Association of TyG index and TG/HDL-C ratio with arterial stiffness progression in a non-normotensive population

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

BACKGROUND

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

METHODS

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

RESULTS

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

LIMITATIONS

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

CONCLUSIONS

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

Potential Modulatory Roles of Gut Microbiota and Metabolites in the Associations of Macronutrient-to-Physical Activity Ratios With Dyslipidemia

BACKGROUND

Lifestyle factors toward diet and physical activity (PA) may directly influence the pathophysiology of dyslipidemia. However, the associations of the specific macronutrient-to-PA ratio with dyslipidemia, and the underlying mechanisms regarding gut microbiota and metabolites, remain largely unexplored.

METHODS

Dietary and PA information from 273 participants with or at risk of metabolic syndrome was collected via a food frequency questionnaire and the International Physical Activity Questionnaire. Gut microbial genera and fecal metabolites were profiled through 16S rRNA sequencing and untargeted LC-MS metabolomics, respectively. Machine-learning algorithms were applied to identify gut microbiome features of macronutrient-to-PA ratios and to construct microbiome risk score.

RESULTS

Higher macronutrient-to-PA ratios, especially for high saturated fatty acid intake, were associated with increased risks of dyslipidemia, with adjusted odds ratio (95% CIs) of 2.87 (1.41-5.99) for hypercholesteremia, 2.21 (1.11-4.48) for hypertriglyceridemia, and 2.52 (1.26-5.16) for high low-density lipoprotein cholesterol. Microbiome risk scores were significantly associated with elevated levels of total cholesterol, triglycerides, and low-density lipoprotein cholesterol. Additionally, for each macronutrient-to-PA ratio, a core group of gut microbial genera were identified (eg, Phocaeicola, Lachnoclostridium, Limosilactobacillus, and Tyzzerella), exhibiting positive associations with lipid disorders and superior discrimination capacities for hypercholesterolemia, hypertriglyceridemia, and high low-density lipoprotein cholesterol. Furthermore, we identified 9 metabolites (eg, acetyl phosphate, glycerol, and pyruvic acid), predominantly enriched in dyslipidemia-related pathways and associated with both core gut microbial taxa and macronutrient-to-PA ratios.

CONCLUSIONS

This study identified varied associations between macronutrient-to-PA ratios and dyslipidemia and depicted the potential modulatory roles of gut microbiota and fecal metabolites.

Association between TG/HDL-C and depression in US adults: A nationally representative cross-sectional study

Lipid profile disturbances are frequently observed in depressive patients. Triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) can be reflective of the level of blood lipids. However, it remains unclear whether higher TG/HDL-C increases the risk of depression. This study aimed to investigate the association between TG/HDL-C and depression. In this cross-sectional study, 20,406 participants were analyzed from the National Health and Nutrition Examination Survey between 2005 and 2020. A weighted multivariable logistic regression model, restricted cubic spline regression model and threshold effect analysis were used to explore the association of TG/HDL-C with depression risk. A total of 20,406 participants who had complete data on TG/HDL-C and depression measurement were included in this study (median age 47 years, 50.51% female). Participants with depression had higher TG/HDL-C than those without depression (0.97 [0.54-1.64] vs 0.82 [0.50-1.38], P < .001). TG/HDL-C was associated with an increased risk of depression after adjusting for all covariates (in model 3: odds ratio (OR) = 1.31, 95% confidence interval (CI): 1.04-1.64, P = .02). Moreover, a nonlinear J-shaped relationship was observed between TG/HDL-C ratio and the risk of depression, with an inflection point of 0.402 by threshold effect analysis. These findings indicate that TG/HDL-C has a J-shaped association with the risk of depression (P for non-linearity = .008).

Multimodal Visualization and Explainable Machine Learning-Driven Markers Enable Early Identification and Prognosis Prediction for Symptomatic Aortic Stenosis and Heart Failure With Preserved Ejection Fraction After Transcatheter Aortic Valve Replacement: Multicenter Cohort Study

BACKGROUND

Currently, there is a paucity of literature addressing personalized risk stratification using multimodal data in patients with symptomatic aortic stenosis and heart failure with preserved ejection fraction (HFpEF) following transcatheter aortic valve replacement (TAVR).

OBJECTIVE

This study aimed to enhance the performance of risk assessment models in this patient population by developing a predictive model for adverse outcomes using various machine learning (ML) techniques.

METHODS

This multicenter cohort study included 326 patients diagnosed with severe AS and HFpEF who underwent TAVR between January 2017 and December 2023. Patients were allocated to training (n=195) and independent validation (n=131) sets based on hospital affiliation. A dual-phase feature selection process, combining least absolute shrinkage and selection operator logistic regression and the Boruta algorithm, was used to identify relevant variables from the multimodal dataset. A total of 5 ML model-decision trees, K-nearest neighbors, random forest, support vector machine, and extreme gradient boosting were used to construct a visualization and explainable predictive framework to elucidate model decision-making processes.

RESULTS

The primary features identified included age, N-terminal pro-brain natriuretic peptide, fasting blood glucose, triglyceride/high-density lipoprotein cholesterol ratio, triglyceride glucose index, triglyceride glucose-BMI index, atherogenic index of plasma index, and Apolipoprotein B. Among the 5 models, the support vector machine demonstrated the best predictive performance for major adverse cardiovascular and cerebrovascular events in patients with severe AS and HFpEF following TAVR, achieving an area under the curve of 0.756 (95% CI 0.631-0.881) in the independent validation set. The model exhibited good calibration and robust predictive power in both training and validation sets and demonstrated the highest net benefit in decision curve analysis compared to other models. To extract significant variables influencing the algorithm and ensure model appropriateness, we interpreted cohort and personalized model predictions using Shapley Additive Explanations values.

CONCLUSIONS

Our ML-based multimodal model, incorporating 8 readily accessible predictors, demonstrated robust predictive capability for 12 months of major adverse cardiovascular and cerebrovascular events risk. This model can be used to identify high-risk individuals with AS and HFpEF following TAVR, potentially aiding in risk stratification and personalized treatment strategies.

Inverse association of triglyceride-glucose and triglyceride/HDL-c indexes with serum 25(OH) vitamin D levels in US adults

The triglyceride-glucose index (TyG) and the triglyceride to high-density lipoprotein ratio (TG/HDL-c) are novel indicators for assessing insulin resistance (IR) in epidemiological studies. This study aimed to evaluate the association between 25-hydroxy-vitamin D [25(OH)D] levels and these two indicators in the adult population of the United States. 14,380 participants aged 20 years and older were included from the National Health and Nutrition Examination Survey (NHANES). Multivariable linear regression models were used to analyze the association between 25(OH)D and TyG, as well as TG/HDL-c. Smooth fitting curves were employed to identify potential non-linear relationships between 25(OH)D, TyG, and TG/HDL-c. The findings revealed a negative association between 25(OH)D and TyG, with the effect being more pronounced in males and individuals with diabetes (p < 0.01). Similarly, 25(OH)D was negatively associated with TG/HDL-c, with a stronger impact observed in males compared to females. The study population was divided into four quartiles based on 25(OH)D concentration, and TyG and TG/HDL-c levels in Q3 and Q4 were lower than those in Q1. Furthermore, a non-linear relationship was observed between 25(OH)D and TyG, with an inflection point at 19.352 ng/mL. A non-linear relationship was also found between TG/HDL-c and 25(OH)D, with an inflection point at 37.211 ng/mL. 25(OH)D is an independent factor significantly associated with TyG and TG/HDL-c indexes. This negative association may be related to the role of 25(OH)D in insulin resistance.

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.

High Cumulative Non-High-Density Lipoprotein-Cholesterol Concentration Increases the Risk of New-Onset Arterial Stiffness - A Prospective Cohort Study

BACKGROUND

The relationship between cumulative non-high-density lipoprotein-cholesterol (cum-non-HDL-C) and the risk of new-onset arterial stiffness has not been characterized.

METHODS AND RESULTS

A total of 6,852 participants with 3 consecutive measurements of total cholesterol and HDL-C and a baseline brachial-ankle pulse wave velocity (baPWV) <1,400 cm/s during 2010-2011, 2012-2013, and 2014-2015 were included. The cum-non-HDL-C concentrations were determined using time weighting, and the participants were grouped: G1 <130 mg/dL, G2 130-159 mg/dL, G3 160-189 mg/dL, and G4 ≥190 mg/dL. Cox models were used to characterize the relationships between cum-non-HDL-C and arterial stiffness by calculating hazard ratios (HRs) and 95% confidence intervals (CIs). Arterial stiffness (baPWV ≥1,800 cm/s) was present in 327 (4.77%) participants over a median follow-up period of 7.7 (interquartile range 7.2-8.2) years. After adjustment for multiple confounders, G2-4 had adjusted HRs (95% CIs) of 1.12 (0.85, 1.48), 1.45 (1.05, 1.99), and 2.52 (1.69, 3.74), respectively (P=0.0004), vs. G1. The adjusted HRs (95% CIs) for exposures of 2, 4, and 6 years were 1.17 (0.87, 1.58), 1.46 (1.96, 2.01), and 1.67 (1.14, 2.44), respectively (P=0.0029), vs. 0 years. Restricted cubic spline analysis revealed a linear dose-response relationship between cum-non-HDL-C and arterial stiffness risk.

CONCLUSIONS

A high cum-non-HDL-C concentration and prolonged exposure to this increase the risk of arterial stiffness. The monitoring and maintenance of appropriate cum-non-HDL-C may reduce the risk of arterial stiffness.

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Association between TG/HDL-C and hypertension in Chinese middle-aged and older adults: findings from CHARLS

BACKGROUND

The triacylglycerol to high-density lipoprotein cholesterol ratio (TG/HDL-C) has been recognized as one of the risk factors for cardiovascular diseases, insulin resistance and metabolic syndrome. We aimed to investigate the relationship between TG/HDL-C and hypertension in a Chinese middle-aged and elderly population.

METHODS

We used data from the CHARLS database 2011-2018 to explore the relationship between TG/HDL-C and hypertension through cross-sectional and longitudinal studies. Hypertension was identified by self-report or taking anti-hypertensive medications. Participants aged below 45, or with missing data on TG/HDL-C or hypertension record, or taking lipid-lowering medication were excluded. Participants were divided into three or two groups based on triplets TG/HDL-C and median TG/HDL-C in cross-sectional and longitudinal analysis. Multivariate logistic regression analysis, subgroup analysis, and restricted cubic splines were used in statistics.

RESULTS

In the cross-sectional analysis, a total of 12,824 participants were included, after adjusting for potential confounders, there was a significant association between higher TG/HDL-C and increased prevalence of hypertension (OR = 1.86, 95% CI: 1.65-2.09, p < 0.001), systolic blood pressure (SBP) above 140 mmHg (OR = 1.37, 95% CI: 1.25-1.50, p < 0.0001), diastolic blood pressure (DBP) above 90 mmHg (OR = 1.47, 95% CI: 1.29-1.67, p < 0.0001), and pulse pressure (PP) above 60 mmHg (OR = 1.17, 95% CI: 1.07-1.29, p < 0.0011). The longitudinal analysis included 7909 participants, there was a significant association between higher TG/HDL-C and increased incidence of hypertension (OR = 1.51, 95% CI: 1.32-1.73,p < 0.001). Restricted cubic splines show nonlinear relationship between TG/HDL-C and hypertension.

CONCLUSION

These results demonstrated significant positive association between TG/HDL-C and the prevalence & incidence of hypertension, in a nationwide representative middle-aged and elderly population in China.

Establishing and internally validating a predictive model for coronary heart disease incorporating triglyceride-glucose index, monocyte-to-high-density lipoprotein cholesterol ratio and conventional risk factors in patients experiencing chest pain and referred for invasive coronary angiography

BACKGROUND

Coronary heart disease (CHD) represents a severe form of ischemic cardiac condition that necessitates timely and accurate diagnosis. Although coronary angiography (CAG) remains widely used to detect CHD, healthcare facilities, medical expenses, and equipment technology often limit its availability. Therefore, it is imperative to identify a non-invasive diagnostic approach with high accuracy for CHD.

METHODS

This cross-sectional research included patients with chest pain (≥ 18 years) hospitalized at Chengde Central Hospital between September 2020 and March 2024. Among the participants, 70% were split into the training, and 30% were randomly entered into the validation sets. In the training dataset, univariate and multivariate logistic regression analyses were rigorously employed to ascertain predictors of CHD. A model was formulated by incorporating these predictors in a nomogram, which was evaluated for accuracy using calibration curves. The model's discrimination was quantified by calculating the area under the receiver operating characteristic (ROC) curve, denoted as the area under the curve (AUC), and its clinical application value was determined through decision curve analysis (DCA). Finally, we compare our model against the pretest probability (PTP) calculated by the Update Diamond-Forrester Model (UDFM) as recommended by the ECS guidelines to comprehensively assess its performance.

RESULTS

This study included 1501 patients who presented with chest pain, with a mean age of 60.45 years, 865 males (57.60%). Multivariate logistic regression analysis revealed TyG index, MHR, male, age, diabetes, systolic blood pressure (SBP), regional wall motion abnormality (RWMA), ST-T changes, and low-density lipoprotein cholesterol (LDL-C) as independent predictors of CHD. A novel nomogram incorporating these independent risk factors exhibited high accuracy and perfect consistency, with a training set AUC calculated to be 0.733 (95% CI: 0.698-0.768), and the validation set maintained a strong performance at 0.721 (95% CI: 0.663-0.779). The calibration curves and the Hosmer-Lemeshow test confirmed the well-fitting model (P = 0.576 and P = 0.694). ROC curve analysis and DCA demonstrated that the model has robust forecasting capability.

CONCLUSION

The nomogram model in this study exhibited good discriminative ability, calibration, and a favorable net benefit. Its predictive performance exceeds that of the traditional PTP tool and may serve as a non-invasive and promising approach to aid clinicians in the early identification of CHD risk in patients presenting with chest pain.

Association Between Triglyceride/High-Density Lipoprotein Ratio and Incidence Risk of Heart Failure: A Population-Based Cohort Study

Background/Objectives: The triglyceride/high-density lipoprotein (TG/HDL) ratio serves as a simple marker for insulin resistance. We investigated whether the TG/HDL ratio would be associated with the incidence risk of heart failure (HF). Methods: The study utilized data from the National Health Insurance Service-Health Screening Cohort database of South Korea from 2002 to 2019. The TG/HDL ratio was utilized as a time-dependent covariate or average value of at least three times throughout the follow-up period. The outcome of interest was incident heart failure (HF) corresponding with the International Classification of Disease, Tenth Revision code of I50. Results: A total of 293,968 individuals were included in this study. During the median 9.6 years (interquartile range 9.2-10.13), 27,852 individuals (9.47%) had a cumulative incidence of HF. Considering the multivariable time-dependent Cox proportional hazard model with the repeated measures of the TG/HDL ratio, per unit increase in the TG/HDL ratio significantly increased the risk of HF in the entire cohort (hazard ratio (HR): 1.007, 95% confidence interval (CI): 1.002-1.011), diabetes mellitus (DM) cohort (HR: 1.006. 95% CI: 1.002-1.010), and non-DM cohort (HR: 1.008, 95% CI: 1.003-1.013). Regarding average TG/HDL ratio quartiles, compared to the lowest quartiles (Q1), the highest quartiles (Q4) were positively associated with the incidence risk of HF accompanied by a significant p for trend (HR: 1.114, 95% CI: 1.075-1.155) in fully adjusted multivariable analysis. Conclusions: Our study demonstrated that the repeatedly measured TG/HDL ratio was associated with the incidence risk of HF regardless of the presence of DM history in the general population.

Predictive value of TG/HDL-C and GFR-adjusted uric acid levels on cardiovascular mortality: the URRAH study

BACKGROUND

Insulin resistance (IR) and serum uric acid (SUA) are closely interconnected: SUA contributes to adversely affects the insulin signaling pathway and contributes to IR, while IR is a known predictor for the development of hyperuricemia. The triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio has been proposed as an easily obtainable marker for IR. This research aimed to investigate the interaction between IR and glomerular filtration rate (GFR)-adjusted uricemia (SUA/GFR ratio) in determining CV risk in a large population cohort study.

METHODS

Data from 18,694 subjects were analyzed from Uric acid Right foR heArt Healt (URRAH) database. The study evaluated the association between TG/HDL-C ratio and SUA/GFR ratio, as well as their impact on the development of outcomes during the follow-up study period. The primary endpoint was CV mortality.

RESULTS

After a mean follow-up of 124 ± 64 months, 2,665 (14.2%) CV deaths occurred. The incidence of fatal and non-fatal CV events increased in parallel with the increase of TG/HDL-C quintiles. TG/HDL-C ratio showed a positive association with increasing of SUA/GFR ratio, even in non-diabetic patients. Multivariate analysis showed that the TG/HDL-C ratio increases the mortality risk even after adjustment for potential confounding factors. Finally, IR and GFR-adjusted hyperuricemia showed an additive effect on CV mortality.

CONCLUSIONS

Both IR and SUA/GFR ratio independently predict CV mortality, regardless of age, gender, BMI, diabetes, hypertension and statin use. The joint effect of the TG/HDL-C ratio and the elevated SUA/GFR ratio was greater than the presence of each single risk factor on CV mortality. This highlights the importance of monitoring these markers to better assess cardiovascular risk.

Triglyceride-glucose-body mass index and the incidence of cardiovascular diseases: a meta-analysis of cohort studies

BACKGROUND

Numerous studies have shown that insulin resistance (IR) is closely related to the pathogenesis of cardiovascular disease (CVD). This study aims to summarize the correlation between the triglyceride-glucose-body mass index (TyG-BMI index), a novel surrogate indicator of insulin resistance, and the incidence of CVD in patients without CVD at baseline through meta-analysis.

METHOD

Cohort studies assessing multivariate-corrected hazard ratios (HRs) for associations between the TyG-BMI index and cardiovascular disease (CVD) were obtained by searching PubMed, Cochrane Library, EMBASE, and Web of Science. Results were combined using a random-effects model to account for heterogeneity among the included studies. Robust error meta-regression was used to fit the nonlinear dose-response relationship. Statistical analysis was performed using Review Manager 5.4 and STATA 18.0.

RESULT

Ten cohort studies involving a total of 871,728 subjects were included. The results indicated that Compared with the lowest TyG-BMI index category, the highest TyG-BMI index was related to a higher incidence of cardiovascular diseases (CVD) (HR = 1.62; 95% confidence interval (CI): 1.35-1.95; I2 = 94%),coronary artery disease (CAD) (HR = 1.69; 95% (CI): 1.23-2.31; I2 = 94%). stroke(HR = 1.57; 95% (CI): 1.11-2.23; I2 = 94%).In the dose-response analysis, there was a linear association of the TyG-BMI index with the risk of CVD (Pnonlinear = 0.223), CAD (Pnonlinear = 0.693), and stroke (Pnonlinear = 0.122)No significant effects were observed regarding participants' gender, length of follow-up, sample size or mean age(P > 0.05).

CONCLUSION

Higher TyG-BMI may be independently associated with an increased risk of CVD in individuals without CVD at baseline. Numerous cohort studies are needed to further validate and elucidate the pathologic role between Tyg-BMI and CVD and to determine whether it can be incorporated into CVD risk prediction tools to enhance predictive accuracy.

Association of the triglyceride glucose index with obesity indicators and hypertension in American adults based on NHANES 2013 to 2018

This cross-sectional study aimed to investigate the association between the TyG index and both obesity indicators and hypertension among American adults. Data were drawn from 4,813 adults in the 2013-2018 National Health and Nutrition Examination Survey (NHANES). Multivariate logistic regression models indicated significant associations between TyG and obesity-related indices with hypertension. Using Cox regression analysis, we examined the relationship between TyG and obesity-related indices in relation to hypertensive prognosis, employing threshold effect analysis and fitted smoothed curves for consistency. Subgroup analyses and interaction tests were conducted. Results showed strong correlations between TyG, TyG-BMI, TyG-WHtR, TyG-WC and hypertension, with odds ratios (ORs) of hypertension rising across TyG quartiles (Q1-Q4). Cardiovascular mortality analysis revealed that TyG (HR = 1.89, 95% CI (1.03,3.51), P < 0.05) and the Q2 group (HR = 4.93, 95% CI (1.29,18.80), P < 0.05) were significantly associated with increased risk. A positive correlation between TyG and hypertension was noted below a threshold of 8.1, with inverse associations beyond this point. The TyG-BMI, TyG-WHtR, and TyG-WC exhibited positive correlations with hypertension, although weakened after reaching a certain threshold. These findings suggested that TyG and related indices are associated with hypertension and may aid in understanding risk stratification in this context.

Association between triglyceride/high density lipoprotein ratio and incidence risk of Parkinson's disease: a population-based cohort study

The association between insulin resistance and increased risk of Parkinson's disease (PD) has rarely been investigated. Our study aimed to investigate the association between the triglyceride/high-density lipoprotein (TG/HDL) ratio (which represents insulin resistance), and the incidence risk of PD in the general population. This study was conducted using data from the National Health Insurance Service-Health Screening Cohort Database of South Korea (2002-2019). We enrolled 310,023 participants who had no previous PD history and who had undergone more than three repeated measurements for the TG/HDL cholesterol ratio. The diagnosis of PD was determined using the International Classification of Diseases, 10th Revision code G20, specific reimbursement codes for Rare Intractable Diseases of V124, and a history of anti-PD drug prescription. During a median of 9.64 years (interquartile range 8.72-10.53), 4,587 individuals (1.47%) had an incidence of PD. Considering the multivariable time-dependent Cox proportional hazard model with repeated measures of average TG/HDL cholesterol ratio, a per unit increase in TG/HDL cholesterol ratio significantly increased the risk of PD in the entire cohort (hazard ratio (HR), 1.010; 95% confidence interval (CI), 1.001-1.020). These repeated measures of the average TG/HDL cholesterol ratio were associated with the incidence risk of PD in a J-shaped pattern for the entire diabetes mellitus (DM) and non-DM cohorts in restricted cubic spline analysis. Compared to the lowest tertiles (T1), the highest tertiles (T3) were positively associated with the incidence risk of PD (HR: 1.149, 95% CI 1.065-1.239 in the entire cohort, p for trend < 0.001; HR: 1.175, 95% CI 1.075-1.285 in the non-DM cohort, p for trend < 0.001). In contrast, the lowest (T1) and highest tertiles (T3) were not associated with the incidence risk of PD in the DM cohort (HR: 1.128, 95% CI 0.909-1.348) in fully adjusted multivariable analysis. Our study provides information that TG/HDL ratio may be positively associated with PD incidence risk in a non-DM population in longitudinal setting of the general population.

Association between the triglyceride/high-density lipoprotein (TG/HDL) ratio and incidence of gout: A nationwide cohort study

Introduction

The global burden of gout, a severe and painful arthralgia, is of note and is expected to increase in the future. We aimed to investigate the association between the triglyceride/high-density lipoprotein (TG/HDL) ratio, a simple and validated biomarker for insulin resistance, and the incidence of gout in a longitudinal setting in the general population.

Methods

Our study was conducted using the National Health Insurance Service-Health Screening Cohort database of Republic of Korea (2002-2019). We included 300,107 participants who had no previous history of gout and had data for more than three repeated measurements of the triglyceride-glucose (TyG) index. The incidence of gout was determined using at least two or more claims of the ICD-10 code M10.

Results

During a median 9.62 years (interquartile range 8.72-10.53), 14,116 individuals (4.72%) had a reported incidence of gout. In a fully adjusted multivariable time-dependent Cox proportional hazards model with repeated measures of the TyG index, a unit increase in the index significantly increased the risk of gout in the entire cohort (hazard ratio (HR) = 1.150, 95% confidence interval (CI) 1.116-1.184). In a multivariable Cox proportional model of average TyG index quartiles, comparison of the lowest (Q1) and highest quartiles (Q4) indicated a significant positive association with the incidence of gout (HR: 1.326, 95% CI: 1.260-1.397). This association was non-linear (J-shape) when assessing the entire cohort and the diabetes and non-diabetes cohorts.

Conclusion

Our study demonstrated that increased TyG index was associated with an incidence risk of gout in the general population. Additionally, this association was non-linear (J-shape) not only in the entire cohort, but also in diabetes mellitus and non-diabetes mellitus cohorts. The TyG index may be an important predictor of gout.

Association of Triglyceride-Glucose Index, Triglyceride to High-Density Lipoprotein Cholesterol Ratio, and Related Parameters With Prehypertension and Hypertension

The objective of this study was to investigate the association between triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-c), triglyceride-glucose index (TyG), and related parameters (TyG-BMI, TyG-WC) with prehypertension and hypertension over 45 years old. According to the blood pressure diagnosis, the enrolled individuals were divided into two groups, which were prehypertension and hypertension. In multivariate logistic regression analysis, after adjusting for confounders, the highest quartile groups of TG/HDL-c, TyG, and related parameters showed a significantly increased risk of hypertension compared to the lowest quartile groups, and there was associated with hypertension when comparing the highest TG/HDL-c to the lowest TG/HDL-c and corresponding ORs were 1.416 (1.234, 1.625) and 1.029 (0.893, 1.187), respectively. Furthermore, when comparing the fourth quartile to the first quartile of TG/HDL-c, TyG index, and related parameters, respectively, both corresponding ORs of hypertension were higher than prehypertension. Elevated TyG, TyG-BMI, TyG-WC index, and TG/HDL-c ratio levels were associated with hypertension in individuals over 45 years. Moreover, the receiver operating characteristic curve was used to compare the predictive ability of each parameter in identifying people with hypertension suggested that the TyG-WC index ([Area under the curve] AUC: 0.601 [CI: 0.588-0.615]), TyG-BMI, and TyG were more significant than TG/HDL-c in distinguishing hypertension. However, in the prehypertension population, the area under the ROC curve for TyG-BMI (0.543 [CI: 0.530-0.556]) was better than that of other parameters. They have the potential to become cost-effective monitors in the hierarchical management of hypertension.

Association between the triglyceride-glucose index and carotid artery plaque burden in patients with primary hypertension: A cross-sectional study

BACKGROUND

Studies have shown an association between the triglyceride-glucose (TyG) index and carotid artery plaque (CAP). However, the relationship between the TyG index and plaque burden in individuals with primary hypertension remains uncertain. Our study specifically aimed to explore this relationship among primary hypertension patients.

METHODS

This study involved 5,153 hospitalized patients diagnosed with primary hypertension who were undergoing treatment at the Affiliated Hospital of Jiangxi University of Chinese Medicine. We utilized multivariate logistic regression, penalized spline regression, and generalized additive models to assess the association between the TyG index and CAP burden.

RESULTS

There were 2,400 patients with primary hypertension in all. The multivariate study, which took into account all covariables, showed a positive correlation between the TyG index and CAP (OR: 1.25, 95% CI: 1.04-1.5). When the TyG index was evaluated as quartiles, the risk of CAP in the Q3 and Q4 levels of the TyG index were 1.4 (95% CI: 1.03-1.91) and 1.54 (95% CI: 1.11-2.14) times greater than in the Q1 level after adjusting for all covariables (P for trend < .05). Regardless of whether the TyG index was used as a continuous variable or a categorical variable, it has no significant association with the risk of single plaque after adjusting for all confounders (p ≥ .05). The TyG index was found to be substantially correlated with the presence of multiple plaques when analyzed as a continuous variable (OR: 1.32, 95% CI: 1.09-1.59, p = .004). When the TyG index was evaluated as quartiles, the adjusted OR in Q3 and Q4 were 1.49 (95% CI: 1.06-2.1) and 1.67 (95% CI: 1.16-2.41), respectively, with Q1 as reference (P for trend = .005). The relationship between the TyG index and the presence of multiple plaques is also consistent in all subgroups.

CONCLUSION

The TyG index is positively associated with the presence of multiple plaques in patients with primary hypertension, whereas no association is found between the TyG index and the presence of a single carotid plaque.

Association Between Percent Body Fat Reduction and Changes of the Metabolic Score for Insulin Resistance in Overweight/Obese People with Metabolic Dysfunction-Associated Steatotic Liver Disease

Purpose

This study investigated the relationship between the difference in percent body fat (∆PBF) decrease and the change in the metabolic score for insulin resistance (METS-IR) in Chinese overweight/obese people with combined metabolic dysfunction-associated steatotic liver disease (MASLD) after weight loss.

Patients and Methods

A total of 357 overweight/obese MASLD patients were included using a retrospective study method. The subjects were divided into two groups (< 5% and ≥ 5%) based on the ∆PBF. The changes in METS-IR (∆METS-IR) and metabolic indices before and after fat loss were compared between the two groups. Spearman correlation analysis was employed to investigate the correlation between METS-IR changes and the decrease in PBF. A linear regression model was fitted using a restricted cubic spline (RCS) curve to investigate the dynamic relationship between ∆METS-IR and ∆PBF.

Results

Following the fat reduction, both groups' body measurements and liver fat content exhibited a notable reduction, accompanied by a decline in METS-IR. In particular, the decrease in METS-IR was more pronounced in the group with a ≥5% decrease in PBF. Significant correlations were observed between ∆PBF and various insulin resistance indices. The correlation between ΔPBF and ∆METS-IR was noteworthy (r = 0.438, p < 0.001). RCS analysis revealed that when ΔPBF exceeded 3.2%, ∆METS-IR exhibited an upward trend with further reduction in PBF.

Conclusion

The reduction of PBF was closely associated with changes in METS-IR, indicating that fat loss is an effective method for improving insulin resistance in overweight/obese MASLD patients.

Longitudinal analysis of insulin resistance and sarcopenic obesity in Chinese middle-aged and older adults: evidence from CHARLS

Objective

The correlation between surrogate insulin resistance (IR) indices and sarcopenic obesity (SO) remains uncertain. This study aimed to assess the association between six IR surrogates-triglyceride-glucose (TyG), TyG-waist circumference (TyG-WC), TyG-waist-to-height ratio (TyG-WHtR), triglyceride-to-high-density lipoprotein-cholesterol ratio (TG/HDL), metabolic score for insulin resistance (METS-IR), and Chinese visceral adiposity index (CVAI)-and SO risk in a middle-aged and older population in China.

Methods

The study employed longitudinal data obtained from the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2015, involving 6,395 participants. We used multivariate logistic regression models to examine the link between six surrogates and SO. Nonlinear relationships were evaluated using restricted cubic spline analysis, and subgroup analyses were conducted for validation. Receiver operating characteristic (ROC) curves were used to assess predictive capabilities.

Results

Over the course of a 4-year follow-up period, 319 participants (5.0%) developed SO. In the fully adjusted model, all six surrogates were significantly associated with SO. The adjusted odds ratios (ORs) with a 95% confidence interval (95% CI) per standard deviation increase were 1.21 (1.08-1.36) for TyG, 1.56 (1.39-1.75) for TyG-WC, 2.04 (1.81-2.31) for TyG-WHtR, 1.11 (1.01-1.21) for TG/HDL, 1.67 (1.50-1.87) for METS-IR, and 1.74 (1.55-1.97) for CVAI. Notably, TyG-WC, TyG-WHtR, TG/HDL, METS-IR, and CVAI exhibited nonlinear correlations with SO. Conversely, TG/HDL did not exhibit a significant association during subgroup analysis. Furthermore, TyG-WHtR had a significantly larger area under the receiver operating characteristic curve than other indices.

Conclusion

The results indicated that TyG, TyG-WC, TyG-WHtR, METS-IR, and CVAI were significantly and positively associated with SO incidence. Meanwhile, TyG-WC, TyG-WHtR, METS-IR, and CVAI showed nonlinear relationships with SO. Specifically, TyG-WHtR may be the most appropriate indicator for predicting SO among middle-aged and older Chinese adults.

An equation for calculating small dense low-density lipoprotein cholesterol

OBJECTIVE

Small dense low-density lipoprotein cholesterol (sdLDL-C), as an emerging atherogenic factor of cardiovascular diseases, requires additional tests. We aimed to establish a sdLDL-C equation using standard lipid profile and evaluate its capacity of identifying the residual cardiovascular risk beyond LDL-C and apolipoprotein B (ApoB).

METHODS

This cross-sectional study included 25 435 participants from Health Management Cohort and 11 628 participants from China Health and Retirement Longitudinal Study (CHARLS) to construct and evaluate the sdLDL-C equation by least-squares regression model. The equation for sdLDL-C depended on low-density lipoprotein cholesterol (LDL-C) and an interaction term between LDL-C and the natural log of triglycerides (TG).

RESULTS

The modified equation (sdLDL-C = 0.14*ln(TG)*LDL-C - 0.45*LDL-C + 10.88) was more accurate than the original equation in validation set (slope = 0.783 vs. 0.776, MAD = 5.228 vs. 5.396). Using the 80th percentile (50 mg/dL) as a risk-enhancer rule for sdLDL-C, accuracy of the modified equation was higher than the original equation in validation set (90.47% vs. 89.73%). The estimated sdLDL-C identified an additional proportion of high-risk individuals in BHMC (4.93%) and CHARLS (1.84%).

CONCLUSION

The newly developed equation in our study provided an accurate tool for estimating sdLDL-C level among the Chinese population as a potential cardiovascular risk-enhancer.

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.

Association between triglyceride glycemic index and ejection fraction preserved heart failure in hypertensive patients

Background

The triglyceride-glucose (TyG) index is regarded as an independent predictor of cardiovascular disease consequences and a reliable surrogate measure of insulin resistance (IR). However, the correlation analysis between triglyceride glucose index and heart failure with preserved ejection fraction in patients with essential hypertension remains unknown.

Methods

A single-center, retrospective study was conducted with patients diagnosed with essential hypertension at the First Affiliated Hospital of Xinjiang Medical University, from December 2018 to September 2020. Participants were selected based on specific inclusion and exclusion criteria, with their clinical data and laboratory tests collected. The study employed Spearman's correlation analysis, logistic regression models, restricted cubic spline plots, and receiver operating characteristic (ROC) curves to investigate the relationships between the TyG index and HFpEF.

Results

Out of 1,602 enrolled hypertensive patients, 992 were included in the analysis after applying exclusion criteria. Patients were categorized into tertiles based on the TyG index, which showed that patients in the highest tertile had characteristics associated with a higher risk of HFpEF, including age, body mass index (BMI), systolic blood pressure (SBP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and left ventricular mass index (LVMI). A significant, independent association between the TyG index and HFpEF was confirmed, with an odds ratio (OR) of 5.127 (95% CI [3.894-6.856]). Furthermore, an S-shaped nonlinear relationship was observed between the TyG index and the incidence of HFpEF (nonlinear p < 0.001). TyG index (AUC: 0.824, 95% CI [0.795-0.854]), NT-proBNP (AUC: 0.840, 95% CI [0.816-0.864]), and LVMI (AUC: 0.847, 95% CI [0.820-0.875]) showed good predictive ability for HFpEF. In addition, the TyG+LVMI combination demonstrated the strongest predictive ability (AUC: 0.907, 95% CI [0.887-0.927]).

Conclusion

The study underscores a significant association between IR, as indicated by the TyG index, and the development of HFpEF in hypertensive patients. It highlights the critical role of metabolic dysfunction in the pathophysiology of HFpEF, advocating for a broader perspective on cardiovascular risk management.

Investigating the association between the triglyceride-glucose index and peripheral artery disease: a systematic review and meta-analysis

BACKGROUND

Peripheral artery disease (PAD) is a common disease associated with atherosclerosis, leading to significant mortality and morbidity worldwide. Our study focuses on the association between insulin resistance (IR) and PAD, specifically investigating the triglyceride-glucose index (TyG) as a potential surrogate marker of IR in the context of PAD by pooling the existing studies on this topic.

METHODS

Online databases, including PubMed, Embase, Scopus, and the Web of Science, were searched to find the studies comparing the TyG index in PAD vs. control, reporting the TyG index among PAD severities, and assessing the association of increase in TyG with PAD prevalence. Random-effect meta-analysis was performed to calculate the standardized mean difference (SMD) and 95% confidence interval (CI) for TyG level comparison and to calculate pooled odds ratio (ORs) for a 1-unit increase in TyG and higher vs. lower quartile/tertile of TyG association with PAD.

RESULTS

In the final review, 22 studies comprising 73,168 cases were included. Random-effect meta-analysis showed that patients with PAD had significantly higher levels of the TyG index compared with controls (SMD 0.76, 95%CI 0.65-0.88, P < 0.001). Also, higher severities of PAD were associated with higher TyG levels (SMD 0.48, 95%CI 0.22-0.74, P = 0.0003). Additionally, a 1-unit increase in TyG was associated with a 60% increase in odds of PAD (OR 1.60, 95%CI 1.41-1.80, P < 0.001). Finally, the highest quartile (Q4) of TyG had significantly higher odds of PAD compared to Q1 (OR 1.94, 95%CI 1.49-2.54, P < 0.001).

CONCLUSION

Our meta-analysis has identified a significant association between TyG levels and PAD and its severity. These findings not only contribute to our understanding of the role of IR in PAD pathology but also offer clinicians an exact index for evaluating PAD risk and its complications. This could potentially lead to more effective prevention and management strategies in the future.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Prognostic Value of Estimated Glucose Disposal Rate and Systemic Immune-Inflammation Index in Non-Diabetic Patients Undergoing PCI for Chronic Total Occlusion

BACKGROUND AND OBJECTIVES

Chronic total occlusion (CTO) is a complex lesion of coronary artery disease (CAD) with a detection rate of approximately 25% on coronary angiography. CTO patients generally experience poor quality of life and prognosis. This study aims to evaluate the association between the estimated glucose disposal rate (eGDR), a surrogate marker for insulin resistance (IR), and the prognosis of CTO PCI patients, as well as to investigate the potential role of the systemic immune-inflammation index (SII) in this process.

METHODS

We retrospectively included 1482 non-diabetic patients who underwent successful CTO PCI at Anzhen Hospital between January 2018 and December 2021. The primary endpoint was major adverse cardiovascular events (MACEs). Clinical characteristics, biochemical markers, and interventional records were collected, and the eGDR and SII were calculated. Cox regression, restricted cubic splines (RCSs), receiver operating characteristic (ROC) analysis, and Kaplan-Meier curves were used to assess associations.

RESULTS

MACEs occurred in 158 patients (10.67%). Patients with MACEs had lower eGDR and higher SII levels. A high eGDR significantly reduced MACE risk (Q4 vs. Q1: HR 0.06, 95% CI 0.03-0.12), while a high SII increased it (Q4 vs. Q1: HR 3.32, 95% CI 1.78-6.33). The combination of low eGDRs and high SIIs predicted the highest MACE risk (HR 4.36, 95% CI 2.71-6.01). The SII partially mediated the relationship between eGDR and MACEs.

CONCLUSIONS

A low eGDR and high SII are significant predictors of poor prognosis in non-diabetic CTO PCI patients. Combining the eGDR and the SII provides a comprehensive assessment for better predicting cardiovascular outcomes.

Association of higher triglyceride-glucose index and triglyceride-to-high-density lipoprotein cholesterol ratio with early neurological deterioration after thrombolysis in acute ischemic stroke patients

Background

Insulin resistance (IR) can predict the prognosis of patients suffering from cerebrovascular disorders. The triglyceride-glucose (TyG) index and triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio have been confirmed to be easy and reliable indicators of IR. However, the relationships between the TyG index or TG/HDL-C ratio and early neurological deterioration (END) after thrombolysis in patients with acute ischemic stroke (AIS) are uncertain.

Methods

A retrospective analysis of 1,187 patients diagnosed with AIS who underwent intravenous thrombolysis between January 2018 and February 2024 was performed. Post-thrombolysis END was defined as an increase in the National Institutes of Health Stroke Scale (NIHSS) score of ≥4 within 24 h after thrombolysis. Logistic regression analysis was performed to explore the relationships of the TyG index and TG/HDL-C ratio with post-thrombolysis END. Receiver operating characteristic (ROC) analysis was used to assess the ability of the TyG index and TG/HDL-C ratio to discriminate post-thrombolysis END.

Results

Among the 1,187 recruited patients, 179 (15.08%) were diagnosed with post-thrombolysis END, and 1,008 (84.92%) were diagnosed with non-END. A binary logistic regression model indicated that the TyG index (odds ratio [OR], 2.015; 95% confidence interval [CI] 1.964-2.414, p = 0.015) and TG/HDL-C ratio (OR, 1.542; 95% CI, 1.160-2.049, p = 0.004) were independent factors for post-thrombolysis END. The area under the curve (AUC) values for the TyG index, TG/HDL-C ratio, and TyG index combined with the TG/HDL-C ratio for post-thrombolysis END were 0.704, 0.674, and 0.755, respectively.

Conclusion

This study indicates that the TyG index and TG/HDL-C ratio can be used as prognostic factors to predict post-thrombolysis END.

Interacting and joint effects of triglyceride-glucose index and blood pressure on cardiovascular diseases risk: a prospective cohort study

AIMS

The triglyceride-glucose (TyG) index and hypertension (HTN) are established risk factors of CVD. However, there is a dearth of studies investigating the synergistic influence of the elevated TyG index and HTN on CVD risk, as well as any potential interaction between these factors.

METHOD

For this investigation, we enlisted 88,384 individuals from the Kailuan Study who did not have a history of stroke, myocardial infarction, or cancer at baseline. Incidences of CVD between 2006 and 2021 were confirmed through a thorough review of medical records. Participants were categorized into 6 groups according to BP status(normal/elevated BP, stage 1 and stage 2) or the TyG index(low and elevated group), respectively. The Cox proportional hazard regression models were used to assess the association of BP status and TyG index with incident CVD. The multiplicative and additive interactions were also determined.

RESULTS

Following a mean follow-up period of 13.66 ± 3.24 years, incidents of CVD, MI, and stroke were observed in 8,205, 1,728, and 6,705 individuals, respectively. The BP category and TyG index additively increased the risk of CVD, MI and stroke. There were significant interacting and joint effects of TyG index and BP status on CVD risk. Additionally, stratification analysis further confirmed that the relative contribution of hypertension to the CVD development decreased with deteriorating TyG index and that of TyG index was attenuated with increasing BP status.

CONCLUSION

Our study demonstrated that a significant interaction between TyG index and BP status on the risk of CVD.

The triglyceride glucose index was nonlinearly associated with all-cause mortality in diabetic patients

BACKGROUND AND AIM

The TyG index has been linked with cardiometabolic diseases. Our study aimed to investigate the specific relationship between the triglyceride and glucose index (TyG) and both all-cause and cardiovascular mortality in diabetic patients.

METHODS AND RESULTS

We enrolled 3120 participants with diabetes from the National Health and Nutrition Examination Survey. The TyG index was calculated using the formula ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Hazard ratios (HRs) of TyG associated with mortality risk were assessed using Cox proportional hazard regression models. Over a follow-up period of 10.8 thousand person-years, we observed 768 all-cause deaths and 155 cardiovascular deaths. Compared to the reference quartile, the multivariate-adjusted hazard ratios and 95% confidence intervals for all-cause mortality were 1.02 (1.01-1.05; p = 0.008) in the fourth quartile. Dose-response analysis revealed a non-linear association. However, no significant associations were found between the TyG index and cardiovascular mortality.

CONCLUSIONS

The TyG index exhibited a non-linear association with the risk of all-cause mortality in diabetic patients.

Arterial stiffness progression in metabolic dysfunction-associated fatty liver disease subtypes: A prospective cohort study

BACKGROUND AND AIMS

We aimed to investigate the correlation and to explore which MAFLD subtypes have the greatest influence on progression of arterial stiffness risk.

METHODS AND RESULTS

Using data from a health examination-based cohort, a total of 12,129 participants who underwent two repeated health examinations that included brachial-ankle pulse wave velocity (baPWV) from 2012 to 2020 were enrolled. Participants were separated into non-MAFLD, overweight/obese (OW-MAFLD), lean/normal weight (lean-MAFLD) and diabetes (DM-MAFLD) groups. Among the participants with a median follow-up of 2.17 years, 4511 (37.2%) participants had MAFLD at baseline, among which 3954 (87.7%), 123 (2.7%), and 434 (9.6%) were OW-, lean- and DM-MAFLD, respectively. Analyses using linear regression models confirmed that compared with the non-MAFLD group, the elevated baPWV change rates (cm/s/year) were 12.87 (8.81-16.94), 25.33 (7.84-42.83) and 38.49 (27.88-49.10) in OW, lean and DM-MAFLD, respectively, while the increased change proportions (%) were 1.53 (1.10-1.95), 3.56 (1.72-5.40) and 3.94 (2.82-5.05), respectively. Similar patterns were observed when these two baPWV parameters were transformed in the form of the greatest increase using Cox proportional hazards model analyses. Furthermore, the risk of arterial stiffness progression across MAFLD subtypes presented a significant, gradient, inverse relationship in the order of DM-, lean-, OW with metabolic abnormalities (MA)-, and OW without MA-MAFLD.

CONCLUSION

MAFLD, especially DM-MAFLD and lean-MAFLD, was significantly associated with arterial stiffness progression, providing evidence that stratification screening and surveillance strategies for CVD risk have important clinical implications.

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.

The roles of lipids and inflammation in the association between the triglyceride-glucose index and arterial stiffness: evidence from two large population-based surveys

BACKGROUND

The triglyceride-glucose (TyG) index is a risk marker for arterial stiffness; however, the extent to which the TyG index is associated with arterial stiffness via lipids and inflammation remains unknown. The first aim was to probe the relationship between the TyG index and arterial stiffness in two surveys. The second aim was to clarify whether lipids and inflammation mediate this relationship.

METHODS

The sample size of 13,726 U.S. individuals from the National Examination Survey (NHANES) and 3,964 Chinese individuals from the China Health and Retirement Longitudinal Study (CHARLS 2015) were enrolled. Weighted multivariate logistic and linear regression models, as well as restricted cubic spline (RCS) and mediation analyses, were utilized to estimate complex relationships between the TyG index, arterial stiffness, lipids (non-high-density lipoprotein cholesterol [non-HDL-C]) and inflammation (C-reactive protein [CRP]) biomarkers.

RESULTS

A total of 3,420 U.S. patients and 992 Chinese patients were diagnosed with increased arterial stiffness. Regression analyses demonstrated that higher quartiles of the TyG index were associated with a greater incidence of increased arterial stiffness (NHANES: OR = 2.610, 95% CI = 2.043-3.334, P < 0.001; CHARLS: OR = 1.579, 95% CI = 1.057-2.360, P < 0.001). Participants with a higher TyG index/higher CRP level or with a higher TyG index/higher non-HDL-C level had the highest incidence of increased arterial stiffness in the two surveys. The results were still consistent when the sensitivity analysis was implemented with stricter clinical cut-off values of non-HDL-C. Mediation analysis verified that lipids (mediated effect: β = 0.012, P < 0.001 in NHANES; β = 0.020, P < 0.001 in CHARLS) and inflammation (mediated effect: β = 0.003, P < 0.001 in NHANES; β = 0.006, P < 0.001 in CHARLS) partially mediated this relationship.

CONCLUSIONS

These results indicated a positive linear correlation between the TyG index, non-HDL-C level, CRP level and increased arterial stiffness in two surveys. Furthermore, lipids and inflammation could partly mediate the correlation of the TyG index with arterial stiffness in both surveys.

Long-term prognostic implications of brachial-ankle pulse wave velocity in patients undergoing percutaneous coronary intervention

Objective

The long-term clinical effect of arterial stiffness in high-risk disease entities remains unclear. The prognostic implications of brachial-ankle pulse wave velocity (baPWV) were assessed using a real-world registry that included patients who underwent percutaneous coronary intervention (PCI).

Methods

Arterial stiffness was measured using baPWV before discharge. The primary outcome was net adverse clinical events (NACE), defined as a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, or major bleeding. Secondary outcomes included major adverse cardiac and cerebrovascular events (MACCE: a composite of all-cause death, non-fatal myocardial infarction, or non-fatal stroke), and major bleeding. The outcomes were assessed over a 4-year period.

Results

Patients (n = 3,930) were stratified into high- and low-baPWV groups based on a baPWV cut-off of 1891 cm/s determined through time-dependent receiver operating characteristic curve analysis. baPWV was linearly correlated with 4-year post-PCI clinical events. The high baPWV group had a greater cumulative incidence of NACE, MACCE, and major bleeding. According to multivariable analysis, the high baPWV groups had a significantly greater risk of 4-year NACE (adjusted hazard ratio [HRadj]: 1.44; 95% confidence interval [CI]: 1.12-1.85; p = 0.004), MACCE (HRadj: 1.40; 95% CI: 1.07-1.83; p = 0.015), and major bleeding (HRadj: 1.94; 95% CI: 1.15-3.25; p = 0.012).

Conclusion

In PCI-treated patients, baPWV was significantly associated with long-term clinical outcomes, including ischemic and bleeding events, indicating its value for identifying high-risk phenotypes.

Comparison of triglyceride glucose index and modified triglyceride glucose indices in prediction of cardiovascular diseases in middle aged and older Chinese adults

BACKGROUND

Triglyceride and glucose (TyG) index, a surrogate marker of insulin resistance, has been validated as a predictor of cardiovascular disease. However, effects of TyG-related indices combined with obesity markers on cardiovascular diseases remained unknown. We aimed to investigate the associations between TyG index and modified TyG indices with new-onset cardiovascular disease and the time-dependent predictive capacity using a national representative cohort.

METHODS

This study is a retrospective observational cohort study using data from China Health and Retirement Longitudinal Study (CHARLS) of 7 115 participants. The TyG index was calculated as Ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. The modified TyG indices were developed combining TyG with body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR). We used adjusted Cox proportional hazards regression to analyze the association and predictive capacity based on hazard ratio (HR) and Harrell's C-index.

RESULTS

Over a 7-year follow-up period, 2136 participants developed cardiovascular disease, including 1633 cases of coronary heart disease and 719 cases of stroke. Compared with the lowest tertile group, the adjusted HR (95% CI) for new-onset cardiovascular disease in the highest tertile for TyG, TyG-BMI, TyG-WC, and TyG-WHtR were 1.215 (1.088-1.356), 1.073 (0.967-1.191), 1.078 (0.970-1.198), and 1.112 (1.002-1.235), respectively. The C-indices of TyG index for cardiovascular disease onset were higher than other modified TyG indices. Similar results were observed for coronary heart disease and stroke.

CONCLUSION

TyG and TyG-WhtR were significantly associated with new-onset cardiovascular diseases, and TyG outperformed the modified TyG indices to identify individuals at risk of incident cardiovascular event.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Remnant Cholesterol is More Strongly Associated with Arterial Stiffness than Traditional Lipids and Lipid Ratios in the General Chinese Population

AIM

Studies on the relationship between remnant cholesterol (RC) and arterial stiffness (AS) are limited. This study aims to investigate the relationship between RC and AS and to explore RC, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), non-HDL-C, LDL-C/HDL-C, TG/HDL-C, lipoprotein combine index (LCI), and TC/HDL-C, which are lipid parameters most strongly associated with AS.

METHODS

A total of 4653 participants from the REACTION (Risk Evaluation of Cancers in Chinese Diabetic Individuals) study were recruited. AS was defined as a brachial-ankle pulse wave velocity of ≥ 1400 cm/s. Multiple logistic regression analyses were performed to detect its association with lipid parameters (RC, TG, TC, HDL-C, LDL-C, non-HDL-C, LDL-C/HDL-C, TG/HDL-C, LCI, and TC/HDL-C).

RESULTS

Logistic regression analysis showed that compared with other traditional or non-traditional lipid parameters, the association between RC and AS was the strongest (odds ratio (OR) 1.59, 95% confidence interval (CI) 1.30-1.95, P＜0.001). In the stratified analysis, RC was significantly associated with AS in both sexes and at any age, as well as blood glucose, blood pressure, and body mass index levels. Besides, RC and AS were still significantly associated when TG＜1.7 mmol/L (OR:1.58, 95% CI: 1.02-2.45, P=0.04), LDL-C ＜3.4 mmol/L (OR:1.32, 95% CI: 1.01-1.73, P=0.041), HDL-C ≥ 1.0 mmol/L (OR:1.67, 95% CI: 1.34-2.08, P＜0.001), or non-HDL-C＜4.1 mmol/L (OR: 1.42, 95% CI: 1.10-1.82, P=0.007) are controlled within the appropriate range.

CONCLUSION

In conclusion, compared with traditional lipids and lipid ratios, RC is more strongly associated with AS. The association between RC and AS remains significant even when TG, LDL-C, HDL-C, or non-HDL-C levels are controlled within the appropriate range.

Dose-response associations of triglyceride to high-density lipoprotein cholesterol ratio and triglyceride-glucose index with arterial stiffness risk

BACKGROUND

The triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio and triglyceride-glucose (TyG) index are novel indexes for insulin resistance (IR). We aimed to evaluate associations of TG/HDL-C and TyG with arterial stiffness risk.

METHODS

We enrolled 1979 participants from the Rural Chinese Cohort Study, examining arterial stiffness by brachial-ankle pulse wave velocity (baPWV). Logistic and linear regression models were employed to calculate effect estimates. For meta-analysis, we searched relevant articles from PubMed, Embase and Web of Science up to August 26, 2023. The fixed-effects or random-effects models were used to calculate the pooled estimates. We evaluated dose-response associations using restricted cubic splines.

RESULTS

For cross-sectional studies, the adjusted ORs (95%CIs) for arterial stiffness were 1.12 (1.01-1.23) and 1.78 (1.38-2.30) for per 1 unit increment in TG/HDL-C and TyG. In the meta-analysis, the pooled ORs (95% CIs) were 1.26 (1.14-1.39) and 1.57 (1.36-1.82) for per 1 unit increment of TG/HDL-C and TyG. Additionally, both TG/HDL-C and TyG were positively related to PWV, with β of 0.09 (95% CI 0.04-0.14) and 0.57 (95% CI 0.35-0.78) m/s. We also found linear associations of TG/HDL-C and TyG with arterial stiffness risk.

CONCLUSIONS

High TG/HDL-C and TyG were related to increased arterial stiffness risk, indicating TG/HDL-C and TyG may be convincing predictors of arterial stiffness.

Association between six different types of anthropometric indices and arterial stiffness measured by brachial-ankle pulse wave velocity in hypertensive Chinese adults

Background

The associations of body fat parameters with arterial stiffness measured by brachial-ankle pulse wave velocity in hypertensive patients were scarce.

Methods

This cross-sectional study analyzed 4322 hypertensive adults. The correlations between the anthropometric indexes (body mass index [BMI], waist circumference, waist-tohip ratio [WHR], waist-to-height ratio [WHtR], a body shape index [ABSI], body round index [BRI]) and ba-PWV values were analyzed using multivariable linear regression model.

Results

In both sex categories, linear regression models showed that BMI levels were inversely related to baPWV (adjusted-β per SD increase in male: -0.51, 95% CI -0.66 to -0.36, P < 0.001; female: -0.50, 95% CI -0.63 to -0.37, P < 0.001). Waist circumference positively correlated with baPWV only in male hypertensive individuals. BaPWV positively correlated to WHR or WHtR levels (adjusted-β per SD increase: 0.32, 95% CI 0.21 to 0.43, P < 0.001; 0.64, 95% CI 0.47 to 0.82, P < 0.001; respectively), ABSI (adjusted-β per SD increase for ABSI × 100: 0.27, 95% CI 0.18 to 0.36, P < 0.001) and BRI (adjusted-β per SD increase: 0.64, 95% CI 0.46 to 0.81, P < 0.001) levels. The relationship between anthropometric indices and arterial stiffness based on baPWV values were also consistent. ABSI had the highest predictive power of arterial stiffness (area under the curve, 0.594; P < 0.001).

Conclusion

In Chinese adults with hypertension, BMI was inversely related to baPWV, while WHR, WHtR, ABSI and BRI were positively related. Waist circumference positively correlated with baPWV only in male hypertensive individuals.

Arterial Stiffness and Obesity as Predictors of Diabetes: Longitudinal Cohort Study

BACKGROUND

Previous studies have confirmed the separate effect of arterial stiffness and obesity on type 2 diabetes; however, the joint effect of arterial stiffness and obesity on diabetes onset remains unclear.

OBJECTIVE

This study aimed to propose the concept of arterial stiffness obesity phenotype and explore the risk stratification capacity for diabetes.

METHODS

This longitudinal cohort study used baseline data of 12,298 participants from Beijing Xiaotangshan Examination Center between 2008 and 2013 and then annually followed them until incident diabetes or 2019. BMI (waist circumference) and brachial-ankle pulse wave velocity were measured to define arterial stiffness abdominal obesity phenotype. The Cox proportional hazard model was used to estimate the hazard ratio (HR) and 95% CI.

RESULTS

Of the 12,298 participants, the mean baseline age was 51.2 (SD 13.6) years, and 8448 (68.7%) were male. After a median follow-up of 5.0 (IQR 2.0-8.0) years, 1240 (10.1%) participants developed diabetes. Compared with the ideal vascular function and nonobese group, the highest risk of diabetes was observed in the elevated arterial stiffness and obese group (HR 1.94, 95% CI 1.60-2.35). Those with exclusive arterial stiffness or obesity exhibited a similar risk of diabetes, and the adjusted HRs were 1.63 (95% CI 1.37-1.94) and 1.64 (95% CI 1.32-2.04), respectively. Consistent results were observed in multiple sensitivity analyses, among subgroups of age and fasting glucose level, and alternatively using arterial stiffness abdominal obesity phenotype.

CONCLUSIONS

This study proposed the concept of arterial stiffness abdominal obesity phenotype, which could improve the risk stratification and management of diabetes. The clinical significance of arterial stiffness abdominal obesity phenotype needs further validation for other cardiometabolic disorders.

Association between cardiometabolic index and controlled attenuation parameter in U.S. adults with NAFLD: findings from NHANES (2017-2020)

BACKGROUND

Cardiometabolic index (CMI), a novel indicator that combines abdominal obesity and lipid levels, has been confirmed to correlate with non-alcoholic fatty liver disease (NAFLD). However, limited research has been conducted on the relationship between CMI and controlled attenuation parameter (CAP), a parameter measured by transient elastography and reflecting the extent of fat accumulation in the liver. The objective of our study was to investigate the relationship between the two variables.

METHODS

This was a cross-sectional study with a sample size of 1,759 U.S. adults with NAFLD sourced from the NHANES 2017-2020. Participants with a median CAP ≥ 248 dB/m were considered to have hepatic steatosis. CMI was calculated as [waist circumference (cm)/height(cm)]×[TG (mmol/L)/HDL-C (mmol/L)]. Multivariate linear regression, generalized additive model and subgroup analysis were employed to examine the association of CMI and CAP.

RESULTS

The average age of the 1,759 participants was 50.2 years, with males accounting for 50.76% and females 49.24%. The average BMI was 32.23 kg/m². The multivariate linear regression model indicated that with every 1-unit increase in CMI, there was an associated rise of 10.40 dB/m in CAP (95% CI, 7.14-13.67) after adjusting for covariates and a p for trend < 0.05 suggested the existence of a linear association between the two variables. Similarly, generalized additive model also found it a roughly linear relationship between the two. Subgroup analysis revealed a positive correlation in the majority of subgroups.

CONCLUSIONS

CMI was positively associated with CAP in U.S. adults with NAFLD. Our findings indicated that CMI may serve as an ideal indicator for monitoring the degree of hepatic steatosis among patients with NAFLD.

Triglyceride-glucose body mass index predicts prognosis in patients with ST-elevation myocardial infarction

Triglyceride glycemic-body mass index (TyG-BMI) is a simple and reliable surrogate for insulin resistance (IR). However, it is still unclear if TyG-BMI has any predictive value in patients having percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). The purpose of this study was to examine the TyG-BMI index's prognostic significance and predictive power in patients with STEMI. The study comprised a total of 2648 consecutive STEMI patients who underwent PCI. The primary endpoint was the occurrence of major adverse cardiovascular events (MACE), defined as the combination of all-cause death, nonfatal myocardial infarction, nonfatal stroke, and coronary revascularization. The TyG-BMI index was formulated as ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2] × BMI. 193 patients in all experienced MACE over a median follow-up of 14.7 months. There was a statistically significant difference between the Kaplan-Meier survival curves for the TyG-BMI index tertiles (log-rank test, p = 0.019) for the cumulative incidence of MACE. The adjusted HRs for the incidence of MACE in the middle and highest quartiles of the TyG-BMI index compared with the lowest quartile were 1.37 (95% CI 0.92, 2.03) and 1.53 (95% CI 1.02, 2.29), respectively, in the fully adjusted Cox regression model. At six months, one year, and three years, the TyG-BMI area under the curve (AUC) for predicting MACE was 0.691, 0.666, and 0.637, respectively. Additionally, adding the TyG-BMI index to the risk prediction model enhanced outcome prediction. In STEMI patients undergoing PCI, TyG-BMI was independently linked to MACE. TyG-BMI could be a simple and solid way to assess MACE risk and prognosis.

Triglyceride-glucose index as a suitable non-insulin-based insulin resistance marker to predict cardiovascular events in patients undergoing complex coronary artery intervention: a large-scale cohort study

BACKGROUND

Insulin resistance (IR), a hallmark of proceeding diabetes and cardiovascular (CV) disease, has been shown to predict prognosis in patients undergoing percutaneous coronary intervention (PCI). The triglyceride-glucose (TyG) index, triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio and metabolic score for insulin resistance (METS-IR) have been shown to be simple and reliable non-insulin-based surrogates for IR. However, limited studies have determined the associations between distinct non-insulin-based IR markers and CV outcomes in patients undergoing complex PCI who are at higher risk of CV events after PCI. Therefore, this study aimed to investigate and compare the prognostic value of these markers in patients undergoing complex PCI.

METHODS

This was a descriptive cohort study. From January 2017 to December 2018, a total of 9514 patients undergoing complex PCI at Fuwai Hospital were consecutively enrolled in this study. The 3 IR indices were estimated from the included patients. The primary study endpoint was CV events, defined as a composite of CV death, nonfatal myocardial infarction and nonfatal stroke.

RESULTS

During a median follow-up of 3.1 years, 324 (3.5%) CV events occurred. Multivariable Cox regression models showed per-unit increase in the TyG index (hazard ratio [HR], 1.42; 95% confidence interval [CI] 1.13-1.77), rather than per-unit elevation in either Ln(TG/HDL-C ratio) (HR, 1.18; 95%CI 0.96-1.45) or METS-IR (HR, 1.00; 95%CI 0.98-1.02), was associated with increased risk of CV events. Meanwhile, adding the TyG index to the original model led to a significant improvement in C-statistics (0.618 vs. 0.627, P < 0.001), NRI (0.12, P = 0.031) and IDI (0.14%, P = 0.003), whereas no significant improvements were observed when adding Ln (TG/HDL-C ratio) or METS-IR (both P > 0.05) to the original model.

CONCLUSIONS

The TyG index, not TG/HDL-C ratio and METS-IR, was positively associated with worse CV outcomes in patients undergoing complex PCI. Our study, for the first time, demonstrated that the TyG index can serve as the suitable non-insulin-based IR marker to help in risk stratification and prognosis in this population.

Association of Abnormal Lung Function and Its Subtypes With Arterial Stiffness: A Longitudinal Cohort Study

BACKGROUND

Prior studies have reported the cross-sectional relationship between lung function and arterial stiffness, while the longitudinal association remains unclear to date. This study aimed to investigate whether abnormal lung function and its subtypes at baseline are associated with increased arterial stiffness using a cohort.

METHODS AND RESULTS

This was a secondary analysis extracting 2461 participants from Beijing Health Management Cohort as baseline and annually followed for development of arterial stiffness. Abnormal lung function was defined by forced expiratory volume in 1s <80% of the predicted value, forced vital capacity of the predicted value, or forced expiratory volume in 1s/forced vital capacity ratio <70%. Increased arterial stiffness was determined by brachial-ankle pulse wave velocity ≥1400 cm/s. Cox proportional hazards model was used to calculate the hazard ratio and population attributable fraction. The mean age was 42.8±8.1 years, and 444 (18.0%) cases developed increased arterial stiffness during a median follow-up of 3.0 years. The adjusted hazard ratio (95% CI) of arterial stiffness was 1.47 (95% CI, 1.10-1.96) for abnormal lung function, with a population attributable fraction of 3.9% (95% CI, 0.8-7.1). Of subtypes, only obstructive ventilatory dysfunction was significantly associated with arterial stiffness (adjusted hazard ratio, 2.06 [95% CI, 1.27-3.36]), not restricted ventilatory dysfunction (adjusted hazard ratio, 0.95 [95% CI, 0.54-1.65]). Consistent results were observed on multiple sensitivity analyses.

CONCLUSIONS

Our study indicated a longitudinal association of abnormal lung function with increased arterial stiffness using a large cohort, especially for the obstructive ventilatory dysfunction.

Association between the metabolic score for insulin resistance (METS-IR) and arterial stiffness among health check-up population in Japan: a retrospective cross-sectional study

Aim

This study examined the association between the metabolic score for insulin resistance (METS-IR), a novel surrogate indicator of insulin resistance, and brachial-ankle pulse wave velocity (baPWV) in Japanese health check participants.

Methods

A cross-sectional research was conducted involving individuals in a program of medical health screening at the Medical Health Check-up Center in Japan. The study assessed the connection between METS-IR and baPWV in 912 participants who joined the program between 3/1/2004 and 12/31/2012. Serum laboratory tests and lifestyle surveys were the covariates. Multivariate linear regression analysis and subgroup analyses were performed.

Results

912 participants were involved in this cross-sectional study. Adjusted for age, sex, BMI, AST, UA, HDL, eGFR, ankle-brachial index (ABI), alcohol consumption, and smoking status, multivariate linear regression analysis showed that METS-IR and baPWV showed a significant positive association (adjusted β=15.3, 95% confidence interval (CI): 6.61~23.98) with METS-IR as a continuous variable. When converting METS-IR to quartile categorical variables, higher quartile METS-IR indices had longer baPWV (Q3 vs Q1, β=86.14, 95% CI: 23.45~148.83; Q4 vs Q1, β=125.41, 95% CI: 39.99~210.84). In subgroup analysis, METS-IR was associated with baPWV in people with eGFR > 60 ml/min (adjusted β= 14.44, 95% CI: 5.61~23.26, P=0.001), none or light alcohol consumption (adjusted β=16.92, 95% CI: 6.85~27, P=0.001), non-smokers (adjusted β=15.48, 95% CI: 5.86~25.1, P=0.002), non-regular exercisers(adjusted β=17.34, 95% CI: 8.03~26.65, P<0.001), non-fatty liver (adjusted β=17.65, 95% CI: 5.92~29.39, P=0.003), and non-hypertensive (adjusted β=16.13, 95% CI:8.45~23.8, P<0.001).

Conclusion

METS-IR are remarkably associated with baPWV among health check-up participants in Gifu, Japan. As a simple, easily calculated predictor of arterial stiffness, METS-IR could be considered for primary care as a monitoring tool to identify people with high risk of cardiovascular disease in order to intervene early on risk factors. Future prospective, large-sample researches are still needed to confirm this.

TyG index is a predictor of all-cause mortality during the long-term follow-up in middle-aged and elderly with hypertension

BACKGROUND

The triglyceride and glucose (TyG) index has been found to be significantly associated with a higher risk of mortality. However, there has been a lack of studies exploring the specific relationship between the TyG index and all-cause and cardiovascular mortality among middle-aged and elderly with hypertension.

METHODS

A total of 3,614 participants with hypertension were enrolled from the National Health and Nutrition Examination Survey. The TyG index was calculated using the formula log [fasting triglycerides (mg/dL) x fasting glucose (mg/dL)/2]. The Cox proportional hazard ratios were used to evaluate the association between the TyG index and the risk of mortality.

RESULTS

Over a follow-up period of 7.87 years, 991 all-cause death and 189 cardiovascular deaths occurred. Compared with the reference quartile, the multivariate-adjusted hazard ratios and 95% confidence intervals were 1.28 (1.07-1.53; p = .006) in the fourth quartile for all-cause mortality and 0.63 (0.42-0.96; p = .031) in the second quartile for cardiovascular mortality. Dose-response analysis indicated an L-shaped relationship.

CONCLUSIONS

The TyG index exhibited an L-shaped association with the risk of all-cause mortality among middle-aged and elderly with hypertension.

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.

Estimated glucose disposal rate and risk of arterial stiffness and long-term all-acuse mortality: a 10-year prospective study

BACKGROUND

To assess the applicability of the association between estimated glucose disposal rate (eGDR) and all-cause mortality in the elderly population, and the mediating role of brachial-ankle pulse wave velocity (baPWV).

METHODS

This was a follow-up cohort study based on the cross-sectional survey of community-dwelling elderly. All participants in the study were included between September 2009 and June 2010, and the follow-up time was December 2020. Participants included 1862 Chinese community-dwelling elderly aged 60 years and above. Insulin resistance assessed by eGDR and arterial stiffness assessed by baPWV were the primary exposures of interest. Mortality, which was followed up until December 2020, was the primary outcome. Cox proportional hazards regression models were used to estimate the association of eGDR with mortality. The mediating effect of baPWV in this association was assessed by mediation analysis.

RESULTS

A total of 1826 participants with a mean age of 71.03 years old were included in the study. During the median follow-up of 10.75 years, 334 participants died. The adjusted HR comparing the highest versus the lowest eGDR quartile was 0.22 (95% CI 0.09 to 0.54; p<0.001) in the Cox proportional hazards model. The results of mediation analysis showed that baPWV had a significant mediation impact on the link between eGDR and all-cause mortality both as continuous or categorical variables.

CONCLUSION

eGDR is an independent predictor of all-cause mortality in the elderly population. baPWV partially mediated the association of eGDR and long-term all-cause mortality as a mediator factor.

Diabetes, glycemic control and arterial stiffness: a real-world cohort study in the context of predictive, preventive, and personalized medicine

Background

Arterial stiffness is a major contributor to morbidity and mortality worldwide. Although several metabolic markers associated with arterial stiffness have been developed, there is limited data regarding whether glycemic control modifies the association between diabetes and arterial stiffness. For these reasons, identification of traits around diabetes will directly contribute to arterial stiffness and atherosclerosis management in the context of predictive, preventive, and personalized medicine (PPPM). Thus, this study aimed to explore the relationship of diabetes and glycemic control status with arterial stiffness in a real-world setting.

Methods

Data of participants from Beijing Xiaotangshan Examination Center (BXEC) with at least two surveys between 2008 and 2019 were used. Cumulative hazards were presented by inverse probability of treatment weighted (IPTW) Kaplan-Meier curves. Cox models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI). Arterial stiffness was defined as brachial-ankle pulse wave velocity (baPWV) ≥1400 cm/s.

Results

Of 5837 participants, the mean baseline age was 46.5±9.3 years, including 3791 (64.9%) males. During a median follow-up of 4.0 years, 1928 (33.0%) cases of incident arterial stiffness were observed. People with diabetes at baseline had a 48.4% (HR: 1.484, 95% CI: 1.250-1.761) excessive risk of arterial stiffness. Adherence to good glycemic control attenuated the relationship between diabetes and arterial stiffness (HR: 1.264, 95% CI: 0.950-1.681); while uncontrolled diabetes was associated with the highest risk of arterial stiffness (HR: 1.629, 95% CI: 1.323-2.005). Results were consistent using IPTW algorithm and multiple imputed data.

Conclusion

Our study quantified that diabetes status is closely associated with an increased risk of arterial stiffness and supported that adherence to good glycemic control could attenuate the adverse effect of diabetes on arterial stiffness. Therefore, glucose monitoring and control is a cost-effective strategy for the predictive diagnostics, targeted prevention, patient stratification, and personalization of medical services in early vascular damages and arterial stiffness.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-023-00347-z.

Properties and physiological effects of dietary fiber-enriched meat products: a review

Meat is a rich source of high biological proteins, vitamins, and minerals, but it is devoid of dietary fiber, an essential non-digestible carbohydrate component such as cellulose, hemicellulose, pectin, lignin, polysaccharides, and oligosaccharides. Dietary fibers are basically obtained from various cereals, legumes, fruits, vegetables, and their by-products and have numerous nutritional, functional, and health-benefiting properties. So, these fibers can be added to meat products to enhance their physicochemical properties, chemical composition, textural properties, and organoleptic qualities, as well as biological activities in controlling various lifestyle ailments such as obesity, certain cancers, type-II diabetes, cardiovascular diseases, and bowel disorders. These dietary fibers can also be used in meat products as an efficient extender/binder/filler to reduce the cost of production by increasing the cooking yield as well as by reducing the lean meat content and also as a fat replacer to minimize unhealthy fat content in the developed meat products. So, growing interest has been observed among meat processors, researchers, and scientists in exploring various new sources of dietary fibers for developing dietary fiber-enriched meat products in recent years. In the present review, various novel sources of dietary fibers, their physiological effects, their use in meat products, and their impact on various physicochemical, functional, and sensory attributes have been focused.

Triglyceride-glucose index, renal function and cardiovascular disease: a national cohort study

BACKGROUND

The triglyceride-glucose (TyG) index is a predictor of cardiovascular diseases; however, to what extent the TyG index is associated with cardiovascular diseases through renal function is unclear. This study aimed to evaluate the complex association of the TyG index and renal function with cardiovascular diseases using a cohort design.

METHODS

This study included participants from the China Health and Retirement Longitudinal Study (CHARLS) free of cardiovascular diseases at baseline. We performed adjusted regression analyses and mediation analyses using Cox models. The TyG index was calculated as Ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. Renal function was defined by the estimated glomerular filtration rate (eGFR).

RESULTS

A total of 6 496 participants were included in this study. The mean age of the participants was 59.6 ± 9.5 years, and 2996 (46.1%) were females. During a maximum follow-up of 7.0 years, 1 996 (30.7%) people developed cardiovascular diseases, including 1 541 (23.7%) cases of heart diseases and 651 (10.0%) cases of stroke. Both the TyG index and eGFR level were significantly associated with cardiovascular diseases. Compared with people with a lower TyG index (median level) and eGFR ≥ 60 ml/minute/1.73 m2, those with a higher TyG index and decreased eGFR had the highest risk of cardiovascular diseases (HR, 1.870; 95% CI 1.131-3.069). Decreased eGFR significantly mediated 29.6% of the associations between the TyG index and cardiovascular diseases.

CONCLUSIONS

The combination of a higher TyG index and lower eGFR level was associated with the highest risk of cardiovascular diseases. Renal function could mediate the association between the TyG index and cardiovascular risk.