Triglyceride-glucose index and the risk of stroke and its subtypes in the general population: an 11-year follow-up

Association between cumulative changes of the triglyceride glucose index and incidence of stroke in a population with cardiovascular-kidney-metabolic syndrome stage 0-3: a nationwide prospective cohort study

BACKGROUND

The triglyceride-glucose (TyG) index was associated with higher risk of mortality in individuals with Cardiovascular-Kidney-Metabolic (CKM) syndrome stages 0-3. However, the relationship between cumulative of TyG (cumTyG) and incidence of stroke remains unclear in individuals with CKM syndrome stages 0-3.

METHOD

Participants with CKM syndrome stage 0-3 were enrolled from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015. TyG was calculated as ln [fasting triglyceride (mg/dL)×fasting glucose (mg/dL)/2], and the cumTyG, as an area-under-the-curve estimate (mean TyG × time span), was calculated as (TyG2012 + TyG 2015)/2 * time (2015-2012). TyG control levels were classified using k-mean clustering analysis. Logistic regression was used to analyze the effect of cumTyG and TyG control levels on the incidence of stroke. Restricted cubic spline models (RCS) were performed to explore the potential non-linear relationship between cumTyG and stroke risk at different CKM syndrome stages 0-3.

RESULTS

A total of 4,700 CKM syndrome stages 0-3 participants were enrolled, among 280 patients had developed stroke during the 3-year follow-up period. After adjusting for confounders, compared to class 1 group, the odds ratio (OR) of incidents of stroke for class 2 was 1.39 [95% confidence interval (CI) 1.003, 1.92], P = 0.046; the OR of incidents of stroke for class 3 was 1.28 (95% CI 0.92-1.77), P = 0.147, the OR of incidents of stroke for class 4 was 1.28 (95% CI 0.84-1.94), P = 0.238. Elevated cumTyG was associated with an increase in incidence of stroke (OR 1.13, 95% CI 1.05, 1.22, P = 0.002). The relationship between the cumTyG index and stroke was linear in restricted cubic spline regression.

CONCLUSIONS

Elevated cumTyG was associated with an increased risk of stroke events in the population of CKM syndrome stages 0-3. Long-term dynamic monitoring of changes of TyG may help in the early identification of patients at high risk of developing stroke in the individuals with CKM syndrome stages 0-3.

The relationship between the triglyceride-glucose index and functional outcomes in patients with aneurysmal subarachnoid hemorrhage: a retrospective cohort study

BACKGROUND

Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening disease with high morbidity and mortality. The triglyceride-glucose (TyG) index, a marker of insulin resistance (IR), has been linked to adverse outcomes in cerebrovascular conditions; however, its influence on functional prognosis in aSAH remains unclear. This study aimed to elucidate the relationship between the TyG index and functional outcomes in aSAH patients.

METHODS

A retrospective cohort study included consecutive aSAH patients. Functional outcomes were assessed using the modified Rankin Scale (mRS) at 3 months and categorized as favorable (mRS 0-2) or unfavorable (mRS 3-6). Univariate and multivariate logistic regression analyzed the association between the TyG index and functional outcomes. Propensity score matching (PSM) was used to mitigate confounding. Non-linear relationships were explored with restricted cubic splines (RCS), and subgroup analyses were performed. A nomogram integrating the TyG index and traditional prognostic scales was developed, and model predictive performance was compared using the area under the curve (AUC) on a test set.

RESULTS

A total of 470 patients (61.7% female) were enrolled, with 154 experiencing unfavorable outcomes. Multivariate logistic regression showed a significant association between the TyG index and adverse outcomes (OR: 1.86, 95% CI 1.12-3.1, P = 0.017). An optimal TyG index cutoff of 8.83 was identified. Patients with TyG index ≥ 8.83 had a higher risk of poor outcomes (48.7% vs. 24.8%; P = 0.015). PSM confirmed these findings. RCS indicated a progressive association between elevated TyG index and increased risk of adverse functional outcome. Subgroup analyses showed consistent relationships. The enhanced model with the TyG index had a higher AUC (0.899) than the traditional model (0.889, DeLong test P = 0.048).

CONCLUSIONS

A high TyG index is significantly associated with an increased risk of unfavorable functional outcomes in patients with aSAH.

Association between triglyceride glucose weight adjusted waist index and stroke risk in different glucose metabolism status

The triglyceride glucose-weight adjusted waist index (TyG-WWI) has emerged as a straightforward and reliable alternative for assessing insulin resistance (IR). However, the relationship between the TyG-WWI index and the incidence of stroke, especially in individuals with different glucose metabolism status, is still unclear. The data for this study was obtained from the China Health and Retirement Longitudinal Study (CHARLS). The primary endpoint was the occurrence of stroke events. We utilized multivariate Cox proportional hazard models and restricted cubic spline (RCS) analysis to examine the relationship between the TyG-WWI index and the risk of stroke in individuals with different glycemic metabolic states. A total of 8895 participants were included in this study, 831 (9.3%) stroke events were recorded during the follow-up period. After fully adjusting for covariates, per SD increase in the TyG-WWI index was associated with a 11% increase in stroke risk (HR: 1.11, 95% CI 1.02, 1.20) in all participants. The TyG-WWI index was further categorized into quartiles, the adjusted HRs (95% CIs) for Q2, Q3, and Q4 compared to Q1 being 1.37 (95% CI 1.09, 1.72), 1.42 (95% CI 1.13, 1.78), and 1.50 (95% CI 1.17, 1.93), respectively. Furthermore, high levels of the TyG-WWI index were found to be linked to an increased risk of stroke in prediabetes mellitus (Pre-DM) participants across Cox models. However, this association was not observed in participants with normal glucose regulation (NGR) and diabetes mellitus (DM) (all P > 0.05). RCS analysis also demonstrated that higher baseline TyG-WWI index levels were associated with higher HRs for stroke in all participants and those with Pre-DM. The TyG-WWI index significantly associates with stroke risk in middle-aged and elderly Chinese populations. Moreover, this relationship exhibits distinct characteristics influenced by the individual's glucose metabolism status.

Enhanced Stroke Risk Stratification Using Triglyceride-Glucose-Waist Circumference in Chinese Adults Without Diabetes

INTRODUCTION

Insulin resistance is a well-establsihed risk factor for stroke. However, the relationship between triglyceride-glucose (TyG) index; its modified indices‒TyG-waist circumference (TyG-WC); TyG-waist-to-height ratio (TyG-WHtR); and TyG-BMI and the risk of stroke in populations without diabetes remains underexplored.

METHODS

Data from the CHARLS on 4,029 participants without diabetes aged 45+ years at baseline (2011‒2012) were analyzed, with follow-ups through 2020. Statistical analysis and modeling were performed in 2024. Incident strokes occurring between 2015 and 2020 were examined. TyG and its modified indices were categorized into tertiles and analyzed based on baseline levels, changes over time, and cumulative measures. Changes in TyG and its modified indices were identified using K-means clustering, while cumulative indices were calculated using a formula: (TyG2012+TyG2015)/2 × time (2015-2012).

RESULTS

Between 2015 and 2020, 225 participants (5.6%) experienced a stroke. After full adjustment, for cofounders only TyG-WC remained significantly associated at each level across its baseline levels, changes, and cumulative measures (p<0.05), outperforming TyG, TyG-WHtR and TyG-BMI. Compared to Tertile 1, AORs (95% CIs) for stroke associated with TyG-WC were 1.64 (1.10, 2.47) in Tertile 2 and 1.79 (1.15, 2.82) in Tertile 3. For changes in TyG-WC, ORs (95% CIs) were 1.70 (1.14, 2.60) in Class 2 and 1.80 (1.11, 2.97) in Class 3. Regarding cumulative TyG-WC, the ORs (95% CIs) were 1.61 (1.08, 2.41) for Tertile 2 and 1.70 (1.10, 2.66) for Tertile 3. Additionally, TyG-WC demonstrated superior predictive performance for stroke compared to other indices.

CONCLUSIONS

TyG-WC is strongly associated with stroke risk in populations without diabetes, offering superior risk stratification compared to other TyG indices.

The Association Between the Triglyceride Glucose Index and Hyperuricemia: A Dose-Response Meta-Analysis

Background: The triglyceride glucose (TyG) index has been correlated with all kinds of diseases. However, its association with hyperuricemia is still a subject of controversy. Methods: This meta-analysis encompassed relevant studies on the TyG index and hyperuricemia obtained from electronic databases, from the launch date until March 2025. The effect sizes and corresponding 95% confidence intervals (CIs) were obtained using a random effects model. Results: Twenty-six trials with 637,954 subjects were incorporated in this study. It was revealed that the TyG index was linked to hyperuricemia (OR = 2.67; 95% CI: 2.34, 3.04; p < 0.001). A dose-response analysis demonstrated that with each 1 mg/dL rise in the TyG index, the risk of being diagnosed with hyperuricemia increased by 2.07 times (OR = 2.07; 95% CI: 1.89, 2.25; p < 0.001). Conclusions: The TyG index has an association with hyperuricemia. Given the constraints identified in our meta-analysis, further cohort studies will be essential to confirm this correlation.

Association between Triglyceride-Glucose indices and ischemic stroke risk across different glucose metabolism statuses

BACKGROUND

Triglyceride-glucose (TyG) related indices, including TyG, TyG-body mass index (TyG-BMI), and TyG-waist circumference (TyG-WC), have been identified as promising biomarkers for assessing insulin resistance (IR), a known risk factor for ischemic stroke. While previous research has highlighted the relevance of these indices in various metabolic disorders, their predictive utility for ischemic stroke across different glucose metabolic statuses has not been extensively explored.

METHOD

This study utilized data from the UK Biobank, analyzing 392,733 participants free from ischemic stroke at baseline, categorized into normal glucose, prediabetes, and diabetes groups based on American Diabetes Association criteria. TyG-related indices were computed using baseline measures of fasting blood glucose and triglycerides. Participants were followed for a median of 14.68 years to assess the incidence of ischemic stroke. Cox proportional hazards models adjusted for demographic and clinical covariates were used to explore the associations between TyG indices and stroke risk.

RESULTS

Over the follow-up period, 8033 participants experienced an ischemic stroke. Higher TyG-related indices were associated with an increased stroke risk in all glucose metabolism groups, with the strongest associations observed in the prediabetes and normal glucose groups. The risk of stroke increased progressively across quartiles of TyG, TyG-BMI, and TyG-WC indices. The analysis revealed that each unit increase in the TyG index significantly elevated stroke risk in diabetic individuals, while TyG-BMI and TyG-WC indices showed significant predictive power in the prediabetes and normal glucose groups.

CONCLUSION

TyG-related indices, particularly TyG-BMI and TyG-WC, are effective in predicting the risk of ischemic stroke, especially among individuals with prediabetes and normal glucose levels. These findings underscore the utility of TyG indices as tools for early detection and preventive strategies in stroke risk management across various states of glucose metabolism.

Association between triglyceride glucose-waist height ratio and stroke: a population-based study

Background

Stroke poses a substantial threat to global public health. The triglyceride glucose-waist height ratio (TyG-WHtR), which incorporates the TyG metric with obesity-related WHtR, has demonstrated superior diagnostic and predictive value compared to the TyG index alone. Nevertheless, there is still a lack of in-depth exploration into the relationship between TyG-WHtR and stroke. This study seeks to address this gap by extracting information from the National Health and Nutrition Examination Survey (NHANES) to elucidate the potential association between TyG-WHtR levels and stroke.

Methods

This study included 8,757 individuals from four research cycles conducted between 2011 and 2018. To examine the potential relationship between TyG-WHtR and stroke, we conducted multivariable logistic regression analysis. In addition, smooth curve fitting was applied to display the nonlinear association. Subgroup analyses and sensitivity analyses contributed to examining the robustness and consistency of the relationship between TyG-WHtR and stroke. The receiver operating characteristic (ROC) curves were employed to evaluate the diagnostic capability of TyG-WHtR and TyG.

Results

After adjusting for relevant covariates, a positive association between TyG-WHtR levels and stroke occurrence was observed (OR: 1.26, 95% CI: 1.02-1.55). Specifically, each unit increase in TyG-WHtR was associated with a 26% higher likelihood of stroke. The findings of sensitivity analysis further demonstrated the stability of this positive relationship. Subgroup analysis revealed that this association was significant among participants who did not engage in moderate exercise and those without coronary heart disease or angina pectoris. ROC analysis demonstrated that TyG-WHtR exhibited superior predictive value compared to TyG.

Conclusion

This study identified an association between elevated TyG-WHtR levels and an increased prevalence of stroke, suggesting that TyG-WHtR may serve as a valuable predictive tool for stroke risk, with potential implications for clinical prevention and early intervention.

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.

Two-Sample Bidirectional Mendelian Randomization Study With Causal Association Between Metabolic Syndrome and Cerebral Aneurysm

BACKGROUND

We used a two-sample mendelian randomization (MR) method to comprehensively investigate the causality of metabolic syndrome (MetS) or its components, including MetS, triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), fasting blood glucose (FBG), waist circumference (WC), and hypertension (HP), with cerebral aneurysm including nonruptured and ruptured aneurysmal subarachnoid hemorrhage (SAH).

METHODS

By leveraging large-scale genome-wide association study (GWAS) summary statistics of MetS or its components and cerebral aneurysm (nonruptured and SAH) from European, MR, reverse-direction MR, and sensitivity analysis were utilized to quantify the genetic correlations and causal relationships. In addition, we adjusted for multiple comparisons using the false discovery rate (FDR) correction.

RESULTS

Two-sample MR analysis showed that HP was a risk factor for cerebral aneurysm (nonruptured and SAH) with odds ratio (OR) of 58.959 (95% confidence interval [95% CI] = 12.073-287.920, p < 0.001, q < 0.001), and 32.290 (95% CI = 5.615-185.671, p < 0.001, q < 0.001), respectively. HDL-C (OR = 0.836, 95% CI = 0.728-0.960, p = 0.011, q = 0.039) and FBG (OR = 0.626, 95% CI = 0.426-0.919, p = 0.017, q = 0.039) were negatively correlated with cerebral aneurysm (nonruptured). The HDL-C result was inconsistent after adjusting for TG and LDL-C by multivariable MR analysis. In reverse MR analysis, we found that there was no statistical causal association between cerebral aneurysm (nonruptured) and MetS or its components. Genetic liability to cerebral aneurysm (SAH) was inversely associated with HDL-C and FBG but was not associated with others, however, sensitivity analysis showed that few instrumental variables made a big difference.

CONCLUSIONS

Genetically determined elevated FBG level reduces the risk of cerebral aneurysm (nonruptured). However, hypertension increases the risk of cerebral aneurysm (nonruptured and SAH).

Triglyceride-glucose index and the risk of in-hospital and ICU all-cause mortality: a systematic review and meta-analysis of observational studies

Several studies have illustrated the association of the triglyceride glucose (TyG) index with in-hospital and intensive care unit (ICU) mortality. However, no studies have compiled this evidence and reached a conclusion. This study aimed to quantify the association of the TYG index with the risk of in-hospital and ICU mortality. An extensive search of databases including PubMed, Scopus, and Web of Science, was performed up to 21 Jan 2024. Nineteen studies were included in the meta-analysis. The outcomes were in-hospital mortality in 18 studies and ICU mortality in 8 studies. Among the 42,525 participants, 5233 in-hospital and 1754 ICU mortality cases were reported. The pooled analysis revealed that each unit increase in the TYG index was associated with a 33% and 45% increase in the risk of in-hospital (RR = 1.33; 95% CI: 1.23, 1.43; I squared = 90.3%) and ICU (RR: 1.45; 95% CI: 1.25, 1.67; I squared = 44.8%) mortality, respectively. Subgroup analysis revealed a stronger association between the TYG index and the risk of in-hospital mortality in patients with cardiovascular diseases than in those with cerebrovascular diseases (Pheterogeneity between Groups = 0.014). The findings of this study showed a positive association between the TyG index and the risk of in-hospital and ICU mortality. (PROSPERO registration ID: CRD420245414390).

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

Objective

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

Methods

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

Results

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

Conclusion

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

Triglyceride-glucose index and mortality risks in Helicobacter pylori-infected patients: a national cohort study

BACKGROUND

While Helicobacter pylori (H. pylori) infection is associated with insulin resistance and higher mortality, research on insulin resistance indices and outcomes in H. pylori-infected patients is scarce. This study examines the association between the triglyceride-glucose (TyG) index, an insulin resistance marker, and all-cause and cardiovascular mortality in these patients.

METHODS

This study analyzed NHANES 1999-2000 data to assess the association between the TyG index and all-cause and cardiovascular mortality in H. pylori-infected patients using weighted Cox models and restricted cubic spline analysis.

RESULTS

Among 627 participants with a median follow-up of 20.8 years, 108 all-cause and 28 cardiovascular deaths occurred. Cox models showed that TyG was linked to a hazard ratio (HR) of 1.70 for all-cause mortality (95% CI: 1.23-2.34, P < 0.01) and an HR of 2.90 for cardiovascular mortality (95% CI: 1.91-4.42, P < 0.001). Restricted cubic spline analysis confirmed a linear relationship between the TyG index and both mortality risks. Stratified analyses showed that this relationship was significantly associated in most subgroups, but there was no significant interaction.

CONCLUSION

Higher TyG index is strongly linked to increased risks of both all-cause and cardiovascular mortality in H. pylori-infected patients.

Association Between Triglyceride-Glucose Index and Carotid Plaque Stability in Different Glycemic Status: A Single-Center Retrospective Study

BACKGROUND

The triglyceride-glucose (TyG) index has been proposed as a reliable marker of insulin resistance. However, its value in patients with carotid plaque stability remains unclear. This study investigated the association between the TyG index and unstable carotid plaque.

METHODS

A total of 12 068 participants were enrolled. Carotid ultrasound was used to determine the stability of carotid plaque. Logistic regression was used to analyze the relationship between the TyG index and unstable carotid plaque. The relationship between the TyG index and unstable carotid plaque was evaluated according to sex, age, and glucose metabolism states. Further, the dose-response relationship between the TyG index and unstable carotid plaque was also determined by restrictive cubic splines.

RESULTS

Of the 12 068 participants, 11 601 had stable carotid plaque and 467 had unstable carotid plaque. In several different adjustment models, the TyG index is significantly related to the risk of unstable carotid plaque. The association between the TyG index and an unstable carotid plaque was similar between men and women, despite the fact that the odds ratio (OR) tended to be higher in men (OR, 2.80 [95% CI, 2.04-3.83]) than women (OR, 2.07 [95% CI, 1.51-2.82]), and higher in older patients (aged >60 years; (OR, 3.59 [95% CI, 2.74-4.70]) than middle-aged patients (aged ≤60 years) (OR, 2.00 [95% CI, 1.36-2.95]). The TyG index of patients with different glycemic status was significantly correlated with the risk of unstable carotid plaque, among which the OR value of diabetes (OR, 2.51 [95% CI, 1.87-3.36]) was the highest. The restrictive cubic spline analysis indicated a nonlinear relationship between the TyG index and unstable carotid plaque, with TyG index >8.63 identified as an independent risk factor for unstable carotid plaque.

CONCLUSIONS

The TyG index has a significant association with unstable carotid plaque. The association between the TyG index and unstable carotid plaque is similar between men and women, and the association in older patients is higher than that in middle-aged patients. In different glycemic status, the association between the TyG index and unstable carotid plaque is highest in patients with diabetes.

Incidence, case fatality, and functional outcome of intracerebral haemorrhage, according to age, sex, and country income level: a systematic review and meta-analysis

Background

Intracerebral haemorrhage (ICH) accounts for approximately 28% of all strokes worldwide. ICH has a high case fatality, and only few survivors recover to independent living. Over the past decades, demographic changes, and changes in prevalence and management of risk factors may have influenced incidence. Widespread implementation of stroke units and improved care in general may have affected case fatality and outcome. We aimed to update the evidence on incidence, case fatality, and functional outcome of ICH, according to age, sex, and country income level.

Methods

We systematically searched PubMed and Embase from 2008 to April 2023 for prospective population-based studies on incidence, case fatality, or functional outcome of first-ever ICH. We excluded studies in which less than 80% of cases was confirmed with imaging or autopsy. Quality of the studies was assessed based on the used case finding methods. We used inverse variance-based random-effects meta-analyses to pool the crude incidence, case fatality at 1 month, and the percentage of patients with good functional outcome after 3, 6, or 12 months, as defined by the authors of the individual studies. Time trends were assessed using weighted linear meta-regression. Funnel plots were constructed to study publication bias. The review was registered on PROSPERO (CRD42023413314).

Findings

We identified 70 eligible studies, describing 19,470 ICH patients from 26 different countries. Of these, 62 studies reported on crude incidence, 41 on case fatality, and 10 on functional outcome. Overall crude incidence was 29.2 per 100,000 person-years (95% CI 23.3-36.4; I2 = 100%). Incidence was lower in women than in men and increased with age. Incidence was highest in lower-middle income countries, followed by high and upper-middle income countries. Case fatality at 1 month was 35.5% (95% CI 32.3-38.9; I2 = 90%). The percentage of patients with good functional outcome (mRS 0-2 in nine studies, mRS 0-3 in one) after 3-12 months was 31.2% (95% CI 24.7-38.6; I2 = 76%). We found no time trends in incidence, case fatality, or functional outcome.

Interpretation

Our results demonstrate the persistently high burden and devastating consequences of ICH, stressing the need for better preventive strategies and acute treatments.

Funding

None.

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.

Association between triglyceride-glucose (TyG) related indices and cardiovascular diseases and mortality among individuals with metabolic dysfunction-associated steatotic liver disease: a cohort study of UK Biobank

BACKGROUND

Triglyceride-glucose (TyG) related indices, which serve as simple markers for insulin resistance, have been closely linked to metabolic dysfunction-associated steatotic liver disease (MASLD), cardiovascular disease (CVD), and mortality. However, the prognostic utility of TyG-related indices in predicting the risk of CVD and mortality among patients with MASLD remains unclear.

METHODS

Data of 97,331 MASLD patients, with a median age of 58.0 years and free of CVD at baseline, were obtained from the UK Biobank. The TyG index, along with its combination with adiposity parameters (i.e. body mass index [BMI], waist circumference [WC], and waist-to-height ratio [WHtR]), were calculated. Cox proportional hazards models and restricted cubic spline (RCS) were performed to evaluate the associations between TyG-related indices and the risk of overall CVD, coronary heart disease (CHD), stroke, all-cause mortality, and cardiovascular mortality. Additionally, Harrell's C-index, net reclassification index (NRI), and integrated discrimination improvement index (IDI) were used to assess the predictive performance of these indices.

RESULTS

Over a median follow-up of 13.56 years, we identified 13,256 cases of overall CVD, 10,980 CHD, 2,926 stroke, 8,809 all-cause mortality, and 1,796 cardiovascular mortality. Compared with the lowest quartile of TyG-related indices, participants with MASLD in the high quartile of TyG-related indices had a significantly increased risk of incident overall CVD, CHD, stroke, and mortality. Specifically, the hazard ratios of occurring overall CVD in the fourth versus the first quartiles were 1.19 (95% confidence interval: 1.13-1.25) for TyG, 1.35 (1.28-1.42) for TyG-BMI, 1.33 (1.26-1.40) for TyG-WC, and 1.39 (1.32-1.46) for TyG-WHtR. RCS analyses indicated a nonlinear association of TyG with CVD outcomes (all P values for nonlinearity < 0.05), whereas there exhibited linear trends in TyG-BMI, TyG-WC, and TyG-WHtR with CVD outcomes (all P values for nonlinearity > 0.05, except for TyG-WC with stroke). Furthermore, TyG-WC and TyG-WHtR demonstrated the significantly higher C-index, NRI, and IDI in predicting risk of CVD and mortality in MASLD patients.

CONCLUSION

TyG-related indices, especially TyG-WC and TyG-WHtR, had significant predictive values for the risk of incident CVD and mortality in individuals with MASLD. TyG-related indices may serve as effective surrogate predictors of CVD and mortality in MASLD patients.

Joint association of triglyceride glucose index (TyG) and a body shape index (ABSI) with stroke incidence: a nationwide prospective cohort study

BACKGROUND

Triglyceride glucose index(TyG) and a body shape index(ABSI) are both independent predictor of stroke incidence or adverse prognosis but these two indicators seldom were combined to predict. The purpose of this study is to evaluate whether the combination of TyG and ABSI better predict the incidence of stroke.

METHODS

Based on the China Health and Retirement Longitudinal Study(CHARLS), 8,257 people aged 45 years and older without stroke were enrolled and followed up to 9 years. Sociodemographic information, health status, physical examination and blood data were collected retrospectively. Cox regressions were to determine the relationship between different groups and stroke incidence, using receiver operating characteristic curves to evaluate the diagnostic value. Meanwhile, subgroup analysis was performed to investigate the prediction performance among different population.

RESULTS

672(8.14%) of 8,257 participants had stroke incidence during 9 years. In the adjusted multivariate cox regression model, both TyG and ABSI were still predictors of stroke. The HR of TyG was 1.25(95%CI: 1.06-1.47) and the HR of ABSI was 1.33(95%CI: 1.06-1.68). Restricted cubic spline regression showed the associations between TyG or ABSI and stroke. The combination of TyG and ABSI had the highest diagnostic efficacy(AUC: 0.579, 95%CI: 0.553-0.597), compared to TyG(AUC:0.566, 95%CI: 0.544-0.587) and ABSI(AUC:0.533, 95%CI: 0.524-0.597). Kaplan-Meier curves showed that the highest cumulative stroke incidence was among people with high TyG and ABSI(TyG ≥ 8.5742, ABSI ≥ 0.0852; P < 0.0001), which had the highest HR of stroke incidence(HR:1.64, 95%CI:1.2-2.24).

CONCLUSION

The combined prediction of TyG and ABSI had higher clinical value and enabled earlier detection of the stroke in the general population, which could be monitored and intervened to reduce the overall burden of stroke.

Clinical predictive model of new-onset atrial fibrillation in patients with acute myocardial infarction after percutaneous coronary intervention

New-onset atrial fibrillation (NOAF) is associated with increased morbidity and mortality. Despite identifying numerous factors contributing to NOAF, the underlying mechanisms remain uncertain. This study introduces the triglyceride-glucose index (TyG index) as a predictive indicator and establishes a clinical predictive model. We included 551 patients with acute myocardial infarction (AMI) without a history of atrial fibrillation (AF). These patients were divided into two groups based on the occurrence of postoperative NOAF during hospitalization: the NOAF group (n = 94) and the sinus rhythm (SR) group (n = 457). We utilized a regression model to analyze the risk factors of NOAF and to establish a predictive model. The predictive performance, calibration, and clinical effectiveness were evaluated using the receiver operational characteristics (ROC), calibration curve, decision curve analysis, and clinical impact curve. 94 patients developed NOAF during hospitalization. TyG was identified as an independent predictor of NOAF and was significantly higher in the NOAF group. Left atrial (LA) diameter, age, the systemic inflammatory response index (SIRI), and creatinine were also identified as risk factors for NOAF. Combining these with the TyG to build a clinical prediction model resulted in an area under the curve (AUC) of 0.780 (95% CI 0.358-0.888). The ROC, calibration curve, decision curve analysis, and clinical impact curve demonstrated that the performance of the new nomogram was satisfactory. By incorporating the TyG index into the predictive model, NOAF after AMI during hospitalization can be effectively predicted. Early detection of NOAF can significantly improve the prognosis of AMI patients.

Insulin resistance, vulnerable plaque and stroke risk in patients with carotid artery stenosis

Insulin resistance (IR) is linked to both the vulnerable plaque and the stroke risk. However, the precise extent of this correlation and its impact on stroke risk in carotid artery stenosis patients remain unclear. Therefore, this study aims to investigate the relationship between vulnerable plaque and IR and stroke risk and the mediating role of vulnerable plaque in patients with carotid artery stenosis. This study included 505 patients with carotid artery stenosis. IR was assessed using the triglyceride-glucose (TyG) index. The association of the TyG index and vulnerable plaque with stroke risk was investigated using the restricted cubic splines (RCS)and adjusted Logistic regression. Additionally, the mediation analysis was used to explore the mediating impact of the vulnerable plaque on the association between the TyG index and stroke risk. A total of 184 (36.4%) stroke events were recorded. The RCS curves revealed a positive linear association between TyG index and risk events among patients with carotid artery stenosis (P-value < 0.001 and P for nonlinear = 0.860). After fully adjusting for covariates, both the TyG index and vulnerable plaque emerged as significant predictors of stroke events. Mediation analysis indicated that the vulnerable plaque mediated 18.3%, 15.8%, 13.9%, and 11.6% of the correlation between the TyG index and stroke risk in different adjusted models, respectively. TyG index and vulnerable plaque are associated with a higher risk of stroke in patients with carotid artery stenosis. In addition, vulnerable plaques partially mediated the relationship between TyG index and stroke risk.

Insulin Resistance Predicts Prognosis in Patients With Subarachnoid Hemorrhage

OBJECTIVE

The objective of this study was to determine whether insulin resistance (IR) could be used as a predictor of poor prognosis at 3 months after subarachnoid hemorrhage (SAH).

METHODS

The study included patients aged 18 years or older with a confirmed diagnosis of SAH due to ruptured aneurysm from January 2021 to March 2024. Patients with confirmed diabetes mellitus and taking glucose-lowering drugs, or taking lipid-lowering drugs, or SAH not due to ruptured aneurysm, or comorbid systemic diseases were excluded. Patients were classified into good prognosis (modified Rankin scale [MRS] 0-2) and poor prognosis (MRS 3-6). Receiver operating characteristic curve (ROC), least absolute shrinkage and selection operator (LASSO) analysis, and multivariate logistic regression analysis were used to determine the potential of triglyceride-glucose (TyG) index and the triglyceride to high-density lipoprotein cholesterol (TG/HDL) ratio as predictors of poor prognosis. Finally, a prognostic prediction model based on IR was constructed.

RESULTS

A total of 358 patients were included in this study. Poor prognosis patients had higher age, BMI, hypertension percentage, glucose, triglycerides, TyG index and TG/HDL ratio, and lower HDL. ROC, LASSO, and multivariate logistic regression analysis revealed that age, glucose, TyG index, and TG/HDL ratio had significant potential to predict the prognosis of SAH patients. The prognostic prediction model constructed by combining age, glucose, TyG index, and TG/HDL ratio had high discriminatory power (area under the curve [AUC] = 0.80), satisfactory calibration curves, and good clinical utility.

CONCLUSION

IR is strongly associated with the prognosis of SAH patients, and the combination of age, glucose, TyG index, and TG/HDL ratio can provide a new direction for future treatment.

C-reactive protein-triglyceride glucose index predicts stroke incidence in a hypertensive population: a national cohort study

BACKGROUND

Both the triglyceride-glucose (TyG) index, a predictor of insulin resistance (IR), and inflammation are risk factors for stroke in hypertensive patients. However, only a handful of studies have coupled the TyG index and inflammation indices to predict stroke risk in hypertensive patients. The C-reactive protein-triglyceride-glucose index (CTI) is a novel marker that comprehensively assesses the severity of IR and inflammation. The present study explored the association between CTI and the risk of stroke in patients with hypertension.

METHODS

A total of 3,834 hypertensive patients without a history of stroke at baseline were recruited from the China Health and Retirement Longitudinal Study (CHARLS). Multivariate Cox regression and restricted cubic spline (RCS) analyses were employed to assess the relationship between CTI and stroke risk in hypertensive patients. Furthermore, the Boruta algorithm was applied to evaluate the importance of CTI and construct prediction models to forecast the incidence of stroke in the study cohort.

RESULTS

After 7 years of follow-up, the incidence of stroke in hypertensive patients was 9.6% (368 cases). Multivariate Cox regression analysis revealed a 21% increase in stroke risk with an increase in each CTI unit (hazard ratio (HR) = 1.21, 95% confidence interval (CI) = 1.08-1.37). The top quartile group was 66% more likely to have a stroke than the bottom quartile group (HR = 1.66, 95% CI = 1.23-2.25). RCS analysis confirmed a linear relationship between CTI and stroke risk. The Boruta algorithm validated CTI as a crucial indicator of stroke risk. The Support Vector Machine (SVM) survival model exhibited the best predictive performance for stroke risk in hypertensive patients, with an area under the curve (AUC) of 0.956.

CONCLUSIONS

An increase in CTI levels is associated with a higher risk of stroke in hypertensive patients. This study suggests that CTI may emerge as a unique predictive marker for stroke risk.

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.

Relationship between triglyceride-glucose index and carotid artery plaques in ischemic stroke patients: Based on blood pressure status, sex, and age

BACKGROUND

Numerous studies have shown that the triglyceride-glucose (TyG) index is a reliable substitute marker for insulin resistance. Nevertheless, its correlation with carotid artery plaques (CAPs) among patients with ischemic stroke (IS) remains to be elucidated.

METHODS

9248 IS patients hospitalized at the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine were grouped according to the quartiles of TyG index. Patients were further stratified by blood pressure status, sex, age and hypertension control status. Employing logistic regression to examine the connection between the TyG index and CAPs.Additionally, analyzing the receiver operating characteristic (ROC) curve to evaluate the predictive value of the TyG index for CAPs.

RESULTS

Participants with an elevated TyG index had an increased prevalence of CAPs. The TyG index was positively correlated with CAPs (OR: 1.26, CI: 1.14-1.40, P<0.001). Compared with normal blood pressure and prehypertensive patients, the TyG index was markedly correlated with CAPs among hypertensive patients (OR: 1.29, 95% CI: 1.15-1.44, P<0.001). Females had a higher OR value than males(OR: 1.31, 95% CI: 1.11-1.54, P=0.001 versus OR: 1.24, 95% CI: 1.09-1.41, P=0.001). Older patients (>60 years) had a higher OR value than their middle-aged counterparts (≤60 years) (OR: 1.35; 95% CI: 1.16-1.58, P<0.001 versus OR: 1.20; 95% CI: 1.05-1.37, P=0.007). Patients with poorly-controlled hypertension had a higher OR value than patients with well-controlled hypertension(OR: 1.36; 95% CI: 1.14-1.63, P=0.001 versus OR: 1.24; 95% CI: 1.07-1.44, P=0.003). After adjusting for potential confounding factors, the area under the ROC curve (AUC) value in the overall population, sex-stratified group, hypertensive patients and hypertension control status-stratified group were all above 0.7 (P<0.01), demonstrating good forecasting capability.

CONCLUSIONS

In IS patients, the TyG index was significantly associated with CAPs. Additionally, this correlation was more pronounced in hypertensive patients, females, older individuals and patients with poorly-controlled hypertension.

Analysis of risk factors for carotid artery plaque in asymptomatic adults

OBJECTIVE

This study aimed to investigate the risk factors affecting the presence of carotid plaque in asymptomatic adults.

METHODS

Asymptomatic adults (age > 40 years, no symptoms of cardiovascular and cerebrovascular diseases) undergoing routine health examinations from physical examination department were included in this study. Carotid plaque was measured by Resona 7OB and Resona 8EXP color Doppler ultrasound and L9-3U and L4-5WU probes. The focal carotid intima-media thickness was greater than 1.1 mm, and the local protrusion of the artery wall into the artery lumen suggested the presence of carotid atherosclerotic plaque. According to their ultrasound results, 1077 asymptomatic adults were divided into a group with carotid plaque (477) and a group without carotid plaque (600).

RESULTS

A total of 1077 asymptomatic adults were included in this study, of whom 44.3% had carotid plaque. The proportion of men with carotid plaque was 84.5%. Multifactorial logistic analysis suggested that age, fasting blood glucose (FBG), total cholesterol (TC), homocysteine (Hcy) and male gender were risk factors for carotid atherosclerosis. The predictive probability of these risk factor indicators derived from the multifactorial model was calculated using receiver operating characteristic (ROC) curves with SPSS 25.0 software. The calculated area under the receiver operating characteristic curve (AUC) was 0.715 (95% CI, 0.685-0.746).

CONCLUSION

Age, FBG, TC, Hcy and male gender are risk factors for carotid atherosclerosis in asymptomatic adults. Gender differences in carotid atherosclerosis deserve further attention.

Predictive Value of Triglyceride-Glucose Index for All-Cause and Cardiovascular Mortality in Patients With Diabetes Mellitus: A Retrospective Study: TyG Index and Mortality in Diabetes

Objective: To determine the associations between triglyceride-glucose (TyG) index and mortality from all causes and cardiovascular causes in diabetic population. Methods: 3349 participants with diabetes mellitus (DM) from the 1999-2014 National Health and Nutrition Examination Surveys (NHANES), aged 18-85 years were included and grouped based on the TyG index in quintiles. Mortality was followed up through December 31th, 2015. Cox proportional hazards models were used to assess the hazard ratios (HRs) and 95% confidence intervals (CIs). We clarified the shape of association between TyG index and mortality using restricted cubic splines and piecewise linear regression. Results: After a median follow-up period of 82 months, 800 (23.9%) deaths occurred, of which 190 (5.7%) were due to cardiovascular causes. Participants in the top quintile had higher risks of all-cause mortality (HR, 1.38; 95% CI, 1.04-1.48) and cardiovascular mortality (HR, 2.43; 95% CI, 1.32-4.45) than those in the lowest quintile. TyG index and all-cause mortality had a J-shaped relationship with a threshold value of 9.32, while TyG index and cardiovascular mortality had a reversed L-shaped relationship with a threshold value of 9.37. Higher TyG index was associated with increased risks of all-cause mortality (per SD increment, HR, 1.52; 95% CI, 1.27-1.82) and cardiovascular mortality (per SD increment, HR, 2.17; 95% CI, 1.54-3.04) when above the threshold values. The sensitivity analyses demonstrated similar findings. Conclusions: TyG index in diabetic patients was nonlinearly correlated with mortality risks, potentially predicting all-cause and cardiovascular mortality.

Triglyceride-glucose index prediction of stroke incidence risk in low-income Chinese population: a 10-year prospective cohort study

Aim

The Triglyceride-Glucose (TyG) index, an indicator of insulin resistance, has been proposed as a predictor of cardiovascular diseases. However, its role in predicting stroke risk, particularly in low-income populations, is not well understood. This study aimed to investigate the predictive value of the TyG index for stroke incidence in a low-income Chinese population, with a focus on gender and age-specific differences.

Methods

This 10-year prospective cohort study included 3,534 participants aged ≥45 years from rural areas in northern China. Baseline data on demographic characteristics, lifestyle factors, and clinical measurements were collected. Participants were followed for stroke incidence, categorized into ischemic and hemorrhagic stroke. Multivariate logistic regression models were used to assess the association between the TyG index and stroke incidence, adjusting for potential confounders.

Results

During the follow-up period, 368 participants (10.4%) experienced a stroke, with 327 ischemic and 31 hemorrhagic strokes. TyG index was significantly associated with total and ischemic stroke incidence but not hemorrhagic stroke. After adjusting for confounding factors, for every one standard deviation increase in TyG index, the risk of stroke increased by 32% for overall stroke (RR: 1.32; 95% CI: 1.08-1.61; P=0.006) and 39% for ischemic stroke (RR: 1.39; 95% CI: 1.12-1.73; P=0.003). The risk of stroke in the highest TyG tertile levels (tertile 3) increased by 49% (RR: 1.49; 95% CI 1.11-1.99; P=0.007) for overall stroke, compared to those in the lowest tertile levels (tertile 1). For ischemic stroke, the risk of stroke increased by 53% (RR: 1.53; 95% CI 1.12-2.11; P=0.008) in the highest TyG tertile levels (tertile 3) compared to those in the lowest tertile levels (tertile 1).

Conclusion

This 10-year prospective cohort study has established the TyG index as an independent predictor of both total and ischemic stroke incidence in a low-income Chinese population. The findings indicate that the TyG index is particularly effective in predicting stroke risk among women and older adults (≥60 years), but not for hemorrhagic stroke. These insights are crucial for improving clinical practice and stroke prevention strategies.

Sex-specific differences in the association between triglyceride glucose index and carotid plaque in a cardiovascular high-risk population: a cross-sectional study based on a Chinese community-dwelling population

Background

To date, numerous studies have investigated the relationship between the triglyceride glucose (TyG) index and carotid plaques, but the impact of gender on this relationship has not been explored. Therefore, this study aims to investigate gender-specific differences in the relationship between the TyG index and carotid plaques in a high cardiovascular risk population in China.

Methods

This cross-sectional study's data were derived from a longitudinal pilot study involving 1,085 high-risk cardiovascular subjects. A multivariable logistic regression model was used to analyze the relationship between the TyG index and carotid plaques. A generalized additive model combined with a stratified regression model was employed to assess the nonlinear relationship between the TyG index and carotid plaques across different genders. In the nonlinear relation, the inflection point was calculated by a two-piecewise linear regression model.

Results

After adjusting for confounders such as age, sex, BMI, SBP, DBP, AST/ALT, TC, LDL-c, HDL-c, creatinine, smoking, and antilipemic medication, the generalized additive model results revealed a nonlinear relationship between the TyG index and carotid plaque formation, with significant differences across genders. In males, the relationship between the TyG index and carotid plaques was S-shaped. The two-piecewise linear regression model identified two inflection points: TyG = 8.39 (P = 0.017) and TyG = 10.2 (P = 0.009).

Conclusion

The relationship between the TyG index and the formation of carotid plaques is nonlinear, and there are significant differences in the correlation between males and females.

Association of triglyceride glucose index with clinical outcomes in ischemic stroke: a retrospective study

BACKGROUND

Stroke is a major cause of illness, death, and long-term disability and a major health concern worldwide. Experts consider insulin resistance (IR), a defining feature of the metabolic syndrome and a significant risk factor for stroke. Insulin resistance, or IR, is common among stroke patients. The triglyceride-glucose (TYG) index's relevance to both lipotoxicity and glucotoxicity has led to its proposal as an alternative indicator of IR.

AIM

Examining the connection between elevated TYG INDEX scores and worse clinical outcomes in ischemic stroke patients is the main goal. Finding out how often bad outcomes (recurrence and all-cause death) are in ischemic stroke patients is the secondary goal.

METHOD

This was a retrospective observational study that involved patients admitted to the 850-bed Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, a tertiary care teaching hospital located in the Krishna district of Andhra Pradesh (India). The study was conducted over a period of six months. All the 95 patients who satisfied the eligibility criteria were included. The patients' TYG INDEX values were first determined and patients with ischemic stroke who had elevated TYG INDEX values were then compared for clinical outcomes including recurrence and all-cause death with ischemic patients with normal TYG INDEX.

RESULTS

In this study, the total cholesterol of the patients (mean ± SD) was 165.01 ± 51.5 mg/dL; Triglycerides was 157.031 ± 98.9 mg/dL; HDL-c was 37.253 ± 5.52 mg/dl; LDL-c was 107 ± 48.3 mg/Dl; and FBS was 153.74 ± 71.52 mg/dL. The chi-square test showed that only FBS, Triglyceride, and Total cholesterol were significantly associated with TYG INDEX whereas other variables like age, LDL, and HDL were not. There was no significant association between the TYG INDEX and clinical outcomes of ischemic stroke. In both groups of patients, risk and no risk TYG INDEX values, the mRS score showed variable and unpredictable relationship with the TYG INDEX.

CONCLUSION

Contrary to the few studies that discovered one, our research leads us to the conclusion that there may not be a relevant association between the TYG INDEX and clinical results in patients with ischemic stroke.

METS-IR as an important predictor of neurological impairment severity in patients with severe cerebral infarction: a multicenter study based on the Chinese population

Background

Insulin resistance (IR) is linked to an increased risk of neurological impairment following a stroke and may contribute to poor neurological prognosis in affected patients. The metabolic score for the insulin resistance index, shortened as the METS-IR, generally serves as a surrogate index for IR. However, its association with the severity of neurological impairment in patients with severe cerebral infarction (CI) in neurological intensive care units (ICU) has not been fully established.

Methods

Patients with a diagnosis of CI, admitted to the neurological ICUs of Yangzhou University's Affiliated Hospital and Xuzhou Medical University's Affiliated Hospital, were included in the study. A multivariate logistic regression model and restricted cubic splines (RCS) were employed to explore the relationship between the METS-IR index and the severity of neurological impairment in these patients. The predictive capabilities of the METS-IR index and the triglyceride-glucose (TyG) index for outcome measures were compared through the ROC curve. Furthermore, a decision curve analysis was executed, and the integrated discrimination improvement (IDI) index was computed to evaluate the enhancements in predictive performance and clinical utility of various scoring systems with the inclusion of the METS-IR index. Subgroup analysis was conducted regarding age, BMI, and smoking status.

Results

The study ultimately included 504 participants. Adjusted logistic regression and RCS results showed that as the METS-IR index increases, the risk of neurological impairment in patients with severe CI consistently grows (P for overall = 0.0146, P-nonlinear: 0.0689). The METS-IR index's predictive capability for neurological impairment (AUC = 0.669) was superior to that of the TyG index (AUC = 0.519).

Conclusion

From the study results, the METS-IR index can serve as an important predictor for neurological impairment in ICU patients with severe CI. It can aid in the identification and early intervention of neurological impairment in these patients.

The nonlinear relationship between triglyceride glucose-waist circumference and stroke risk in middle-aged and elderly people: a nationwide prospective cohort study of the CHARLS

BACKGROUND AND AIMS

Numerous research have focused on the relationship of metabolic markers and stroke risk, yet limited research has focused on the triglyceride glucose-waist circumference (TyG-WC) index. This study explored the possible association of TyG-WC and stroke among moderately aged and old Chinese adults over 45 years of age.

METHODS

This observational cohort analysis involved 9054 participants from the Chinese Longitudinal Study of Health and Retirement and employed a standardized questionnaire administered via in-person interviews. Cox proportional hazard model, smoothed curve fitting, and threshold effect analysis were conducted for examining the potential nonlinear relationships among TyG-WC and stroke risk.

RESULTS

Within an average follow-up period of six years, 463 new strokes occurred, representing 5.11% of the total number of patients. After adjusting for possible confounding factors, a nonlinear association between TyG-WC and stroke risk was identified, with a significant dose-response relationship (P = 0.023 for the log-likelihood ratio test). A turning point was identified at the TyG-WC level of 554.48, beyond that the likelihood of stroke increased markedly (HR = 1.323, 95% CI = 1.098-1.594, P = 0.003).

CONCLUSION

This study revealed a specific curvilinear association with the TyG-WC score and stroke risk, identifying a key threshold value. This study focused on Chinese middle-aged and senior adults over the age of 45, emphasizing that increased stroke risk is linked to higher TyG-WC levels.

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.

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

BACKGROUND AND PURPOSE

Triglyceride-glucose (TyG) index has been regarded as a reliable surrogate marker of insulin resistance for predicting cardiovascular outcomes. The current study aimed to explore the associations between TyG index with major adverse cardiovascular events (MACE) in patients with chronic kidney disease (CKD).

METHODS/PATIENTS

13,517 patients with chronic kidney disease (CKD) from the Kailuan study were included. Patients were divided into quartiles according to the TyG index. The outcomes were MACE, including acute myocardial infarction (AMI) and ischemic stroke (IS). The association between TyG index and the risk of MACE was analyzed by Cox regression models.

RESULTS

During 13.87-year follow-up, a total 1356 MACEs occurred. Multivariable Cox proportional-hazards analyses showed that a higher TyG index quartile was associated with an elevated risk of MACE.

CONCLUSIONS

TyG index is significantly related to MACE in patients with CKD. TyG index can be regarded as a novel predictor of MACE for patients with CKD.

Association between triglycerideglucose index and arterial stiffness progression A retrospective cohort study

OBJECTIVES

Insulin resistance (IR) is closely associated with atherosclerosis and adverse cardiovascular events. The triglyceride-glucose (TyG) index is an effective indicator for assessing IR. This study aims to explore the relationship between the TyG index and the risk of arterial stiffness progression.

METHODS

This retrospective cohort study included adults who had undergone at least 2 health examinations with arteriosclerosis testing at the Health Management Medical Center of the Third Xiangya Hospital, Central South University, between January 2012 and December 2022. Clinical data were collected. The TyG index was calculated using the formula of ln (triglycerides×fasting blood glucose/2). The baseline TyG index was assessed as both a continuous variable and as a quartile-based categorical variable. The progression of arteriosclerosis was evaluated by the annual change rate of brachial-ankle pulse wave velocity (baPWV) and the new onset of increased arterial stiffness. Linear regression model and Cox proportional hazard model were used to explore whether the TyG index is an independent risk factor for arterial stiffness progression. Subgroup analyses were performed based on age, gender, body mass index (BMI), and the presence of type 2 diabetes, hypertension, or hyperlipidemia to determine the characteristics of the association between the TyG index and arterial stiffness progression.

RESULTS

A total of 4 971 participants were included, with a follow-up period of (3.01±1.98) years. During follow-up, the annual baPWV change rate was (24.94±81.15) cm/s, and 278 cases of new onset of increased aterial stiffness were recorded. After fully adjusting for confounding factors, the baseline TyG index was independently positively correlated with both the annual baPWV change rate (β=17.5, 95% CI 9.00 to 25.94, P<0.001) and the risk of new onset of increased aterial stiffness [hazard ratio (HR)=1.43, 95% CI 1.18 to 1.74, P<0.001] when the TyG index was treated as a continuous variable. When treated as a categorical variable, higher TyG index quartiles were associated with progressively higher baPWV change rates and new onset of increased arterial stiffness (all P<0.05). In subgroups of participants aged ≥45 years, males, BMI<28 kg/m2, those with or without hypertension, and those without type 2 diabetes or hyperlipidemia, the baseline TyG index (both continuous and categorical) was significantly associated with new onset of increased arterial stiffness (all P<0.05), with no significant interactions observed across subgroups (all P>0.05).

CONCLUSIONS

The TyG index is independently associated with an increased risk of arterial stiffness progression and may serve as a useful indicator for assessing arterial stiffness progression risk in health check-up populations.

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.

Metabolic syndrome parameters' variability and stroke incidence in hypertensive patients: evidence from a functional community cohort

BACKGROUND

Stroke is a common complication of hypertension, but the predictive value of metabolic syndrome parameters' variability on stroke risk in individuals with hypertension remains unclear. Therefore, our objective was to investigate the relationship between metabolic syndrome parameters' variability and the risk of total stroke and its subtypes in hypertensive patients.

METHODS

This prospective cohort study included 17,789 individuals with hypertension from the Kailuan study since 2006. Metabolic syndrome parameters, including waist circumference (WC), fasting blood glucose (FBG), systolic blood pressure (SBP), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG), were collected at three follow-up visits in the 2006, 2008, and 2010 surveys. We assess the variability utilizing the coefficient of variation (CV), standard deviation (SD), average real variation (ARV), and variability independent of the mean (VIM), with CV initially assessed. Participants were categorized based on the number of high-variability metabolic syndrome parameters (0, 1, 2, ≥ 3). Stroke cases were identified by reviewing medical records. The associations between variability in metabolic syndrome parameters and the risk of total stroke and its subtypes were analyzed using Cox proportional hazard regression models.

RESULTS

During a median follow-up of 9.32 years, 1223 cases of stroke were recorded. Participants with ≥ 3 high-variability metabolic syndrome parameters had an increased risk of total stroke (HR: 1.29, 95%CI 1.09-1.52), as well as an increased risk of ischemic stroke (HR: 1.31, 95%CI 1.05-1.63) compared to those without high-variability parameters. The study also examined variability in each metabolic syndrome parameter, and significant associations with an increased risk of total stroke were observed for variability in SBP (HR: 1.24, 95%CI 1.05-1.46) and HDL-C (HR: 1.34, 95%CI 1.09-1.64).

CONCLUSIONS

Long-term fluctuations in metabolic syndrome parameters significantly increase the risk of total stroke, especially ischemic stroke. Maintaining low variability in metabolic syndrome parameters could benefit health, and hypertensive individuals must be regularly monitored.

Triglyceride-glucose index as a potential predictor for in-hospital mortality in critically ill patients with intracerebral hemorrhage: a multicenter, case-control study

BACKGROUND

The correlation between the triglyceride-glucose index (TyG) and the prognosis of ischemic stroke has been well established. This study aims to assess the influence of the TyG index on the clinical outcomes of critically ill individuals suffering from intracerebral hemorrhage (ICH).

METHODS

Patients diagnosed with ICH were retrospectively retrieved from the Medical Information Mart for Intensive Care (MIMIC-IV) and the eICU Collaborative Research Database (eICU-CRD). Various statistical methods, including restricted cubic spline (RCS) regression, multivariable logistic regression, subgroup analysis, and sensitivity analysis, were employed to examine the relationship between the TyG index and the primary outcomes of ICH.

RESULTS

A total of 791 patients from MIMIC-IV and 1,113 ones from eICU-CRD were analyzed. In MIMIC-IV, the in-hospital and ICU mortality rates were 14% and 10%, respectively, while in eICU-CRD, they were 16% and 8%. Results of the RCS regression revealed a consistent linear relationship between the TyG index and the risk of in-hospital and ICU mortality across the entire study population of both databases. Logistic regression analysis revealed a significant positive association between the TyG index and the likelihood of in-hospital and ICU death among ICH patients in both databases. Subgroup and sensitivity analysis further revealed an interaction between patients' age and the TyG index in relation to in-hospital and ICU mortality among ICH patients. Notably, for patients over 60 years old, the association between the TyG index and the risk of in-hospital and ICU mortality was more pronounced compared to the overall study population in both MIMIC-IV and eICU-CRD databases, suggesting a synergistic effect between old age (over 60 years) and the TyG index on the in-hospital and ICU mortality of patients with ICH.

CONCLUSIONS

This study established a positive correlation between the TyG index and the risk of in-hospital and ICU mortality in patients over 60 years who diagnosed with ICH, suggesting that the TyG index holds promise as an indicator for risk stratification in this patient population.

Triglyceride Glucose Index and Prognosis of Patients with Subarachnoid Hemorrhage

OBJECTIVE

The triglyceride glucose (TyG) index is regarded as a reliable alternative indicator for measuring insulin resistance. We investigated the association between the prognosis of patients with subarachnoid hemorrhage (SAH)and the TyG index, explored the potential of the TyG index as a new biomarker for forecasting the outcomes of SAH patients, and explored independent risk factors for predicting the condition of SAH patients.

METHODS

A retrospective analysis was performed of patients who were admitted to a single center due to SAH. Differences in clinical data and correlation between laboratory indexes, disease severity score on admission, and prognosis score were compared between the 2 groups. The study employed multivariate logistic regression analysis to examine the independent influencing aspects of Glasgow Outcome Scale score. The receiver operating characteristic curve was drawn and the area under the curve (AUC) calculated to predict the best cutoff value of the degree of neurological impairment in patients with SAH.

RESULTS

Univariate analysis showed that Glasgow Coma Scale score (86.3% vs. 12.0%, P < 0.001), Hunt-Hess grade (88.2% vs. 15.7%, P < 0.001), white blood cell count (11.20 [7.9, 15.2] vs. 9.1 [7.0, 12.2], P = 0.027), and TyG index (1.49 [1.40, 1.59] vs. 1.16 [1.06, 1.27], P < 0.001) were statistically significantly different. Multivariate analysis showed that TyG index, Hunt-Hess grade, and GCS score were independent risk factors for poor prognosis.

CONCLUSIONS

Patients with SAH may benefit from using the TyG index as a predictive method. In our clinical practice, the TyG index is beneficial for managing diseases and making decisions. More research is required to determine if improved TyG index control would lead to better clinical results in the future.

Utility of the triglyceride-glucose index for predicting restenosis following revascularization surgery for extracranial carotid artery stenosis: A retrospective cohort study

BACKGROUND

Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are effective interventions for treating extracranial carotid artery stenosis (ECAS), but long-term prognosis is limited by postoperative restenosis. Carotid restenosis is defined as carotid stenosis >50% by various examination methods in patients after carotid revascularization. This retrospective cohort study examined the value of the triglyceride-glucose (TyG) index for predicting vascular restenosis after carotid revascularization.

METHODS

A total of 830 patients receiving CEA (408 cases, 49.2%) or CAS (422 cases, 50.8%) were included in this study. Patients were stratified into three subgroups according to TyG index tertile (high, intermediate, and low), and predictive value for restenosis was evaluated by constructing multivariate Cox proportional hazard regression models.

RESULTS

Incidence of postoperative restenosis was significantly greater among patients with a high TyG index according to univariate analysis. Kaplan-Meier survival curve analysis revealed a progressive increase in restenosis prevalence with rising TyG index. Multivariate Cox regression models also identified TyG index as an independent predictor of restenosis, while receiver operating characteristic (ROC) curve analysis showed that TyG index predicted restenosis with moderate sensitivity (57.24%) and specificity (67.99%) (AUC: 0.619, 95% CI 0.585-0.652, z-statistic=4.745, p<0.001). Addition of the TyG index to an established risk factor model incrementally improved restenosis prediction (AUC: 0.684 (0.651-0.715) vs 0.661 (0.628-0.694), z-statistic =2.027, p = 0.043) with statistical differences.

CONCLUSION

The TyG index is positively correlated with vascular restenosis risk after revascularization, which can be used for incremental prediction and has certain predictive value.

Link between triglyceride-glucose-body mass index and future stroke risk in middle-aged and elderly chinese: a nationwide prospective cohort study

OBJECTIVE

Current literature is deficient in robust evidence delineating the correlation between the triglyceride glucose-body mass index (TyG-BMI) and the incidence of stroke. Consequently, this investigation seeks to elucidate the potential link between TyG-BMI and stroke risk in a cohort of middle-aged and senior Chinese individuals.

METHODS

This study employs longitudinal data from four waves of the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2011, 2013, 2015, and 2018, encompassing 8,698 participants. The CHARLS cohort was assembled using a multistage probability sampling technique. Participants underwent comprehensive evaluations through standardized questionnaires administered via face-to-face interviews. Our analytic strategy involved the application of Cox proportional hazards regression models to investigate the association between TyG-BMI and the risk of stroke. To discern potential non-linear relationships, we incorporated Cox proportional hazards regression with smooth curve fitting. Additionally, we executed a battery of sensitivity and subgroup analyses to validate the robustness of our findings.

RESULTS

Our study utilized a multivariate Cox proportional hazards regression model and found a significant correlation between the TyG-BMI and the risk of stroke. Specifically, a 10-unit increase in TyG-BMI corresponded to a 4.9% heightened risk of stroke (HR = 1.049, 95% CI 1.029-1.069). The analysis also uncovered a non-linear pattern in this relationship, pinpointed by an inflection point at a TyG-BMI value of 174.63. To the left of this inflection point-meaning at lower TyG-BMI values-a 10-unit hike in TyG-BMI was linked to a more substantial 14.4% rise in stroke risk (HR 1.144; 95% CI 1.044-1.253). Conversely, to the right of the inflection point-at higher TyG-BMI values-each 10-unit increment was associated with a smaller, 3.8% increase in the risk of stroke (HR 1.038; 95% CI 1.016-1.061).

CONCLUSIONS

In the middle-aged and elderly Chinese population, elevated TyG-BMI was significantly and positively associated with stroke risk. In addition, there was also a specific non-linear association between TyG-BMI and stroke (inflection point 174.63). Further reduction of TyG-BMI below 174.63 through lifestyle changes and dietary control can significantly reduce the risk of stroke.

Predictors of In-Stent Stenosis Following the Implantation of Pipeline Embolization Devices for the Treatment of Aneurysms Located at or beyond the Circle of Willis in the Anterior Circulation

BACKGROUND AND PURPOSE

In-stent stenosis is commonly observed after stent implantation. There is no consensus on the contributing factors for in-stent stenosis, especially for aneurysms located at or beyond the circle of Willis in the anterior circulation. This study aimed to investigate the morbidity and determinants of in-stent stenosis in distal anterior circulation aneurysms following the implantation of Pipeline Embolization Devices.

MATERIALS AND METHODS

Patients who underwent Pipeline Embolization Device treatment at our center between January 1, 2018, and June 15, 2023, were enrolled. Distal anterior circulation aneurysms were defined as those occurring at or beyond the circle of Willis, including anterior communicating artery aneurysms, anterior cerebral artery aneurysms, and MCA aneurysms. Baseline information, aneurysm characteristics, and follow-up data of patients were analyzed. Patients were divided into 2 groups: the in-stent stenosis group (patients with a loss of >25% of the lumen diameter of the parent artery) and the non-in-stent stenosis group. Binary logistic regression and restricted cubic spline curves were used to explore risk factors.

RESULTS

We included 85 cases of 1213 patients treated with flow-diverter devices at our hospital. During an average follow-up period of 9.07 months, the complete occlusion rate was 77.64%. The overall incidence of in-stent stenosis was 36.47% (31/85), of which moderate stenosis accounted for 9.41% (8/85), and severe stenosis, 5.88% (5/85) (triglyceride-glucose index ≥ 8.95; OR = 6.883, P = .006). The difference in diameters between the stent and parent artery of ≥0.09 mm (OR = 6.534, P = .015) and 55 years of age or older (OR = 3.507, P = .036) were risk factors for in-stent stenosis. The restricted cubic spline curves indicated that the risk of in-stent stenosis increased as the difference in diameter between stent and parent artery and the triglyceride-glucose index increased.

CONCLUSIONS

Compared with the on-label use of Pipeline Embolization Devices, the rate of in-stent stenosis did not obviously increase when treating distal anterior circulation aneurysms with these devices. The incidence of in-stent stenosis was 36.47% when defined as a lumen diameter loss of >25%, and 15.2% when defined as a lumen diameter loss of >50%. Stent-size selection and biochemical indicators can potentially impact the incidence of in-stent stenosis.

Association and pathways of baseline and longitudinal hemoglobin A1c with the risk of incident stroke: A nationwide prospective cohort study

AIMS

To investigate the association of baseline and long-term mean hemoglobin A1c (HbA1c) with the risk of stroke.

METHODS

A total of 11,220 participants aged over 45 years and without stroke at baseline were enrolled from the China Health and Retirement Longitudinal Study. Mean HbA1c was calculated as the mean of HbA1c at all previous visits before stroke occurred or the end of follow-up. Multivariable-adjusted Cox regressions and Bayesian network were used for the analysis.

RESULTS

During a median follow-up of 7.50 years, a total of 626 cases of stroke occurred. The risk of stroke increased with quintiles of baseline and mean HbA1c, the hazard ratio (HR) in Q5 versus Q1 was 1.30 (95 % confidence interval [CI],1.03-1.64) and 1.79 (95 % CI, 1.38-2.34), respectively. Per 1 unit increase in baseline and mean HbA1c was associated with 10 % (HR, 1.10; 95 % CI, 1.02-1.18) an 12 % (HR, 1.12; 95 % CI, 1.05-1.19) higher risk of stroke. Bayesian network analysis showed that the pathway from HbA1c to stroke was through hypertension, dyslipidemia, obesity, and inflammation.

CONCLUSIONS

Elevated levels of both baseline and long-term HbA1c were associated with increased risk of stroke, and hypertension and obesity played an important role in the pathway.

Association between triglyceride glucose index and adverse clinical outcomes in patients with acute myocardial infarction and LDL-C≤1.8 mmol/L who underwent percutaneous coronary intervention: a prospective cohort study

Background

Recently, the triglyceride glucose (TyG) index has emerged as a reliable predictive indicator for adverse outcomes of cardiovascular disease. However, the roles of the TyG index in patients with acute myocardial infarction (AMI) and low-density lipoprotein cholesterol (LDL-C)≤1.8 mmol/L after percutaneous coronary intervention (PCI) remain unclear.

Methods

A total of 599 patients diagnosed with AMI and LDL-C ≤ 1.8 mmol/L at the 1-month follow-up after PCI were consecutively enrolled between January 2017 and January 2020. The patients were subsequently divided into three groups based on tertiles of the TyG index. The parameters, including the TyG index, were compared to explore the risk factors associated with major adverse cardiovascular and cerebrovascular events (MACCEs) during the 1-year follow-up.

Results

Sixty-nine patients (11.5%) with 90 MACCEs were recorded during the 1-year follow up, including 13 patients (8.6%) in the Tertile 1 group, 36 (12.0%) in the Tertile 2 group, and 20 (13.4%) in the Tertile 3 group. Patients with a higher TyG index had a significantly increased incidence of MACCEs compared to those with a lower TyG index (22.1% vs. 14.0% vs. 9.9%, p=0.010). Kaplan-Meier analysis demonstrated that patients with a higher TyG index had a significantly lower probability of survival without MACCEs. Furthermore, a binary logistic regression model indicated that the TyG index was the only independent predictor for MACCEs in these patients.

Conclusion

A higher TyG index was associated with a higher incidence of MACCEs in patients with AMI and well-controlled LDL-C levels after PCI. This suggests that the TyG index can serve as a predictive indicator for adverse cardiovascular outcomes in these patients.

[Relationship of triglyceride-glucose index and its derivatives with blood pressure abnormalities in adolescents: an analysis based on a restricted cubic spline model]

OBJECTIVES

To explore the relationship of triglyceride-glucose index (TyG), triglyceride-glucose-body mass index (TyG-BMI), and triglyceride-glucose-waist circumference index (TyG-WC) with blood pressure abnormalities in adolescents, providing theoretical basis for the prevention and control of hypertension in adolescents.

METHODS

A stratified cluster sampling method was used to select 1 572 adolescents aged 12 to 18 years in Yinchuan City for questionnaire surveys, physical measurements, and laboratory tests. Logistic regression analysis and restricted cubic spline analysis were employed to examine the relationship of TyG, TyG-BMI, and TyG-WC with blood pressure abnormalities in adolescents.

RESULTS

Multivariable logistic regression analysis revealed that after adjusting for confounding factors, the groups with the highest quartile of TyG, TyG-BMI, and TyG-WC had 1.48 times (95%CI: 1.07-2.04), 3.71 times (95%CI: 2.67-5.15), and 4.07 times (95%CI: 2.89-5.73) higher risks of blood pressure abnormalities compared to the groups with the lowest quartile, respectively. Moreover, as the levels of TyG, TyG-BMI, and TyG-WC increased, the risk of blood pressure abnormalities gradually increased (P<0.05). A non-linear dose-response relationship was observed between TyG-BMI and the risk of blood pressure abnormalities (P overall trend<0.001, P non-linearity=0.002). Linear dose-response relationships were found between TyG and the risk of blood pressure abnormalities (P overall trend<0.001, P non-linearit =0.232), and between TyG-WC and the risk of blood pressure abnormalities (P overall trend<0.001, P non-linearity=0.224).

CONCLUSIONS

Higher levels of TyG and its derivatives are associated with an increased risk of blood pressure abnormalities in adolescents, with linear or non-linear dose-response relationships.

The triglyceride-glucose index: a novel predictor of stroke and all-cause mortality in liver transplantation recipients

BACKGROUND

The triglyceride-glucose (TyG) index, identified as a reliable indicator of insulin resistance (IR), was reported to be associated with stroke recurrence and morbidity in the general population and critically ill patients. However, the relationship in liver transplantation (LT) recipients remains unknown. This study aimed to investigate the correlation between the TyG index and post-LT stroke along with all-cause mortality and further assess the influence of IR on the LT recipients' prognosis.

METHODS

The retrospective cohort study enrolled 959 patients who underwent LT at a university-based medical centre between January 2015 and January 2021. The participants were divided into three groups according to their TyG index tertiles. The primary outcome was post-LT stroke. Multivariate logistic regression, COX proportional hazards regression, and restricted cubic spline RCS were used to examine the association between the TyG index and outcomes in LT recipients.

RESULTS

With a median TyG index of 8.23 (7.78-8.72), 780 (87.18% males) patients were eventually included. The incidence of post-LT stroke was 5.38%, and the in-hospital, 1-year, and 3-year mortality rates were 5.54%, 13.21%, and 15.77%, respectively. Multivariate regression analysis showed an independent association between the TyG index and an increased risk of post-LT stroke [adjusted odds ratio (aOR), 3.398 (95% confidence interval [CI]: 1.371-8.426) P = 0. 008], in-hospital mortality [adjusted hazard ratio (aHR), 2.326 (95% CI: 1.089-4.931) P = 0.025], 1-year mortality [aHR, 1.668 (95% CI: 1.024-2.717) P = 0.039], and 3-year mortality [aHR, 1.837 (95% CI: 1.445-2.950) P = 0.012]. Additional RCS analysis also suggested a linear increase in the risk of postoperative stroke with elevated TyG index (P for nonlinearity = 0.480).

CONCLUSIONS

The TyG index may be a valuable and reliable indicator for assessing stroke risk and all-cause mortality in patients undergoing LT, suggesting its potential relevance in improving risk stratification during the peri-LT period.

Association between triglyceride glucose index and all-cause mortality in patients with cerebrovascular disease: a retrospective study

BACKGROUND

Triglyceride glucose (TyG) is associated with stroke, atherosclerosis, and adverse clinical outcomes. However, its correlation with cerebrovascular disease (CVD) mortality remains unclear. This study aimed to investigate the relationship between TyG index and mortality in patients with CVD.

METHODS

Patient data sourced from the Medical Information Mart for Intensive Care -IV database were categorized based on TyG quartiles. Kaplan-Meier survival analysis was used to estimate survival disparities among the TyG subgroups. Cox proportional risk modeling was used to examine the association between the TyG index and mortality. Generalized summation models were applied to fit the smoothed curves. log-likelihood ratio test were used to analyze the non-linear relationship.

RESULTS

The study comprised 1,965 patients (50.18% were male). The 28-day and 90-day mortality rates were 20.10% and 24.48%, respectively. The TyG index exhibited a linear relationship with the 28-day mortality (Hazards ratio (HR), 1.16; 95% confidence interval (CI), 0.99-1.36) and the 90-day mortality (HR, 1.18; 95% CI, 1.02-1.37). In the TyG Q4 group, each 1 mg/dl increase was linked to a 35% rise in the risk of 28-day mortality and a 38% increase in the risk of 90-day mortality. Subgroup analyses highlighted a more substantial association between TyG index and 90-day mortality in the diabetic group.

CONCLUSION

Our findings underscore the positive association between TyG and the 28- and 90-day mortality rates in patients with CVD. This insight may prove pivotal for identifying at-risk populations and enhancing risk prediction in the clinical management of CVD.

High triglyceride-glucose index at admission is a predictor of post-stroke cognitive impairment in patients with acute ischemic stroke

BACKGROUND

Post-stroke cognitive impairment (PSCI) is a very common complication of ischemic stroke (IS). Triglyceride-glucose (TyG) index was an effective alternative marker of insulin resistance (IR). This prospective study was designed to explore the correlation between TyG index and PSCI.

METHODS

Between January 1 2021 to June 30 2022, consecutive patients with first onset IS were enrolled prospectively. Baseline information was collected at admission and fasting blood was drawn the next morning. Montreal Cognitive Assessment (MoCA) was used to evaluate cognitive function at three months after stroke. Multiple regression analysis was used to explore the correlation between PSCI and TyG. Receiver operating characteristic (ROC) was performed to evaluate the predictive ability.

RESULTS

Ultimately, 313 patients were enrolled in this study. The TyG index was higher in patients with PSCI than those without PSCI (8.99 (8.55, 9.54) vs. 8.61(8.25, 8.87), P<0.001). The spearman correlation analysis indicated that TyG index was negatively correlated with MoCA score (r=-0.272, P<0.001). The multivariate logistic regression analysis demonstrated that TyG index was correlated with PSCI independently (P<0.001) regardless of whether the patients had diabetes or not. The area under curve (AUC) of the ROC was 0.684 (95%CI=0.635-0.768, P<0.001). The optimal cutoff value of TyG index for predicting PSCI was 8.81, with a sensitivity of 61.7% and a specificity of 73.6%.

CONCLUSION

A higher TyG index level at admission was independently correlated with increased risk of PSCI three months later and could be used as a predictor.

The triglyceride glucose index trajectory is associated with hypertension: a retrospective longitudinal cohort study

BACKGROUND

Previous studies have found that the triglyceride glucose index (TyG index) trajectories are associated with cardiovascular diseases. However, the association between the patterns of TyG index trajectories and risk for hypertension has not been investigated. In a longitudinal general population, we aimed to identify distinct TyG index trajectories over 12 years and describe their association with incidence of hypertension.

METHOD

Of the 15,056 adults retrospectively recruited from the Physical Examination Center of the Second Affiliated Hospital of Dalian Medical University in northeast of China from 2011 to 2022. TyG index was calculated as ln (fasting TG [mg/dL] × FPG [mg/dL]/2) and the TyG index trajectories were developed using group-based trajectory modelling. Cox regression analysis was accomplished to assess the association between TyG index and incidence of hypertension.

RESULTS

The median age of the population was 38 years, and 7352 (48.83%) of the participants were men. Three distinct TyG index trajectories were identified: "low increasing" (N = 7241), "moderate increasing" (N = 6448), and "high stable" (N = 1367). Using "low increasing" trajectory as a reference, "moderate increasing" and "high stable" trajectory were associated with increased risk of hypertension (HR = 2.45; 95% CI 2.25-2.67 and HR = 3.88; 95% CI 3.48-4.33). After adjusting for baseline sex, age, diabetes, smoking, systolic blood pressure, diastolic blood pressure, BMI, cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, blood glucose, triglyceride, urea, uric acid, and glomerular filtration rate, the HR were slightly attenuate in "moderate increasing" and "high stable" trajectories to 1.38 (95% CI 1.23-1.54) and 1.69 (95% CI 1.40-2.02) respectively. Meanwhile, similar results were observed in multiple sensitivity analyses. The HR of the "moderate increasing" and "high stable" trajectory groups were 2.63 (95% CI 2.30-3.00) and 4.66 (95% CI 3.66-5.93) in female, and 1.66 (95% CI 1.48-1.86) and 2.33 (95% CI 2.04-2.66) in male.

CONCLUSIONS

Elevated TyG index at baseline and long-term TyG index trajectories were associated with the risk of hypertension. Early identification of increasing TyG index could provide insights for preventing hypertension later in life.

Triglyceride-glucose index is associated with a higher risk of stroke in a hypertensive population

BACKGROUND

This study aimed to evaluate the association of triglyceride-glucose (TyG) index, an insulin resistance surrogate biomarker, with first stroke in a hypertensive population and to explore potential influencing factors.

METHODS

This study, a cohort study among a rural Chinese hypertensive population, utilized data from the China Stroke Primary Prevention Trial (CSPPT). The TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. Multivariate analysis using Cox proportional hazards models was conducted.

RESULTS

A total of 7569 hypertensive patients were included in this study. When TyG index was assessed as quartiles, compared with the reference group (Quartile 1), the hazard ratio of stroke was 1.04 in Quartile 2, 1.43 in Quartile 3, and 1.45 in Quartile 4, with a significant trend test (P = 0.013). When Quartiles 3 and 4 were combined (≥ 8.8), the hazard ratio was 1.41 compared with combined Quartiles 1 and 2 (< 8.8). Similar findings were observed for the association of TyG index with ischemic stroke. Further, a joint effect of baseline TyG index and age on first stroke was found. Using the group with TyG < 8.8 and age < 60 years as a reference, the highest hazard ratio of stroke was found in the group with a higher TyG index and aged 60 or greater (HR: 2.15, 95% CI 1.50, 3.07, P < 0.001).

CONCLUSIONS

In a hypertensive population, baseline TyG index was associated with a significantly higher risk of first stroke. In addition, age was a significant effect modifier for this association.

Exosomal microRNAs: implications in the pathogenesis and clinical applications of subarachnoid hemorrhage

Subarachnoid hemorrhage (SAH) is a severe acute neurological disorder with a high fatality rate. Early brain injury (EBI) and cerebral vasospasm are two critical complications of SAH that significantly contribute to poor prognosis. Currently, surgical intervention and interventional therapy are the main treatment options for SAH, but their effectiveness is limited. Exosomes, which are a type of extracellular vesicles, play a crucial role in intercellular communication and have been extensively studied in the past decade due to their potential influence on disease progression, diagnosis, and treatment. As one of the most important components of exosomes, miRNA plays both direct and indirect roles in affecting disease progression. Previous research has found that exosomal miRNA is involved in the development of various diseases, such as tumors, chronic hepatitis, atherosclerosis, diabetes, and SAH. This review focuses on exploring the impact of exosomal miRNA on SAH, including its influence on neuronal apoptosis, inflammatory response, and immune activation following SAH. Furthermore, this review highlights the potential clinical applications of exosomal miRNA in the treatment of SAH. Although current research on this topic is limited and the clinical application of exosomal miRNA has inherent limitations, we aim to provide a concise summary of existing research progress and offer new insights for future research directions and trends in this field.

Influence of renal function on the ability of TyG Index to predict all-cause mortality

BACKGROUND

The association between triglyceride-glucose (TyG) index and poor prognosis remains controversial. Whether renal function status affects the ability of the TyG index to predict poor prognosis has not yet been elucidated and merits further studies.

METHODS

This retrospective cohort study included 22,031 participants from communities in the U.S. By juxtaposing the TyG categories with the estimated glomerular filtration rate (eGFR, either < 60 mL/min/1.73m2 or ≥ 60 mL/min/1.73m2), participants were categorized into four distinct groups: (1) TyG_L/eGFR_H; (2) TyG_H/eGFR_H; (3) TyG_L/eGFR_L; and (4) TyG_H/eGFR_L. The endpoint was the all-cause mortality rate. Standard Kaplan-Meier plots were constructed and multifactor Cox regression analyses were carried out and restricted cubic spline regression analysis was utilized to assess the association between death and the TyG index for different renal function statuses.

RESULTS

No statistical differences were found in the TyG groups in participants with normal renal function after adjustment for all covariates (P = 0.070). However, in the high TyG index group with renal insufficiency, the risk of all-cause mortality rates was reduced by 18%. (HR, 0.82; CI, 0.69-0.98). The TyG index (high vs. low) and renal function (eGFR < 60 vs. eGFR ≥ 60) had statistically significant interactions with death (P < 0.001). When all covariates were adjusted, the risk of mortality for the TyG_L combined with eGFR_L group was 56% higher than that for the TyG_L combined with eGFR_H group (HR, 1.56; CI, 1.33-1.82). In the renal insufficiency population, a nonlinear relationship was observed between mortality and the TyG index, albeit with a differing pattern (P for nonlinearity < 0.001).

CONCLUSIONS

While it has been known that TyG index was a prognosis marker of CVD, this research highlights that higher TyG index was associated with higher all-cause mortality rates for all participants. Furthermore, renal function status significantly moderates the effect of the TyG index on all-cause mortality in community-dwelling adults.