 95% CI:1.47-2.76).

Conclusion

Elevated TyG index levels were significantly associated with a higher risk of clinical hypertension, which may provide new insights into the clinical management of hypertension.

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.

Concordance between homeostatic model assessment and triglyceride glucose index in assessing insulin resistance among HIV-infected patients

OBJECTIVES

To evaluate the concordance between the triglyceride glucose (TyG) index and the homeostatic model assessment of insulin resistance (HOMA-IR) in assessing insulin resistance (IR) in people living with HIV (PLWH). Additionally, we aimed to estimate a cut-off value for the TyG index in PLWH.

METHODS

This retrospective, observational study included medical records of patients diagnosed with HIV at Sakarya Training and Research Hospital from January 2019 to January 2024. Based on their HOMA-IR levels, PLWH patients were divided into 2 groups: Group A (patients without IR) and Group B (patients with IR).

RESULTS

In this study, insulin resistance was investigated in 147 people living with HIV (PLWH) between the ages of 18-68. Our results showed a significant positive linear relationship between HOMA-IR and the TyG index (r=0.628, p<0.001). We found the TyG Index cut-off value to predict IR in people living with HIV (PLWH) to be 8.25.

CONCLUSION

Our study identified correlation between the TyG index and HOMA IR index in PLWH. The TyG index may serve as an effective alternative to HOMA-IR for evaluating insulin resistance in PLWH.".

Exploring the association between the TyG-WHtR index and the incidence of stroke in the obese population: based on NHANES data from 1998 to 2018

BACKGROUND

The TyG index is an emerging low-cost and efficient indicator that is significantly associated with stroke. Multiple studies have confirmed the impact of the TyG index on cerebrovascular diseases. However, the role of indices combining TyG with different obesity factors, such as triglyceride glucose-waist-height ratio (TyG-WHtR) on stroke risk in obese individuals remains unclear. This study utilizes data from the National Health and Nutrition Examination Survey database between 1998 and 2018 to explore the relationship between stroke and the TyG-WHtR index in obese individuals.

METHODS

This cross-sectional study analyzed data from 5767 obese individuals from the NHANES database between 1998 and 2018. Univariate and multivariate logistic regression analyses were used to study the association between TyG-WHtR and stroke, utilizing continuous variables or categorizing variables based on quartiles. Propensity score matching (PSM) and subgroup analysis stratifying characteristics of TyG-WHtR and stroke were further conducted to study their relationship. Additionally, restricted cubic spline (RCS) analysis was performed to examine the linear relationship between TyG-WHtR and stroke.

RESULTS

A total of 5767 participants were included in the statistical analysis, comprising 227 stroke patients and 5540 non-stroke participants. Multivariable logistic regression analysis revealed a positive association between TyG-WHtR and stroke both before and after matching (P < 0.001), with statistically significant differences. Subgroup analysis indicated a statistically significant difference among non-Hispanic white individuals, and RCS analysis showed a non-linear relationship between TyG-WHtR and stroke before matching, but a linear relationship after matching.

CONCLUSION

In obese individuals, a higher TyG-WHtR index is positively associated with stroke risk.

Impact of triglyceride-glucose index on risk of cardiovascular disease among non-diabetic hypertension patients: a 10-year prospective cohort study

BACKGROUND

Triglyceride-glucose (TyG) index was regarded as a cost-efficient and reliable clinical surrogate marker for insulin resistance (IR), which was significantly correlated with cardiovascular disease (CVD). However, the TyG index and incident CVD in non-diabetic hypertension patients remains uncertain. The aim of study was to explore the impact of TyG index level and variability on risk of CVD among non-diabetic hypertension patients.

METHODS

A total of 9313 hypertensive patients without diabetes aged 30-70 years in Jiangsu Province who participated in the baseline survey from January 2010 to December 2010 and were followed up to May 2020 were included in this study. The TyG index was calculated as ln [fasting triglyceride (TG) (mg/dl) × fasting plasma glucose (FPG) (mg/dl)/2] and variation degree was calculated as the TyG index at first year follow-up (2011) minus that at baseline (2010). Cox proportional analysis regression and restricted cubic spline were used to investigate the association between TyG index level as well as variability and CVD risk.

RESULTS

Of 9313 included participants, 5423(58.23%) were female. During a mean follow-up of 8.32 ± 1.43 years, 890(9.56%) CVD events was identified. Cox regression analysis showed that with the highest TyG index in Q4 group at baseline, the incidence of CVD risk increased by 33.6% after adjustment for multiple confounders compared to Q1 group. Compared with TyG index variation degree 0 ~ < 1, the hazard ratios (HR) and 95% confidence interval (CI) respectively in < 0, 1 ~ < 2 and 2 ~ were 0.326(0.276, 0.384), 3.216(2.697,3.835) and 4.225(3.359,5.314). The restricted cubic spline indicated that there was a non-linear dose-response relationship between the change degree of TyG and risk of CVD. Similar results were obtained by subgroup analysis and sensitivity analysis.

CONCLUSION

Elevated TyG index may be used as a surrogate for IR and help optimize risk stratification of CVD as well as prevention and management.

Inflammatory markers link triglyceride-glucose index and obesity indicators with adverse cardiovascular events in patients with hypertension: insights from three cohorts

BACKGROUND

Among hypertensive cohorts across different nations, the relationship between the triglyceride-glucose index (TyG) and its conjunction with obesity metrics in relation to cardiovascular disease (CVD) incidence and mortality remains to be elucidated.

METHODS

This study enrolled 9,283, 164,357, and 5,334 hypertensives from the National Health and Nutrition Examination Survey (NHANES), UK Biobank (UKBB), and Shanghai Pudong cohort. The related outcomes for CVD were defined by multivariate Cox proportional hazards models, Generalized Additive Models and Mendelian randomization analysis. Mediation analysis explored the mediating role of inflammatory markers in the above relationships.

RESULTS

Five measures of insulin resistance were linked to CVD and related death in a U-shaped pattern, with the highest group having different risk increases. Higher glucose triglyceride-waist height ratio (TyG-WHTR) was linked to higher all-cause mortality (UKBB: HR 1.21, 95%CI 1.16-1.26, NHANES: HR 1.17, 95%CI 1.00-1.36), CVD mortality (UKBB: HR 1.36, 95%CI 1.23-1.49, NHANES: HR 1.32, 95%CI 1.00-1.72) risks. In the China Pudong cohort, higher triglyceride/high-density lipoprotein-cholesterol (TG/HDL_C) ratio was associated with higher risks of CVD and stroke (HR 1.31, 95%CI 1.00-1.73 and 1.67, 1.06-2.63). Inflammation markers like systemic inflammatory response index (SIRI) and C-reactive protein (CRP) partially explained these links, with CRP having a stronger effect. Genetically predicted TyG was also linked to stroke (OR 1.26, 95%CI 1.10-1.45) risk.

CONCLUSIONS

An elevated TyG index and its related indices are significantly correlated with an increased risk of CVD and related mortality across three national cohorts. These indices are anticipated to serve as valid predictors of incident CVD and mortality in individuals with hypertension.

Correlation of triglyceride glucose index with all cause mortality in acute myocardial infarction patients following percutaneous coronary intervention

The Triglyceride glucose (TyG) index is a dependable indicator of IR, with numerous studies underscoring its influence on Cardiovascular disease. Nevertheless, the connection between the TyG index and prognosis in AMI patients after PCI is still uncertain. This investigation aims to explore the link in individuals who have received PCI for AMI. Upon admission, data regarding the patients' age, sex, concurrent diseases, TyG index, and laboratory findings were meticulously documented. To discern the link between the TyG index and the 30-day and 12-month ACM, we employed a multivariate Cox proportional hazard regression model and K-M survival curve. The concordance evaluation was also enhanced by subgroup analysis. The investigation encompassed data from 1410 AMI patients who received PCI. The 30-day ACM rate was observed to be 15.1% (214/1410), while the rate at 12 months escalated to 26.0% (368/1410). Upon adjusting for potential confounders, multivariate analysis delineated a dramatic link between high TyG index and heightened mortality risk at both 30 days (HR 1.233, 95% CI 1.086-1.399) and 12 months (HR 1.127, 95% CI 0.963-1.318). According to K-M survival curve, patients presenting with higher TyG indexes demonstrated a noticeably higher probability of ACM within both the 30-day and 12-month. In AMI patients after PCI, the TyG index demonstrates a substantial link with ACM at 30-day and 12-month marks. This finding suggests the effectiveness of the TyG index in detecting AMI patients who are at a higher risk of mortality after undergoing PCI.

Triglyceride glucose (TyG) index: A promising biomarker for diagnosis and treatment of different diseases

The Triglyceride-glucose index (TyG index) is a comprehensive statistical measure that incorporates fasting triglyceride and fasting glucose levels. Research has demonstrated that it can serve as an effective alternative biomarker for insulin resistance (IR) due to its high sensitivity and specificity. The TyG index is straightforward to compute and imposes fewer time and cost constraints, rendering it suitable for large populations and advantageous for use in various applications, clinical settings, and epidemiological investigations. Numerous high-quality clinical studies have underscored the significance of the TyG index in diverse medical conditions. This review provides a synthesis of the association between the TyG index and diseases such as diabetes, cardiovascular diseases, cerebrovascular diseases, fatty liver, kidney diseases, and reproductive system diseases. Furthermore, the TyG index has exhibited predictive capabilities for identifying IR in children and adolescents. Through a systematic review of pertinent clinical trials, this paper elucidates the correlation between the TyG index and various diseases. The findings presented herein suggest that the TyG index holds promise as a valuable and practical indicator for different medical conditions, prompting a reevaluation of conventional disease risk assessment paradigms and highlighting the intricate interplay of metabolic parameters with diverse diseases. By leveraging insights from the TyG index, tailored disease risk management strategies can be developed to offer a fresh perspective and guidance for clinical interventions.

Influence of sodium-glucose cotransporter 2 inhibitors on the triglyceride-glucose index in acute myocardial infarction patients with type 2 diabetes mellitus

Background

As a novel oral anti-hyperglycemic agent, sodium-glucose cotransporter 2 inhibitors (SGLT2-i) have been demonstrated to improve cardiovascular outcomes in acute myocardial infarction (AMI) patients with type 2 diabetes mellitus (T2DM). However, the mechanism responsible for the beneficial effects remains unclear. Recently, extensive studies have demonstrated a close relationship between elevated fasting triglyceride-glucose (TyG) index and the risk of AMI. Additionally, research has identified that SGLT2-i can reduce the TyG index in T2DM patients. However, it remains ambiguous whether the benefit of SGLT2-i in patients with AMI and T2DM is due to an improvement in the TyG index. Consequently, we aimed to assess the impact of SGLT2-i on the TyG index in AMI patients with T2DM.

Methods

A retrospective and cross-sectional study was conducted on 180 AMI patients with T2DM admitted to the chest pain center of the Second Affiliated Hospital of Anhui Medical University from January 2020 to January 2023. Based on the hypoglycemic regimens administered after admission, the patients were categorized into a control group (79 cases treated with sulfonylureas, α-glycosidase inhibitors, metformin, etc.) and a SGLT2-i group (101 cases administered with dapagliflozin or empagliflozin). Propensity score matching (PSM) was adopted to balance the baseline characteristics of patients and minimize selection bias to confirm the robustness of the results. After PSM, control group remained 32 patients, and SGLT2-i group remained 37 patients. All patients underwent regular follow-up after discharge, and comparisons were made between the two groups in terms of clinical indicators and major adverse cardiovascular events (MACEs) in 1 year. Univariate and Multivariate Cox regression analysis was performed to identify the predictors of MACE.

Results

Significant differences were observed between the two groups in terms of various parameters before PSM, included age, proportion of insulin use, Gensini score, serum creatinine (Cr), total cholesterol (TC), and cardiac troponin I (cTnI). After PSM, there were no statistically significant differences in baseline clinical indicators and laboratory tests. The median follow-up period was 11 months in both cohorts. The comparison of follow-up results between the two groups after matching confirmed statistically significant differences in triglyceride (TG) reduction index reduction, left ventricular end-diastolic diameter (LVDD) reduction, and white blood cell (WBC) reduction in the SGLT2-i group (all P<0.05). Additionally, a higher incidence of MACEs was observed in the control group (P=0.01). Univariate analysis showed that usage of SGLT2-i, Cr, low-density lipoprotein cholesterol (LDL-C), TyG index at baseline, and changes of TyG index (TyG at follow-up minus TyG at baseline) were associated with the risk of MACE. However, multivariate analysis showed only usage of SGLT2-i was associated with the risk of MACE [hazard ratio (HR) =0.077; 95% confidence interval (CI): 0.009-0.682; P=0.02].

Conclusions

In AMI patients with T2DM, the use of SGLT2-i was associated with a lower risk of MACE and an improvement of TyG index during 11 months follow-up. Our findings offer new insights into the cardio-protective mechanisms of SGLT2-i in the context of AMI.

The role of the triglyceride-glucose index as a biomarker of cardio-metabolic syndromes

BACKGROUND

The Triglyceride-glucose (TyG) index represents a simple, cost-effective, and valid proxy for insulin resistance. This surrogate marker has also been proposed as a predictor of metabolic and cardiovascular disease (CVD). In this descriptive review, we aimed to assess the utility of the TyG index as a predictive biomarker of cardiometabolic diseases.

METHODS

A search was conducted in PubMed, and Web of Science to identify cross-sectional and more importantly prospective studies examining the use of the TyG index as a predictive biomarker. The following terms were utilized in addition to the TyG index: "insulin resistance", "metabolic syndrome", "diabetes"; "cardiovascular diseases".

RESULTS

This descriptive review included thirty prospective studies in addition to cross-sectional studies. Following adjustment for confounding variables, an elevated TyG index was associated with a significantly increased risk for the development of Metabolic Syndrome (MetS), Type 2 Diabetes, hypertension, and CVD. Also in limited studies, the TyG index was associated with endothelial dysfunction, increased oxidative stress and a pro-inflammatory phenotype.

CONCLUSION

Overall, our findings support the use of the TyG index as a valid biomarker to assess the risk of developing MetS, T2DM, as well as atherosclerotic cardiovascular disease.

Relationships among Helicobacter pylori seropositivity, the triglyceride-glucose index, and cardiovascular disease: a cohort study using the NHANES database

BACKGROUND

Helicobacter pylori (H. pylori), a widely prevalent pathogen that can be cured through relatively simple medical methods, is thought to be potentially associated with the risk of cardiovascular diseases (CVD), although controversy remains. Currently, it is unclear whether the triglyceride-glucose index (TGI), a classic indicator of insulin resistance, influences the relationship between H. pylori infection and CVD. The present work explored the relationships between H. pylori seropositivity, the TGI and CVD, and the potential effect of TGI in this association.

METHODS

In this cross-sectional and cohort study, data from the National Health and Nutrition Examination Survey (NHANES) III (1988-1994) and NHANES (1999-2000) were used. The effects of the TGI, H. pylori seropositivity, and their interaction on the risk of CVD were assessed using logistic regression models. The hazard ratios (HRs) and 95% confidence intervals (CI) for all-cause mortality (ACM) were calculated using the Cox proportional hazards model. Restricted cubic spline (RCS) curves were employed to investigate potential non-linear or linear relationships among the TGI, H. pylori seropositivity, occurrence of CVD, and ACM. Mediation analyses were employed to assess the potential effects of H. pylori seropositivity and TGI on the risk of CVD and mortality.

RESULTS

Of the 9,399 participants, 4,488 (47.75%) were H. pylori-immunoglobulin G (IgG)-positive, and 3,934 (41.86%) were diagnosed with CVD. In the general population, participants with a TGI ≥ 75th percentile who were positive for H. pylori-IgG antibody had the highest risk of developing CVD (odds ratio = 1.487; 95% CI: 1.088-2.033). Among patients with CVD, those with a TGI ≥ 75th percentile & positive for H. pylori-IgG antibody were at a higher ACM risk (HR = 1.227; 95% CI: 1.009-1.491). H. pylori exhibited a significant mediating effect on CVD occurrence (Pindir = 0.004) and mortality (Pindir = 0.004) via the TGI.

CONCLUSIONS

H. pylori seropositivity may indirectly elevate the risk of CVD and mortality via the TGI. Combining the patient's H. pylori serological status with their TGI could enhance the predictive ability for CVD occurrence and related mortality. Therefore, the clinical practice of screening for and eradicating H. pylori in CVD patients may be anticipated.

Association of the Triglyceride Glucose Index With Outcomes in Acute Ischemic Stroke Injury

Objectives The study aimed at estimating the triglyceride glucose (TyG) index in patients with ischemic stroke, exploring the correlation between the TyG index and the prognosis of ischemic stroke, and studying the clinical outcome in patients with acute ischemic stroke (AIS) in association with the TyG index. Methods An observational study was conducted on 105 patients with a history of AIS presenting within 24 hours. The TyG index was estimated, and the clinical outcome was studied. The outcome measures were neurological worsening (National Institutes of Health Stroke Scale (NIHSS) >=2 gain at discharge above admission), poor functional outcomes (assessed by derangement of modified Rankin scale (mRS) at three months), stroke recurrence, and three-month mortality rate. The NIHSS and mRS were assessed at admission, discharge, and three months later. Results The mean TyG index of AIS patients was 9.26±0.2. Compared to patients without neurological worsening (n=8), patients with neurological worsening had a significantly higher TyG index (9.5±0.19 vs. 9.21±0.21, p<.0001). Compared to patients without poor functional outcomes (n=20), patients with poor functional outcomes had a similar TyG index (9.31±0.31 vs. 9.25±0.22, p=0.418). Compared to patients without recurrence, those with recurrence of stroke had a significantly higher TyG index (9.55±0.18 vs. 9.15±0.15, p<.0001). On the follow-up of three months post-stroke, compared to survivors, non-survivors had a similar TyG index (9.12±0.25 vs. 9.27±0.24, p=0.09). Conclusion The TyG index showed a significant association with outcomes of AIS in terms of stroke recurrence and neurological worsening. Overall, it shows that insulin resistance has a significant impact on the neurological outcomes and recurrence of stroke in AIS patients.

Pathways from insulin resistance to incident cardiovascular disease: a Bayesian network analysis

BACKGROUND

Insulin resistance coexist with many metabolic disorders, whether these disorders were promotors or pathway-factors for the association of insulin resistance and cardiovascular disease (CVD) remained unclear. We aimed to investigate the pathways related to elevated the triglyceride-glucose (TyG) index and pathways through elevated TyG index to the occurrence of CVD in Chinese adults.

METHODS

A total of 96,506 participants were enrolled from the Kailuan study. Bayesian network model with the max-min hill climbing algorithm and maximum likelihood estimation was applied to identify factors and pathways related to the TyG index, and quantitatively infer the impact of associated factors on elevated TyG index and the occurrence of CVD by computing conditional probabilities.

RESULTS

A final Bayesian network was constructed with 14 nodes and 25 arcs, creating 28 pathways related to elevated TyG index and 8 pathways from elevated TyG index to CVD. Elevated TyG index was causally associated with CVD, the condition probability was 11.9%. Pathways to elevated TyG index were mainly through unhealthy lifestyles and the subsequent increase in lipid profiles, especially smoking and low-density lipoprotein cholesterol. The most important pathway from elevated TyG index to CVD was through overweight/obesity, hypertension, and chronic kidney disease, with a condition probability of 18.5%. The maximum relative change rate related to elevated TyG index was observed for overweight/obesity (64.3%).

CONCLUSIONS

Elevated TyG index was causally associated with the risk of CVD, a combined control of lifestyles and metabolic factors may contribute to the reduction of TyG index and the prevention of CVD.

Triglyceride-glucose index and hsCRP-to-albumin ratio as predictors of major adverse cardiovascular events in STEMI patients with hypertension

This study aimed to evaluate the association between the triglyceride-glucose (TyG) index and high-sensitivity C-reactive protein-to-albumin ratio (hsCAR) and the prognosis of patients with STEMI and hypertension. A total of 699 patients diagnosed with STEMI and hypertension were included in this study database. Compared to the low TyG index group (< 7.8), the high TyG index group (≥ 7.8) was associated with an increased risk of MACE (HR 2.09, 95% CI = 1.58-2.77; P < 0.001). Similarly, a higher hsCAR (≥ 0.15) was linked to an increased risk of MACE (HR 1.46, 95% CI = 1.12-1.90; P = 0.005). Subsequently, we categorized the population into four groups based on the defined cutoff points. Compared to the low TyG-low hsCAR subgroup, the other three subgroups demonstrated an elevated risk of MACE. Among patients treated with PCSK9 and SGLT2 inhibitors, the combined effect of the TyG index and hsCAR on MACE was attenuated. Finally, The combined TyG index and hsCAR model exhibited optimal performance (AUC = 0.71, 95% CI = 0.67-0.75; P < 0.001). This study demonstrates that the TyG index and hsCAR provide strong combined predictive power. The synergistic utilization offers a comprehensive approach to cardiovascular risk assessment.

The Impact of Triglyceride-Glucose (TyG) Index on Future Cardio and Cerebrovascular Events in Patients with Acute Coronary Syndrome, During 3 Years of Follow-Up

Background: The triglyceride-glucose (TyG) index is a new alternative insulin resistance (IR) biomarker. The purpose of this study was to assess whether the TyG index can have a prognostic value in patients with acute coronary syndrome (ACS). Moreover, we wanted to compare the TyG index with HOMA index. Methods: We retrospectively enrolled 115 consecutive subjects, 81 males and 34 females, referred for ACS to our Unit of Cardiovascular Care of Policlinico Paolo Giaccone, Palermo. The subjects were divided into tertiles according to TyG index values and we performed a 3-year follow-up study. We considered as an end point new cardiovascular and cerebral events (MACCEs) during follow-up. Results: We found a significant statistical correlation between the HOMA index and the TyG index (p = 0.001). Patients with elevated TyG index have a higher incidence of MACCE at a 3-year follow-up. In our study the TyG index was an independent predictor of MACCEs (95% CI 1.8158 to 16.8068; P 0.0026) and the optimal TyG index cut-off for predicting MACCEs was 4.92 (sensitivity 76.56% and specificity 72.55%). Conclusions: The TyG index seems to significantly have an important prognostic role in patients with ACS and high values of TyG index are superior to HOMA-IR in predicting MACCEs.

Triglyceride-glucose index improves risk prediction beyond traditional risk factors and hypertension mediated organ damage in healthy adults

BACKGROUND AND AIMS

Triglyceride-glucose (TyG) index, a surrogate measure of insulin resistance, is associated with hypertension mediated organ damage (HMOD) and cardiovascular disease. This study investigated the association between TyG index and major adverse cardiovascular events (MACE) and its interaction with traditional risk factors and HMOD.

METHODS AND RESULTS

Healthy subjects recruited from the general population were thoroughly examined and followed for MACE using nation-wide registries. Cox proportional hazard models were used to calculate the association between TyG index and MACE occurrence. Models were adjusted for Systematic Coronary Risk Evaluation (SCORE) risk factors, pulse wave velocity, left ventricular mass index, carotid atherosclerotic plaque status, and microalbuminuria. Continuous net reclassification and Harrell's Concordance index (C-index) were used to assess the added prognostic value of TyG index. During a follow-up period of mean 15.4 ± 4.7 years, MACE were observed in 332 (17%) of 1970 included participants. TyG index was associated with MACE; HR = 1.44 [95%CI:1.30-1.59] per standard deviation. After adjustment for traditional cardiovascular (CV) risk factors, HR was 1.16 [95%CI:1.03-1.31]. The association between TyG index and MACE remained significant after further adjustment for each HMOD component. However, this finding was evident only in subjects aged 41 or 51 years (HR = 1.39; 95%CI:1.15-1.69). Including TyG index in a risk model based on traditional CV risk factors improved C-index with 0.005 (P = 0.042).

CONCLUSION

In this population-based study of healthy middle-aged subjects, TyG index was associated with MACE independently of traditional CV risk factors and HMOD. TyG index may have a potential role in future risk prediction systems.

Lack of incremental prognostic value of triglyceride glucose index beyond coronary computed tomography angiography features for major events

This study was aim to determine the prognostic value of triglyceride-glucose (TyG) index and coronary computed tomography angiography (CTA) features for major adverse cardiovascular events (MACE). In addition, we investigate the incremental prognostic value of TyG index beyond coronary CTA features in patients with suspected or known coronary artery disease (CAD). The present study ultimately includes 3528 patients who met the enrollment criteria. The TyG index was calculated based on measured levels of triglycerides and fasting blood glucose. Primary combined endpoint consisted of MACE, which defined as myocardial infraction (MI), all-cause mortality and stroke. Three multivariate Cox proportional hazard regression models were performed to assess the association between TyG index and MACE. C-statistic was performed to assess the discriminatory value of models. 212 (6.0%) patients developed MACE during a median follow-up of 50.4 months (IQR, 39.4-55.1). TyG index remained to be a significantly and independent risk factors for predicting MACE after adjusting by different models (clinical variables alone or plus coronary CTA features) in multivariable analysis. Both the addition of TyG index to clinical model plus Coronary Artery Disease Reporting and Data System (CAD-RADS) and to clinical model plus CAD-RADS 2.0 slightly but not significantly increased the C-statistic index (0.725 vs. 0.721, p = 0.223; 0.733 vs. 0.731, p = 0.505). TyG index was associated with an increased risk of MACE. However, no incremental prognostic benefit of TyG index over CAD-RADS or CAD-RADS 2.0 was detected for MACE in patients with suspected or known CAD.

Triglyceride-glucose index is associated with all-cause mortality in critically ill patients with alcohol use disorder: a retrospective cohort study

BACKGROUND

The relationship between Triglyceride-glucose (TyG) index and clinical outcomes in patients with alcohol use disorder (AUD) is unclear. The aim of this study was to evaluate the association between TyG index and all-cause mortality in critically ill patients with AUD.

METHODS

We used data from the multi-parameter intelligent monitoring in intensive care IV (MIMIC-IV) database. The patients were equally divided into quartiles. Kaplan-Meier curves were used for survival analysis. The primary endpoint of the study was 28-day mortality, followed by 1-year mortality. We used Cox proportional hazard models to assess the relationship between TyG index and all-cause mortality at different endpoints.

RESULTS

A total of 537 AUD patients were included. Using TyG value as a continuous variable (HR 1.460, 95% CI 1.121-1.903, p = 0.005) and categorical variable (HR 1.447-3.477 from Q2 to Q4, with Q1 as reference), elevated TyG value was significantly associated with increased 28-day mortality. TyG was positively associated with 1-year mortality in AUD patients with an HR of 1.295 (95% CI 1.011-1.659, p = 0.041).

CONCLUSION

TyG index is positively associated with different clinical outcomes of critically ill AUD patients.

Association of triglyceride-glucose index and its combination with adiposity-related indices with the incidence of myocardial infarction: a cohort study from the UK Biobank

BACKGROUND

The triglyceride-glucose (TyG) index performs better at reflecting insulin resistance when combined with waist circumference (WC), body mass index (BMI), and waist-to-height ratio (WHtR) than when used alone. This study aimed to prospectively examine the relationships between TyG, TyG-BMI, TyG-WC, and TyG-WHtR with the incidence of myocardial infarction (MI) and its subtypes.

METHODS

This cohort study included 370,390 participants from the UK Biobank. The Cox proportional hazards model and restricted cubic spline regression model were used to assess the associations of TyG, TyG-BMI, TyG-WC, and TyG-WHtR with MI, ST-elevation MI (STEMI) and non-ST-elevation MI (NSTEMI). The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were employed to examine the predictive value of four indicators.

RESULTS

The hazard ratios (HRs) and 95% confidence intervals (CIs) of MI in the highest quartiles for TyG, TyG-BMI, TyG-WC, and TyG-WHtR were 1.36 (1.28-1.44), 1.47 (1.39-1.56), 1.53 (1.43-1.64), and 1.58 (1.48-1.68) in the fully-adjusted model. Comparable findings were observed when the outcomes were reclassified as STEMI or NSTEMI. However, the associations of TyG-BMI, TyG-WC, and TyG-WHtR with the risk of STEMI were weaker than MI and NSTEMI. A linear dose-response association between TyG and the risk of MI and NSTEMI were demonstrated. TyG-BMI, TyG-WC, and TyG-WHtR all showed nonlinear patterns in their associations with the risk of MI, STEMI, and NSTEMI. TyG-WC was most effective in diagnosing MI (AUC: 0.648, 95% CI: 0.644-0.653), STEMI (AUC: 0.631, 95% CI: 0.622-0.639), and NSTEMI (AUC: 0.647, 95% CI: 0.641-0.654).

CONCLUSION

The TyG index was linearly associated with increased risk of MI and NSTEMI, whereas TyG-BMI, TyG-WC, and TyG-WHtR were nonlinearly associated with increased risk of MI and NSTEMI. There were distinct patterns in the relationships between these indicators with STEMI. TyG-WC provided the best diagnostic effectiveness for MI, STEMI, and NSTEMI.

The relative and combined ability of triglyceride-glucose index and stress hyperglycemia ratio to predict major adverse cardio-cerebral events in patients with multivessel coronary artery disease

BACKGROUND

Cardiovascular disease continues to be the leading cause of global mortality and disability, particularly posing elevated risks in patients diagnosed with multivessel disease (MVD). Efficient risk stratification in MVD patients is crucial for improving prognosis, prompting investigation into novel biomarkers such as the triglyceride-glucose index (TyG index) and the stress hyperglycemia ratio (SHR).

METHODS

This study enrolled a cohort comprising 679 patients diagnosed with MVD who underwent coronary angiography at Tianjin Chest Hospital. Patients were stratified into four groups based on their TyG index levels, categorized as TyG index-L and TyG index-H, and SHR levels, categorized as SHR-L and SHR-H. The primary endpoint was the occurrence of major adverse cardio-cerebral events (MACCEs). This Study conducted univariate and multivariable Cox regression analyses to assess the association between TyG index and SHR levels, both as continuous and categorical variables, in relation to MACCEs. Kaplan-Meier survival curves were employed to evaluate the correlation among patient groups.

RESULTS

During a mean follow-up of 61 months, 153 cases of MACCEs were recorded. The TyG index and SHR served as independent predictors of long-term prognosis in patients with MVD, whether considered as continuous or categorical variables. Multivariable analysis revealed that patients with TyG index-H + SHR-H group exhibited the highest incidence of MACCEs (HR: 2.227; 95% CI 1.295-3.831; P = 0.004). The area under the curve (AUC) for predicting MACCEs was 0.655 for TyG index, 0.647 for SHR, and 0.674 when combined.

CONCLUSION

This study underscores the potential of the TyG index and SHR as independent and combined predictive markers for MACCEs in patients with MVD. Their integrated assessment enhances risk stratification, providing valuable insights for personalized treatment strategies aimed at optimizing patient prognosis.

Triglyceride-glucose index correlates with the occurrence and prognosis of acute myocardial infarction complicated by cardiogenic shock: data from two large cohorts

BACKGROUND

Triglyceride-glucose (TyG) index, a dependable indicator of insulin resistance, has been identified as a valid marker regarding multiple cardiovascular diseases. Nevertheless, the correlation of TyG index with acute myocardial infarction complicated by cardiogenic shock (AMICS) remains uncertain. Our study aims for elucidating this relationship by comprehensively analyzing two large-scale cohorts.

METHODS

Utilizing records from the eICU Collaborative Research Database and the Medical Information Mart for Intensive Care IV, the link between TyG and the incidence and prognosis of AMICS was assessed multicentrally and retrospectively by logistic and correlation models, as well as restricted cubic spline (RCS). Propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and overlap weighting (OW) were employed to balance the potential confounders. Subgroup analyses were performed according to potential modifiers.

RESULTS

Overall, 5208 AMI patients, consisting of 375 developing CS were finally included. The TyG index exhibited an apparently higher level in AMI populations developing CS than in those who did not experienced CS [9.2 (8.8-9.7) vs. 9.0 (8.5-9.5)], with a moderate discrimination ability to recognize AMICS from the general AMI (AUC: 0.604). Logistic analyses showed that the TyG index was significantly correlated with in-hospital and ICU mortality. RCS analysis demonstrated a linear link between elevated TyG and increased risks regarding in-hospital and ICU mortality in the AMICS population. An increased mortality risk remains evident in PSM-, OW- and IPTW-adjusted populations with higher TyG index who have undergone CS. Correlation analyses demonstrated an apparent link between TyG index and APS score. Subgroup analyses presented a stable link between elevated TyG and mortality particularly in older age, females, those who are overweight or hypertensive, as well as those without diabetes.

CONCLUSIONS

Elevated TyG index was related to the incidence of CS following AMI and higher mortality risks in the population with AMICS. Our findings pointed a previously undisclosed role of TyG index in regard to AMICS that still requires further validation.

Association of triglyceride-glucose index with severity of coronary artery disease among male patients

The correlation between diabetes and coronary artery disease (CAD) is well established. Insulin resistance (IR) is considered a primary contributor to elevated CAD risk in diabetic individuals. The triglyceride-glucose (TyG) index serves as a straightforward surrogate marker for insulin resistance. However, few studies have explored their correlations with myocardial infarction and CAD severity. Therefore, our study aimed to investigate the association between the TyG index and the occurrence of myocardial infarction, as well as the severity of coronary artery disease. We conducted a retrospective study involving 3865 consecutive patients who underwent coronary angiography at the First Affiliated Hospital of Zhejiang University, School of Medicine. Of these, 1724 patients were diagnosed with coronary artery disease. Demographic, biochemical, clinical, and angiographic data were gathered. A robust correlation exists between the TyG index and CAD subtypes, suggesting its potential as an independent clinical diagnostic marker. Moreover, the TyG index exhibited a significant positive correlation with disease severity, as assessed by the Gensini score. Elevated TyG index was associated with an increased predisposition to severe CAD, as indicated by the Gensini score, and myocardial infarction, even after adjusting for well-established cardiovascular risk factors.

Prognostic value of the triglyceride-glucose index for adverse cardiovascular outcomes in young adult hypertension

BACKGROUND

The triglyceride-glucose (TyG) index is a reliable marker of insulin resistance that is involved in the progression of hypertension. This study aimed to evaluate the association of the TyG index with the risk for major cardiovascular events (MACE) in young adult hypertension.

METHODS

A total of 2,651 hypertensive patients aged 18-40 years were consecutively enrolled in this study. The TyG index was calculated as Ln [triglycerides × fasting plasma glucose/2]. The cutoff value for an elevated TyG index was determined to be 8.43 by receiver-operating characteristic curve analysis. The primary endpoint was MACE, which was a composite of all-cause death, non-fatal myocardial infarction, coronary revascularization, non-fatal stroke, and end-stage renal dysfunction. The secondary endpoints were individual MACE components.

RESULTS

During the median follow-up time of 2.6 years, an elevated TyG index was associated with markedly increased risk of MACE (adjusted hazard ratio [HR] 3.440, P < 0.001) in young hypertensive adults. In subgroup analysis, the elevated TyG index predicted an even higher risk of MACE in women than men (adjusted HR 6.329 in women vs. adjusted HR 2.762 in men, P for interaction, 0.001); and in patients with grade 2 (adjusted HR 3.385) or grade 3 (adjusted HR 4.168) of hypertension than those with grade 1 (P for interaction, 0.024). Moreover, adding the elevated TyG index into a recalibrated Systematic COronary Risk Evaluation 2 model improved its ability to predict MACE.

CONCLUSIONS

An elevated TyG index is associated with a higher risk of MACE in young adult hypertension, particularly in women and those with advanced hypertension. Regular evaluation of the TyG index facilitates the identification of high-risk patients.

Triglyceride-Glucose Index as Predictor for Hypertension, CHD and STROKE Risk among Non-Diabetic Patients: A NHANES Cross-Sectional Study 2001-2020

BACKGROUND

Cardiovascular disease (CVD) is a leading cause of global mortality. Early intervention and prevention of CVD depend on accurately predicting the risk of CVD. This study aimed to investigate the association between the TyG index and the risk of coronary heart disease (CHD), congestive heart failure (CHF), heart attack (HA), stroke, and hypertension (HTN) among patients without diabetes in the United States.

METHODS

In this retrospective, cross-sectional study, we used data from the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2020. We conducted several regression analysis models and calculated the sensitivity and specificity of (TyG) index for predicting the onset of CHD, CHF, HA, stroke, and HTN.

RESULTS

A total of 10,937 individuals without diabetes participated in our study. Individuals with a TyG index greater than 8.96 displayed significant increasing in various parameters, including BMI, systolic/diastolic blood pressure, total cholesterol, LDL, and Apo-B levels (p < 0.001). Almost all regression models ensured that a higher TyGI value was associated with higher odds of having CHD, CHF, HA, stroke, and HTN, which patients with a TyGI value higher than 8.96 have odds ratios of 2.24-5.58 for CHD, 1.68-4.42 for stroke, 2.45-3.77 for HA and 1.75-3.93 for HTN comparing than patients with a TyGI value lower than 8.11 (p-value < 0.05).We evaluated the predictive value of the TyG index for each endpoint, obtaining the following area under the curve (AUC) values: 54.75% for CHF (95% CI: 0.542-0.614), 52.32% for stroke (95% CI: 0.529-0.584), 55.67% for HA (95% CI: 0.595-0.646), 55.59% for HTN (95% CI: 0.574-0.597), and 50.31% for CHD (95% CI: 0.592-0.646).

CONCLUSION

The TyG index showed a strong correlation with cardiovascular risk factors in individuals without diabetes, however it was a poor predictor of almost studied cardiovascular diseases.

Relationship of the trajectory of the triglyceride-glucose index with heart failure: the Kailuan study

BACKGROUND

A high triglyceride-glucose index (TyG) is associated with a higher risk of incident heart failure. However, the effects of longitudinal patterns of TyG index on the risk of heart failure remain to be characterized. Therefore, in the present study, we aimed to characterize the relationship between the trajectory of TyG index and the risk of heart failure.

METHODS

We performed a prospective study of 56,149 participants in the Kailuan study who attended three consecutive surveys in 2006-2007, 2008-2009, and 2010-2011 and had no history of heart failure or cancer before the third wave survey (2010-2011). The TyG index was calculated as ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2], and we used latent mixture modeling to characterize the trajectory of the TyG index over the period 2006-2010. Additionally, Cox proportional risk models were used to calculate the hazard ratio (HR) and 95% confidence interval (CI) for incident heart failure for the various TyG index trajectory groups.

RESULTS

From 2006 to 2010, four different TyG trajectories were identified: low-stable (n = 13,554; range, 7.98-8.07), moderate low-stable (n = 29,435; range, 8.60-8.65), moderate high-stable (n = 11,262; range, 9.31-9.30), and elevated-stable (n = 1,898; range, 10.04-10.25). A total of 1,312 new heart failure events occurred during a median follow-up period of 10.04 years. After adjustment for potential confounders, the hazard ratios (HRs) and 95% confidence intervals (CIs) for incident heart failure for the elevated-stable, moderate high-stable, and moderate low-stable groups were 1.55 (1.15, 2.08), 1.32 (1.08, 1.60), and 1.17 (0.99, 1.37), respectively, compared to the low-stable group.

CONCLUSIONS

Higher TyG index trajectories were associated with a higher risk of heart failure. This suggests that monitoring TyG index trajectory may help identify individuals at high risk for heart failure and highlights the importance of early control of blood glucose and lipids for the prevention of heart failure.

Association between triglyceride-glucose index and hypertension: A systematic review and meta-analysis

The triglyceride-glucose (TyG) index is a simple and reliable indicator of insulin resistance, which is an important contributor to the development of hypertension. The aim of this meta-analysis was to determine the dose-response association between the TyG index and the incidence of hypertension. An extensive search was conducted through several databases, including PubMed, EMBASE, ScienceDirect, and Scopus, until June 1, 2024. The TyG index was used as the exposure, and the incidence of hypertension was measured throughout the TyG index intervals. The effect estimates were presented as odds ratios (OR) in both the unadjusted and adjusted models. Adjusted OR were carried out from all included studies to eliminate the possibility of confounding factors being involved in the incidence of hypertension. A total of 108.936 participants (mean age: 48.2 years old, male: 47%, mean body mass index: 23.9 kg/m2) from 14 observational studies were included. The TyG index in the most eminent category was related to a higher risk of hypertension in both unadjusted (OR: 2.59, 95%CI: 2.03-3.31, p<0.001; I2: 97.1%, p<0.001) and adjusted model (OR: 1.74, 95%CI: 1.39-2.19, p<0.001; I2: 92.2%, p<0.001). The dose-response meta-analysis for the adjusted OR showed that the linear association analysis was not significant per 0.1 increase in the TyG index. The dose-response curve became increasingly steeper at the TyG index above 8.5. In conclusion, the TyG index was shown to be strongly linked with hypertension in a non-linear dose-response manner.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Prognostic significance of triglyceride-glucose index in acute coronary syndrome patients without standard modifiable cardiovascular risk factors

BACKGROUND

A significant percentage of patients with acute coronary syndrome (ACS) without standard modifiable cardiovascular risk factors (SMuRFs) are being identified. Nonetheless, the prognostic influence of the TyG index on adverse events in this type of patient remains unexplored. The aim of this study was to assess the prognostic value of the TyG index among ACS patients without SMuRFs for predicting adverse outcomes.

METHODS

This study involved 1140 consecutive patients who were diagnosed with ACS without SMuRFs at Beijing Anzhen Hospital between May 2018 and December 2020 and underwent coronary angiography. Each patient was followed up for a period of 35 to 66 months after discharge. The objective of this study was to examine major adverse cardiac and cerebrovascular events (MACCE), which included all-cause mortality, non-fatal myocardial infarction, non-fatal ischemic stroke, as well as ischemia-driven revascularization.

RESULTS

During the median follow-up period of 48.3 months, 220 (19.3%) MACCE events occurred. The average age of the participants was 59.55 ± 10.98 years, and the average TyG index was 8.67 ± 0.53. In the fully adjusted model, when considering the TyG index as either a continuous/categorical variable, significant associations with adverse outcomes were observed. Specifically, for each 1 standard deviation increase in the TyG index within the highest TyG index group, there was a hazard ratio (HR) of 1.245 (95% confidence interval CI 1.030, 1.504) for MACCE and 1.303 (95% CI 1.026, 1.653) for ischemia-driven revascularization (both P < 0.05), when the TyG index was analyzed as a continuous variable. Similarly, when the TyG index was examined as a categorical variable, the HR (95% CI) for MACCE in the highest TyG index group was 1.693 (95% CI 1.051, 2.727) (P < 0.05) in the fully adjusted model, while the HR (95% CI) for ischemia-driven revascularization was 1.855 (95% CI 0.998, 3.449) (P = 0.051). Additionally, the TyG index was found to be associated with a poor prognosis among the subgroup.

CONCLUSION

The TyG index is correlated with poor prognosis in patients with ACS without SMuRFs, suggesting that it may be an independent predictive factor of adverse events among these individuals.

Prediabetes Increases the Risk of Frailty in Prefrail Older Adults With Hypertension: Beneficial Effects of Metformin

BACKGROUND

Prediabetes has garnered increasing attention due to its association with cardiovascular conditions, especially hypertension, which heightens the risk of prefrailty and frailty among older individuals.

METHODS

We screened elders with prefrail hypertension from March 2021 to January 2023. We assessed the correlation linking cognitive dysfunction (Montreal Cognitive Assessment score), insulin resistance (triglyceride-to-glucose index), and physical impairment (5-meter gait speed). Then, we measured the risk of developing frailty after a 1-year follow-up period, adjusting the outcome using multivariable Cox regression analysis. We also investigated the impact of administering 500 mg of metformin once daily to a subset of frail subjects for an additional 6 months.

RESULTS

We assessed the relationship between the triglyceride-to-glucose index and the Montreal Cognitive Assessment score, observing a significant correlation (r, 0.880; P<0.0001). Similarly, we analyzed the association between the triglyceride-to-glucose index and 5-meter gait speed, uncovering a significant link between insulin resistance and physical impairment (r, 0.809; P<0.0001). Prediabetes was found to significantly (P<0.0001) elevate the risk of frailty development compared with individuals without prediabetes by the end of the 1-year follow-up, a finding confirmed via multivariable analysis with Cox regression. Furthermore, among the subgroup of subjects who developed frailty, those who received metformin exhibited a significant decrease in frailty levels (P<0.0001).

CONCLUSIONS

Insulin resistance and prediabetes play substantial roles in the development of cognitive and physical impairments, highlighting their importance in managing hypertension, even before the onset of frank diabetes. Metformin, a well-established drug for the treatment of diabetes, has shown favorable effects in mitigating frailty.

Could Triglyceride-Glucose Index, a Predictor of Atherosclerosis, Be Associated with Retinal Vein Occlusion?

Objectives

The triglyceride-glucose (TyG) index is a sign of atherosclerosis in cardiovascular diseases. The TyG index is thought to have clinical significance for the assessment of vascular damage. In this study we aimed to demonstrate the connection between the TyG index and retinal vein occlusion (RVO).

Materials and Methods

This case-control observational study involved 492 participants aged 40-90, admitted to the ophthalmology outpatient clinic of our hospital. TyG index was calculated using the formula: ln(fasting TG [mg/dL] × fasting plasma glucose [mg/dL]/2).

Results

The RVO group included 387 patients (181 women and 206 men) and the control group included 115 patients (61 women and 54 men). The average patient age was 62.9±11.1 years in the RVO group and 56.7±8.7 years in the control group. The TyG index was higher in the RVO group (8.9±0.7) than in the control group (8.8±0.6). This difference was statistically significant (p=0.04). The correlation was statistically significant when evaluated according to age and sex by multivariate logistic regression analysis (odds ratio: 1.45, confidence interval: 1.03- 2.02, p=0.03).

Conclusion

The TyG index is a novel atherogenicity index that is derived from routine blood tests and can be used to determine the risk of RVO in at-risk individuals with a simple calculation. Therefore, the TyG index could help as a reliable guide to identify individuals at RVO with high risk and initiate early intervention.

Association of triglyceride-glucose index and its related parameters with atherosclerotic cardiovascular disease: evidence from a 15-year follow-up of Kailuan cohort

BACKGROUND

Triglyceride glucose (TyG) index and its related parameters have been introduced as cost-effective surrogate indicators of insulin resistance, while prospective evidence of their effects on atherosclerotic cardiovascular disease (ASCVD) remained scattered and inconsistent. We aimed to evaluate the association of TyG and its related parameters with new-onset ASCVD, and the predictive capacity were further compared.

METHOD

A total of 95,342 ASCVD-free participants were enrolled from the Kailuan study. TyG and its related parameters were defined by fasting blood glucose, triglyceride, body mass index (BMI), waist circumstance (WC) and waist-to-height ratio (WHtR). The primary outcome was incident ASCVD, comprising myocardial infarction (MI) and ischemic stroke (IS). Cox proportional hazard models and restricted cubic spline (RCS) analyses were adopted to investigate the association between each index and ASCVD. The C-index, integrated discrimination improvement (IDI), and net reclassification improvement (NRI) were used for comparison of their predictive value for ASCVD.

RESULTS

During a median follow-up of 15.0 years, 8,031 new cases of ASCVD were identified. The incidence rate of ASCVD increased along with elevated levels of each index, and the relationships were found to be nonlinear in the RCS analyses. The hazard ratio (HR) and 95% confidence interval (95% CI) for ASCVD was 1.39 (1.35, 1.43), 1.46 (1.41, 1.50), 1.50 (1.46, 1.55), and 1.52 (1.48, 1.57) per 1 IQR increase of baseline TyG, TyG-BMI, TyG-WC, and TyG-WHtR, respectively, and the association were more pronounced for females and younger individuals aged < 60 years (Pfor interaction<0.05). Using the updated mean or time-varying measurements instead of baseline indicators did not significantly alter the primary findings. Additionally, TyG-WC and TyG-WHtR showed better performance in predicting risk of ASCVD than TyG, with the IDI (95% CI) of 0.004 (0.001, 0.004) and 0.004 (0.001, 0.004) and the category-free NRI (95% CI) of 0.120 (0.025, 0.138) and 0.143 (0.032, 0.166), respectively. Similar findings were observed for MI and IS.

CONCLUSIONS

Both the TyG index and its related parameters were significantly and positively associated with ASCVD. TyG-WC and TyG-WHtR had better performance in predicting incident ASCVD than TyG, which might be more suitable indices for risk stratification and enhance the primary prevention of ASCVD.

Elevated atherogenic index of plasma associated with stroke risk in general Chinese

BACKGROUND AND AIMS

The atherogenic index of plasma (AIP) is supposed to be associated with cardiovascular disease (CVD), but there is limited evidence on its longitudinal effect. Our study aimed to explore the associations between baseline and long-term AIP with the risk of stroke and its subtypes.

METHODS AND RESULTS

A total of 97,959 participants free of stroke at baseline were included in the Kailuan study. The AIP was calculated as the logarithm of the ratio of triglyceride to high-density lipoprotein cholesterol. The updated mean AIP was calculated as the average of the AIP from baseline to the first occurrence of outcome or the end of follow-up. The outcome was the first occurrence of stroke, including ischemic stroke (IS) and intracerebral hemorrhage (ICH). We used univariable and multivariable Cox proportional hazard models to explore the association between AIP and the risk of stroke. During a median follow-up of 12.79 years, a total of 6307 participants developed stroke, including 5482 IS and 1024 ICH. Compared with the 1st quartile of baseline AIP, the multivariate-adjusted HR in the 4th quartile was 1.12 (95% CI, 1.03-1.22, p for trend <0.001) for stroke risk. Same results were found in IS, but no significant association was found for ICH. The associations between updated mean AIP and stroke and its subtypes showed similar results.

CONCLUSIONS

Elevated levels of both baseline and long-term updated mean AIP were associated with the risk of stroke and IS but not ICH in the general population.

Association of triglyceride glucose index and triglyceride glucose-body mass index with sudden cardiac arrest in the general population

BACKGROUND

Insulin resistance (IR) significantly contributes to cardiovascular disease (CVD) development. Triglyceride glucose (TyG) index and triglyceride glucose-body mass index (TyG-BMI) are recognised as convenient proxies for IR. However, their relationship with sudden cardiac arrest (SCA) remains unclear.

METHODS

This prospective cohort analysis included 355,242 UK Biobank participants with available TyG index and TyG-BMI data and no history of CVD. Cox proportional risk models assessed the association between the TyG index, TyG-BMI and SCA risk. Additionally, Accelerated Failure Time (AFT) models were employed to investigate the timing of SCA onset. The impact of dynamic increases in TyG index and TyG-BMI levels on SCA risk was examined using restricted cubic spline.

RESULTS

Over a median follow-up period of 165.4 months (interquartile range 156.5-174 months), 1,622 cases of SCA were recorded. Multivariate Cox regression analysis revealed a 9% increase in SCA risk per standard deviation increase in TyG index (adjusted hazard ratio (aHR) = 1.09, 95% confidence interval (CI) 1.04-1.15) and an 14% increase per standard deviation increase in TyG-BMI (aHR 1.14, 95% CI 1.09-1.2). AFT models indicated earlier median times to SCA occurrence with increasing quintiles of TyG index and TyG-BMI compared to the lowest quintile (P for trend < 0.05). SCA risk was linearly (P = 0.54) and non-linearly (P = 0.007) correlated with gradual increases in TyG index and TyG-BMI levels, respectively. Sex-stratified analyses showed stronger associations in women.

CONCLUSIONS

Higher TyG index and TyG-BMI levels are associated with an increased SCA risk and earlier onset, particularly in women.

Association between the triglyceride-glucose index and in-hospital major adverse cardiovascular events in patients with acute coronary syndrome: results from the Improving Care for Cardiovascular Disease in China (CCC)-Acute Coronary Syndrome project

OBJECTIVE

Although the TyG index is a reliable predictor of insulin resistance (IR) and cardiovascular disease, its effectiveness in predicting major adverse cardiac events in hospitalized acute coronary syndrome (ACS) patients has not been validated in large-scale studies. In this study, we aimed to explore the association between the TyG index and the occurrence of MACEs during hospitalization.

METHODS

We recruited ACS patients from the CCC-ACS (Improving Cardiovascular Care in China-ACS) database and calculated the TyG index using the formula ln(fasting triglyceride [mg/dL] × fasting glucose [mg/dL]/2). These patients were classified into four groups based on quartiles of the TyG index. The primary endpoint was the occurrence of MACEs during hospitalization, encompassing all-cause mortality, cardiac arrest, myocardial infarction (MI), and stroke. We performed Cox proportional hazards regression analysis to clarify the correlation between the TyG index and the risk of in-hospital MACEs among patients diagnosed with ACS. Additionally, we explored this relationship across various subgroups.

RESULTS

A total of 101,113 patients were ultimately included, and 2759 in-hospital MACEs were recorded, with 1554 (49.1%) cases of all-cause mortality, 601 (21.8%) cases of cardiac arrest, 251 (9.1%) cases of MI, and 353 (12.8%) cases of stroke. After adjusting for confounders, patients in TyG index quartile groups 3 and 4 showed increased risks of in-hospital MACEs compared to those in quartile group 1 [HR = 1.253, 95% CI 1.121-1.400 and HR = 1.604, 95% CI 1.437-1.791, respectively; p value for trend < 0.001], especially in patients with STEMI or renal insufficiency. Moreover, we found interactions between the TyG index and age, sex, diabetes status, renal insufficiency status, and previous PCI (all p values for interactions < 0.05).

CONCLUSIONS

In patients with ACS, the TyG index was an independent predictor of in-hospital MACEs. Special vigilance should be exercised in females, elderly individuals, and patients with renal insufficiency.

Association between the triglyceride glucose index and length of hospital stay in patients with heart failure and type 2 diabetes in the intensive care unit: a retrospective cohort study

Background

The coexistence of heart failure and diabetes is prevalent, particularly in Intensive Care Units (ICU). However, the relationship between the triglyceride-glucose (TyG) index, heart failure, diabetes, and the length of hospital stay (LHS) in patients with cerebrovascular disease in the ICU remains uncertain. This study aims to investigate the association between the TyG index and LHS in patients with heart failure and diabetes.

Methods

This retrospective study utilized the Medical Information Mart for Intensive Care (MIMIC)-IV database to analyze patients with diabetes and heart failure. Participants were categorized into quartiles based on the TyG index, and the primary outcome was LHS. The association between the TyG index at ICU admission and LHS was examined through multivariable logistic regression models, restricted cubic spline regression, and subgroup analysis.

Results

The study included 635 patients with concurrent diabetes and heart failure. The fully adjusted model demonstrated a positive association between the TyG index and LHS. As a tertile variable (Q2 and Q3 vs Q1), the beta (β) values were 0.88 and 2.04, with a 95% confidence interval (95%CI) of -0.68 to 2.44 and 0.33 to 3.74, respectively. As a continuous variable, per 1 unit increment, the β (95% CI) was 1.13 (0.18 to 2.08). The TyG index's relationship with LHS showed linearity (non-linear p = 0.751). Stratified analyses further confirmed the robustness of this correlation.

Conclusion

The TyG index exhibited a linearly positive association with the LHS in patients with both heart failure and diabetes. Nevertheless, prospective, randomized, controlled studies are imperative to substantiate and validate the findings presented in this investigation.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Changes in baPWV and the risk of clinical outcomes: a cohort study of Chinese community-based population

It has not been fully investigated whether improved arterial stiffness (AS) can reduce the clinical outcomes risk in community population-based study. In this prospective study, a total of 5247 individuals with abnormal AS (at baseline) and repeated brachial-ankle pulse wave velocity (baPWV) measurement before 2018 years were enrolled from the Kailuan Study. According the second baPWV measurement, we divided the participants into two groups, improved AS (defined as transfer elevated AS status to normal) and persistent AS (defined as maintaining elevated AS status). The outcome was a composite event of stroke, myocardial infraction, and all-cause mortality. We used Cox proportional hazards regression to examine the association between AS status at the follow-up and the subsequent outcome. During a median of 5.2 years follow-up, we observed 413 end point events. After adjusted for potential confounders, comparing with the persistent AS group, individuals in the improved AS group had a 43% (hazard ratio [HR], 0.57; 95% confidence interval [CI] 0.35-0.94) decreased the risk of the primary composite events. We also found a baPWV decrease of 1 m/s was associated with a 3% decreased risk (HR, 0.97; 95% CI 0.94-0.99) for primary composite events. We further demonstrated that younger than 60 years, non-smoker, non-hypertension, and non-diabetes were associated with improved the AS status. In conclusion, improving AS status may reduce the risk of clinical events. In the future, more research should be performed to explore the target for improving the AS status.

Association of the triglyceride-glucose index with early-onset atherosclerotic cardiovascular disease events and all-cause mortality: a prospective cohort study

BACKGROUND

The association between the triglyceride glucose (TyG) index and the risk of early-onset atherosclerotic cardiovascular disease (ASCVD) events or all-cause mortality in young and middle-aged people is not fully elucidated.

METHODS

The present study included 64,489 young and middle-aged people who participated in the 2006 Kailuan Study physical examination. Multivariate Cox proportional hazards models and restricted cubic spline curves were used to assess the association of TyG index with early-onset ASCVD events and all-cause mortality.

RESULTS

During a median of 11-year follow-up, 1984 (3.08%) participants experienced at least one ASCVD event and 1,392 (2.16%) participants experienced all-cause death. A higher TyG index was significantly associated with a higher risk of early-onset ASCVD events (HR: 1.61, 95% CI 1.38-1.89) and all-cause mortality (HR: 1.39, 95% CI 1.17-1.65), respectively. For each unit increase in TyG index, the risk of early-onset ASCVD events increased by 20%. In addition, there was a non-linear association between the TyG index and early-onset ASCVD events (P for non-linear < 0.01), and a linear association between TyG index and all-cause mortality (P for non-linear = 0.476).

CONCLUSIONS

A higher TyG index is significantly associated with an increased incidence of early-onset ASCVD events and all-cause mortality in a young and middle-aged population from North China.