Association between the triglyceride-glucose index and severity of coronary artery disease

The association between the triglyceride-glucose index with all-cause and cardiovascular mortality within the infertility population

BACKGROUND

The relationship between triglyceride-glucose (TyG) index and all-cause or cardiovascular mortality among infertile women remains unclear. In this study, we intended to utilize a national cohort from National Health and Nutrition Examination Survey (NHANES) to check the association between them.

METHODS

Ten datasets from the NHANES database spanning almost 20 years were used as the data source and were combined within National Death Index for mortality follow-up. Multiple-variable Cox proportionate hazards regression models and three others were employed in this study to for assessing relationships among TyG index levels with all-cause and cardiovascular mortality. SPSS (version 29.0) and online websites were utilized for conducting the primary statistical analyses.

RESULTS

1,450 female participants were identified in this study. The samples were classified based on TyG index quartiles (7.05-11.95). The TyG index had a mean of 8.58±0.66. Participants with higher TyG indices were older-aged, had greater body mass index (BMI), and a stronger likelihood of having hypertension and diabetes (P < 0.05). Participants whose TyG indices were higher were older in age, along with increased BMI, and blood pressure along with diabetes (P < 0.05). Significant positive associations were observed among the TyG index and total mortality in the crude model (HR: 1.81, 95% CI: 1.27-2.58). Correlation persisted in Model 2 (following the adjustment of age and race) and Model 3 (following the adjustment of age, race, BMI, education, family poverty income ratio, smoking and drinking habits, menstrual regularity, hypertension, and diabetes). The TyG index did not affect the cardiovascular mortality in infertile women.

CONCLUSION

TyG index levels were in positive association with all-cause mortality within the female infertile population.

Comparison of TyG and modified TyG indices in predicting coronary slow flow phenomenon

BACKGROUND

The coronary slow flow phenomenon (CSFP) represents a common condition in patients with ischemia and non-obstructive coronary artery disease (INOCA). The triglyceride-glucose index (TyG) and relative modified indices have been established to be associated with CSFP. However, comparison of the clinical value of TyG and its modified indices in predicting CSFP has not been evaluated.

MATERIALS AND METHODS

INOCA patients were retrospectively enrolled. According to the corrected TIMI counts, the patients were divided into the CSFP group and the non-CSFP group. A total of 4,627 patients were enrolled in our study. Among them, 69 patients were divided into the CSFP group, while 586 patients were divided into the non-CSFP group. Demographic, clinical risk factors, and laboratory results, including TyG and its modified indices, were compared between the two groups. The prognostic value of TyG and its modified indices in CSFP was compared using the area under the curve (AUC).

RESULTS

Most of the demographic and clinical risk factors between CSFP patients and non-CSFP patients were comparable. For patients with CSFP, the patients were more likely to have chronic kidney disease (CKD) (39.13% vs. 20.31%, p < 0.001) and less likely to have anti-diabetic therapy (14.49% vs. 27.13%, p = 0.023). The patients with CSFP also had higher body weight index (BMI) (p < 0.001), higher levels of uric acid (UA), triglyceride (TG) (p = 0.017), total cholesterol (TC) (p = 0.016) and low-density lipoprotein cholesterol (LDL-C) (p = 0.006), homocysteine (p < 0.001) and uric acid (p < 0.002). Both TyG and its modified indices, including TyG-WC, TyG-BMI were demonstrated to be independently associated with CSFP in multi-variable logistic analysis after adjusting other co-variables.Further receiver operating characteristic (ROC) curve demonstrated that TyG-WC showed the best performance in predicting CSFP compared with other indices. Subgroup analysis revealed that the predictive value of TyG-WC in CSFP was consistent in different subgroups except that the predictive value was better in male patients compared with female patients, CONCLUSIONS: Our investigation reveals that TyG, TyG-WC and TyG-BMI were independent risk factors for CSFP. TyG-WC showed a better predictive performance than other indices in predicting CSFP.

Comparative Predictive Value of the TyG Index and UHR for Lower Extremity Artery Disease in Type 2 Diabetes: A Retrospective Analysis

Objective

To compare the predictive value of triglyceride glucose index (TyG) and the ratio of serum uric acid (SUA) to high-density lipoprotein cholesterol (HDL-C) (UHR) for lower extremity atherosclerotic disease (LEAD) in type 2 diabetes (T2DM) patients.

Methods

303 patients with T2DM were divided into LEAD group (n=192) and non-LEAD group (n=111) based on the results of lower extremity vascular color Doppler ultrasound. All patients were divided into a training set and a validation set at a 7:3 ratio. In the training set, Least absolute shrinkage and selection operator (LASSO) regression was applied to screen for predictive factors of LEAD, and a multivariate logistic regression model was constructed to analyze the predictive factors, with a nomogram being plotted. The discriminative ability and calibration of the model were evaluated using the receiver operating characteristic (ROC) curve area under the curve (AUC) and calibration curves in both the training and validation sets. Decision curve analysis (DCA) was used to evaluate the clinical net benefit.

Results

The variables selected by the LASSO regression included age, pulse pressure difference (PP), TyG, and UHR. The multivariate logistic regression model indicated that age, PP, TyG, and UHR were predictive factors for LEAD in T2DM patients (P<0.05). ROC curve analysis suggested that the discriminatory ability was in the following order: the nomogram model (AUC=0.872), TyG (AUC=0.751), and UHR (AUC=0.709), which were greater than that of age and PP. TyG and UHR cut-off values were 9.836 and 216.248, respectively. The specificities of TyG and UHR were 0.760 and 0.547, and the sensitivities were 0.629 and 0.807, respectively. The calibration curve showed the model's predictions matched actual conditions. DCA verified the model's clinical benefit.

Conclusion

Both TyG and UHR have good predictive value and are suitable for screening LEAD in T2DM patients.

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

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

Inverse association between triglyceride-glucose index and maximal oxygen uptake in US young and middle-aged population: a cross-sectional study

Background

The triglyceride-glucose (TyG) index has been linked to impaired cardiovascular fitness (CVF). However, the available evidence regarding the direct relationship between the TyG index and maximal oxygen uptake (VO2max) is limited. This study aims to investigate the association between the TyG index and VO2max.

Methods

We conducted a retrospective cross-sectional study involving 3,571 participants who completed a CVF examination as part of the National Health and Nutrition Examination Survey (NHANES) 1999-2004. Data on triglycerides, glucose, and VO2max were collected from all participants. The TyG index was calculated using the formula: Ln[triglyceride (TG)(mg/dl) × fasting plasma glucose (FPG)(mg/dl)/2]. Linear regression analysis was utilized to substantiate the research objectives.

Results

The complex sampling design and mobile examination center sample weights were considered. In multivariable linear regression analyses, each 1 unit increase in the TyG index was associated with a decrease in VO2max [β = -1.24, 95% CI (-1.97, -0.51), p = 0.002] when expressed as a continuous variable, independent of confounders. The TyG index was converted into a categorical variable based on four quartiles. Compared with the lowest TyG quintile (Q1: 6.750-7.887), the fully adjusted β for Q4 (8.672-12.481) was -1.91 (95% CI: -3.24, -0.57, p < 0.007). A significant interaction (p = 0.007) between sex and the TyG index for VO2max was found in the population using subgroup analysis. The results of the sensitivity analysis remained stable. Mediation analysis showed the direct effect of the TyG index was -1.467 (-2.019, -0.948), with a total effect of -1.813 (-2.377, -1.286). The mediation effect of diastolic blood pressure (DBP), white blood cell count (WBC), and C-reactive protein (CRP) was -0.389 (-0.526, -0.268), -0.308 (-0.432, -0.177), and -0.252 (-0.453, -0.135), respectively. HGB was found to exert a suppressing effect on the relationship between the TyG index and VO2max, with a value of 1.469 (1.252, 1.702). The p-values for all the above effects were <0.05.

Conclusions

In the US young and middle-aged population, the TyG index was significantly adversely associated with VO2max levels. Females may exert an interaction on TyG. Evidence supported DBP, WBC, and CRP as intervening variables through which the TyG index exerts its influence on VO2max. HGB may overrule the potential inverse association between the TyG index and VO2max.NCHS IRB/ERB Protocol Number: Protocol #98-12.

Associations Between the Atherogenic Index of Plasma and Triglyceride-Glucose Index With Coronary Microvascular Dysfunction in Hypertensive Patients

Background

The triglyceride-glucose (TyG) index is a reliable marker of insulin resistance, and the atherogenic index of plasma (AIP) reflects atherosclerosis. However, the relationship between these biomarkers-particularly AIP-and coronary microvascular dysfunction (CMD) in hypertensive patients has not been systematically studied. This study investigates the association between TyG, AIP, and CMD in hypertensive individuals.

Methods

We included 155 hypertensive patients with coronary anatomy confirmed by coronary angiography (CAG) or computed tomography angiography (CTA) within six months of SPECT imaging. CMD was diagnosed with a summed stress score (SSS) ≥4 and a summed difference score (SDS) ≥2. Patients were stratified into tertiles by TyG index and AIP. Logistic regression, adjusted for traditional cardiovascular risk factors, was used to explore the relationship with CMD. The predictive value of TyG and AIP was assessed using receiver operating characteristic (ROC) curves, and decision curve analysis (DCA) evaluated their clinical benefit.

Results

Logistic regression revealed that both TyG and AIP were independently associated with coronary artery disease (CAD) (P<0.05 for both). The area under the ROC curve (AUC) for TyG, AIP, and their combined predictive capacity for CMD was 0.744, 0.707, and 0.748, respectively (P<0.001 for all). The optimal cutoff values for TyG and AIP were 7.012 and 0.5175, respectively. Combining both biomarkers enhanced clinical decision-making and patient benefit.

Conclusion

Higher levels of TyG and AIP are significantly associated with an increased risk of CMD in hypertensive patients. Both biomarkers exhibit strong predictive value, with AIP showing greater specificity and TyG higher sensitivity. Their combined use can improve clinical decision-making and patient outcomes.

Triglyceride-glucose index and prognosis in non-diabetic critically ill patients: data from the eICU database

Background

The triglyceride-glucose (TyG) index is a marker for insulin resistance (IR) linked to diabetes complications and poor outcomes. Its connection to all-cause mortality in non-diabetic critically ill patients is unknown. This study aims to investigate the TyG index's impact on mortality in this population, evaluating how IR affects their prognosis.

Methods

This study is retrospective observational research utilizing data from the eICU Collaborative Research Database. A total of 14,089 non-diabetic critically ill patients were included and categorized into three groups based on the TyG index measured on the first day of admission (T1, T2, and T3). Kaplan-Meier survival analysis was performed to compare the 28-day mortality rates among the different groups. Cox proportional hazards models were used to assess the relationship between the TyG index and 28-day mortality. Additionally, we conducted sensitivity analyses, subgroup analyses, and interaction analyses to assess the robustness of the results.

Results

During the observation period, 730 patients (5.18%) died in the ICU, while 1,178 patients (8.36%) died in the hospital. The 28-day ICU mortality rate and hospital mortality rate significantly increased with higher TyG index values (P < 0.001). Cox proportional hazards models were used to assess the relationship between the TyG index and 28-day mortality. Specifically, Cox proportional hazards models were used to assess the relationship between the TyG index and 28-day mortality. Furthermore, the analysis showed a nonlinear effect of the TyG index on mortality in non-diabetic critically ill patients, with a critical point at 9.94. While Below 9.94, ICU and hospital mortality rates rose with higher TyG index values. But above 9.94, mortality didn't significantly increase despite further rises in the TyG index. Sensitivity and subgroup analyses confirmed the robustness of these results, and E-value analysis indicated strong resistance to unmeasured confounding factors.

Conclusion

The TyG index demonstrates a significant positive correlation with all-cause mortality in non-diabetic critically ill patients, exhibiting a nonlinear relationship. Consequently, the TyG index serves as a crucial tool for identifying high-risk patients, thereby assisting clinicians in formulating more effective monitoring and intervention strategies.

Surrogate markers of insulin resistance and coronary artery disease in type 2 diabetes: U-shaped TyG association and insights from machine learning integration

BACKGROUND

Surrogate insulin resistance (IR) indices are simpler and more practical alternatives to insulin-based IR indicators for clinical use. This study explored the association between surrogate IR indices, including triglyceride-glucose index (TyG), triglyceride glucose-body mass index (TyG-BMI), triglyceride glucose-waist circumference (TyG-WC), triglyceride glucose-waist to height ratio (TyG-WHtR), metabolic score for insulin resistance (METS-IR), and the triglycerides/high-density lipoprotein cholesterol (TG/HDL-C) ratio, and coronary artery disease (CAD) in patients with type 2 diabetes (T2D).

METHODS

Patients with T2D were enrolled in this study and divided into two groups, matched for age and diabetes duration: those with CAD and those without CAD. The association between surrogate IR indices and CAD was evaluated using restricted cubic spline (RCS) and multivariable logistic regression and their discriminative ability was assessed via Receiver operating characteristic (ROC) curve analysis. Additionally, machine learning models, including Logistic Regression, Random Forest, eXtreme Gradient Boosting (XGBoost), Light Gradient Boosting Machine (LightGBM), and Support Vector Machine (SVM), were employed to predict CAD presence using multiple surrogate IR indices and their components.

RESULTS

All surrogate IR indices exhibited non-linear associations with CAD. TyG demonstrated a U-shaped relationship, where both extremely low and high levels were associated with higher odds of CAD compared to intermediate levels. The surrogate IR indices showed a relatively strong discriminative ability for CAD, with AUC values exceeding 0.708 across all indices. The TG/HDL-C ratio displayed the highest AUC (0.721), accuracy (68%), and sensitivity (71%), whereas TyG-WC showed the highest specificity (78%). Machine learning algorithms (except logistic regression) demonstrated greater discriminative power than individual IR indices. Random forest and XGBoost revealed the best performance when using either multiple surrogate IR indices or their components.

CONCLUSIONS

Surrogate IR indices could be used as valuable tools for evaluating cardiometabolic risk in patients with T2D, who are at high risk for CAD. Integrating machine learning models further improved CAD prediction, underscoring their potential for better risk stratification. The observed association between these indices and CAD in T2D may help clarify the complex pathophysiology of CAD and offer insights for future research.

Association between the triglyceride-glucose index and acute kidney injury in patients undergoing percutaneous coronary: a retrospective analysis of the MIMIC-IV database

BACKGROUND

Acute kidney injury (AKI) is a common complication that affects the outcomes of patients undergoing percutaneous coronary intervention (PCI). The triglyceride-glucose (TyG) index, a metric computed from fasting blood triglyceride and glucose levels, is closely associated with poor PCI outcomes. This study examined the association between the TyG index and incidence of AKI in patients undergoing PCI.

METHODS

Clinical information was obtained from the Medical Information Mart for Intensive Care IV database, which contains clinical data on 70,000 patients admitted to the intensive care unit at Beth Israel Deaconess Medical Center from 2008 to 2019. In total, 435 patients who underwent PCI were enrolled in this retrospective study, and they were categorized according to their AKI status, TyG quartiles, and diabetes mellitus (DM) history to analyze their baseline characteristics. The association of the TyG index with the risk of AKI was assessed using restricted cubic spline regression and logistic regression models. Subgroup analyses were also performed in patients with and without DM.

RESULTS

Compared with the non-AKI population, patients with AKI who underwent PCI had a higher mean TyG index (p = 0.004). The restricted cubic spline regression model revealed a linear correlation between the TyG index and AKI risk (p for nonlinear = 0.123) in patients undergoing PCI. A high TyG index was a risk factor for AKI in non-DM subgroup, as well as in patients with BMI < 28 (odds ratio [OR] = 1.77; p = 0.050) and those with no history of diabetes (OR = 1.83; p = 0.047) or COPD (OR = 1.56; p = 0.030).

CONCLUSIONS

This study highlighted the role of the TyG index as a predictive biomarker for AKI in patients without DM undergoing PCI, providing clinicians with a tool for identifying high-risk individuals for early intervention.

Serum magnesium and calcium were inversely associated with hemoglobin glycation index and triglyceride-glucose index in adults with coronary artery disease

Little is known about the associations of magnesium (Mg) and calcium (Ca) with hemoglobin glycation index (HGI) and triglyceride-glucose index (TyG) in adults. In this study, we examined the associations of serum Mg and Ca with HGI and TyG in adults with coronary artery disease (CAD). This hospital-based cross-sectional study included 10757 CAD patients with a mean age of 61.6 years. Serum concentrations of Mg and Ca were measured in clinical laboratory. Overall, serum Mg and Ca were inversely associated with HGI and TyG. In multivariable analyses, Mg and Ca were inversely associated with HGI (MgQ4 vs. Q3: -0.601 vs. -0.528; CaQ4 vs. Q1: -0.769 vs. -0.645). In terms of TyG, inverse associations of serum Mg and Ca with TyG were observed. The corresponding TyG values were 9.054 (vs. 9.099) for Mg and 9.068 (vs. 9.171) for Ca in the fourth quartile compared with the first quartile. Moreover, Mg, Ca or Mg/Ca ratio were also inversely associated with HbA1c and FBG. In path analysis, no mediating effects of obesity on "serum Mg (or Ca)- HGI (or TyG)" associations were observed. Generally, our study identified the inverse associations of the serum Mg and Ca levels with HGI and TyG in adults with CAD. Large sample longitudinal study, and particularly randomized controlled trials, are warranted to validate our findings and overcome the limitations of cross-sectional studies.

Association of the insulin resistance marker triglyceride glucose index with migraine: results of a cross-sectional and prospective cohort study

BACKGROUND

Type 2 diabetes has been shown to reduce the risk of migraine, whereas insulin resistance (IR) is often elevated in migraineurs. The triglyceride glucose index (TyG) serves as a reliable surrogate marker of IR, which has been hypothesized to be associated with migraine pathophysiology. This study aimed to examine the relationship between TyG index scores and incidence as well as the severity of migraines through both cohort and cross-sectional analyses.

METHODS

Using data from the China Health and Retirement Longitudinal Study (CHARLS), we evaluated migraine incidence between 2015 and 2020. TyG index values were calculated using the following formula: ln[fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. The impact of TyG index scores on the incidence of migraines was assessed using a multivariate-adjusted Cox regression model. The cross-sectional study included 161 patients with migraines in Xiamen, China. The relationship between TyG index scores and different migraine characteristics was examined using multivariable and ordered logistic regression models with further subgroup analysis by migraine course.

RESULTS

Among the cohort participants, 1001 new migraine cases were identified during follow-up, with no significant relationship found between TyG index scores and migraine incidence (hazard ratio = 1.024 (0.916, 1.145), p = 0.677 > 0.05). The cross-sectional study showed that migraine-related disability was significantly lower among patients in the second, third and fourth quartiles of TyG index scores compared to the first quartile (odds ratio = 0.402 (0.163, 0.973), 0.322 (0.128, 0.789) and 0.301 (0.119, 0.736), respectively; ptrend = 0.009). A similar trend was observed in patients with migraine history of less than ten years.

CONCLUSIONS

Integrating the results of both cohort and cross-sectional studies, this study suggests that IR may play a protective role in the early stages of migraine. Further research into the relevant underlying mechanisms could aid in identifying new therapeutic targets for migraine management.

Triglyceride-Glucose Index Association With Severity of Coronary Artery Disease

BACKGROUND

Despite previous studies, the relationship between the triglyceride-glucose (TyG) index and coronary artery disease (CAD) is still undetermined. So we aimed to investigate the association between the TyG index and CAD.

METHOD

A total of 2346 subjects were enrolled in the study and were categorised into 5: those with no CAD, angiogram negative (Ang-) patients, those with single-vessel disease (SVD), or two-vessel disease (2VD) or three-vessel disease (3VD). Demographic characteristics, disease history and biochemical investigations were recorded. TyG index was calculated as Ln [fasting TG (mg/dL) × fasting glucose (mg/dL)/2].

RESULTS

Adjusted regression models demonstrated that the odds of 3VD (OR, 5.847; 95% CI, 4.391-7.784), 2VD (OR, 4.943; 95% CI, 3.597-6.791), SVD (OR, 4.722; 95% CI 3.448-6.647) and a negative coronary angiogram (OR, 3.137; 95% CI, 2.431-4.049), increased significantly per each unit elevation of the TyG index, compared to the healthy participants. Also, the odds for being 3VD (1.864, 95%CI 1.402-2.477, p-value < 0.001), 2VD (1.575, 95%CI 1.143-2.171, p-value = 0.005) and SVD (1.505, 95%CI 1.097-2.065, p-value = 0.011) were increased significantly by one-unit elevation of TyG index, compared to Ang- group.

CONCLUSION

Our study demonstrates a significant association between elevated TyG index and the presence and severity of CAD. Higher TyG index values were consistently linked to an increased likelihood of multivessel CAD, especially in diabetic patients. These findings suggest that the TyG index could serve as a valuable marker for assessing CAD risk and stratification.

Association of insulin resistance surrogates with disease severity and adverse outcomes in chronic thromboembolic pulmonary hypertension: a multicenter cohort study

BACKGROUND

Chronic thromboembolic pulmonary hypertension (CTEPH) is a severely progressive disease that leads to right heart failure and death. Previous studies have shown that diabetes and insulin resistance (IR) are closely related to pulmonary hypertension, but the role of IR in patients with CTEPH remains unexplored. In this study, we investigated the relationship between four insulin resistance indices and disease severity, hemodynamic parameters, and adverse outcomes in patients with CTEPH.

METHODS

We conducted a multicenter, retrospective cohort study involving 516 patients diagnosed with CTEPH between January 2013 and December 2022. The metabolic score for IR (METS-IR), triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, triglyceride and glucose (TyG) index, and triglyceride-glucose-body mass (TyG-BMI) index were used to quantify IR levels in patients with CTEPH. The primary endpoint events were clinical worsening. Multivariable Cox regression, restricted cubic splines, and receiver operating characteristic analyses were used to evaluate the predictive value of surrogates for IR.

RESULTS

Compared with in low to intermediate-low risk patients, the METS-IR (36.2 ± 6.7 vs. 37.7 ± 8.7, p = 0.038) and TyG-BMI index (204.0 ± 36.2 vs. 212.6 ± 46.5, p = 0.022) were significantly increased in high to intermediate-high risk patients. METS-IR correlated with markers of disease severity, such as World Health Organization functional class, 6-minute walk distance, and N-terminal pro-brain natriuretic peptide levels. During a mean of 2.5 years' follow-up, 110 participants experienced all-cause death or worsening condition. METS-IR independently predicted clinical worsening (hazard ratio: 1.27; 95% confidence interval 1.06-1.53 per 1.0-standard deviation increment, p = 0.009) after fully adjusting for covariates. Adding METS-IR to the COMPERA 2.0 risk score significantly improved its predictive ability, reclassification and discrimination ability.

CONCLUSIONS

METS-IR is an independent predictor of clinical worsening in patients with CTEPH. It offers a convenient marker for assessing disease severity and long-term outcomes in clinical risk assessment.

Association between Heavy metals and triglyceride-glucose-related index: a mediation analysis of inflammation indicators

BACKGROUND

In cardiovascular diseases (CVD) and insulin resistance (IR), elevated blood lipids and glucose are common. These abnormalities accelerate atherosclerosis and may impair insulin signaling via oxidative stress and inflammation. The triglyceride-glucose (TyG) index is a cost-effective marker for assessing IR and CVD risk, reflecting insulin resistance and early atherosclerosis. However, research on factors affecting the TyG index, especially mixed heavy metal exposure, is limited. Heavy metals might alter the TyG index by inducing oxidative stress and inflammation, affecting lipid and glucose metabolism. This study explores the link between heavy metal exposure and TyG index changes, focusing on inflammation's mediating role, aiming to offer new strategies for CVD and IR prevention and management.

METHOD

This research explores the association between heavy metal concentrations and TyG indicators, drawing on data from the National Health and Nutrition Examination Survey spanning 2011 to 2016. It employs a range of statistical approaches, such as linear and non-linear analyses, multiple linear regression, weighted quantile sum regression, and Bayesian kernel machine regression. Additionally, a mediation analysis investigates the role of inflammation in modifying the effects of heavy metal exposure.

RESULT

The research analyzed data from a sample of 2,050 individuals, finding notable links between mixed heavy metals and variations in TyG markers. Specifically, the presence of heavy metal mixtures was associated with significant increases in these indicators. Additionally, six inflammatory markers were identified that act as intermediaries in the process leading from heavy metal exposure to alterations in TyG indicators.

CONCLUSION

The study establishes a clear association between heavy metal and adverse changes in TyG markers, influenced in part by inflammation. These insights highlight the urgent need for improved monitoring of environmental health and specific strategies to decrease heavy metal exposure, thus lessening their harmful impact on cardiovascular health. The research enhances understanding of the dynamic interactions between environmental exposures and metabolic health, laying groundwork for public health initiatives aimed at curtailing chronic disease risks linked to heavy metals.

Association between TyG related parameters and metabolic dysfunction associated fatty liver disease among nondiabetic individuals

Metabolic dysfunction associated fatty liver disease (MAFLD) is a prevalent liver condition and presents a major clinical and public health problem worldwide. TyG index and its related parameters TyG-WHtR, TyG-WC and TyG-BMI have been proven to label insulin resistance reliably, which makes it an important parameter to reflect the composition and health status of human body. Recent studies in the general population have demonstrated that there exists a correlation between elevated TyG index and the development of MAFLD, but in the nondiabetic US population, this correlation remains unclear. We included 945 nondiabetic adult participants from NHANES 2017-2020 cycle in this cross-sectional study. To find the relationship that exists between TyG, TyG-WHtR, TyG-WC, TyG-BMI, HOMA-IR, QUICKI and the risk of MAFLD, we used four conventional multivariate adjusted logistic regression models, plotted the RCSs to conduct this study, analyzed the thresholds using a two-stage logistic model. We performed stratified and interaction analyses to identify whether the relationships were stable in different subgroups. Moreover, we assessed the predictive ability of these parameters for MAFLD by plotting ROCs. We found that there was a positive correlation between TyG index and the incidence of MAFLD as well as its related parameters in the nondiabetic population.

Differential risk of cardiovascular complications in patients with type-2 diabetes mellitus in Ghana: A hospital-based cross-sectional study

AIM

To characterize clinically relevant subgroups of patients with type-2 diabetes mellitus (T2DM) based on adiposity, insulin secretion, and resistance indices.

METHODS

A cross-sectional study was conducted at Eastern Regional Hospital in Ghana from July to October 2021 to investigate long-term patients with T2DM. To select participants, a systematic random sampling method was employed. Demographic data was collected using a structured questionnaire and fasting blood samples were taken to measure glycemic and lipid levels. Blood pressure and adiposity indices were measured during recruitment. The risk of cardiovascular disease (CVD) was defined using Framingham scores and standard low-density lipoprotein thresholds. To analyze the data, k-means clustering algorithms and regression analysis were used.

RESULTS

The study identified three groups in female patients according to body mass index, relative fat mass, glycated hemoglobin, and triglyceride-glucose index. These groups included the obesity-related phenotype, the severe insulin resistance phenotype, and the normal weight phenotype with improved insulin resistance. Among male patients with T2DM, two groups were identified, including the obesity-related phenotype with severe insulin resistance and the normal weight phenotype with improved insulin sensitivity. The severe insulin resistance phenotype in female patients was associated with an increased risk of high CVD (OR = 5.34, 95%CI:2.11-13.55) and metabolic syndrome (OR = 7.07; 95%CI:3.24-15.42). Among male patients, the obesity-related phenotype with severe insulin resistance was associated with an increased intermediate (OR = 21.78, 95%CI:4.17-113.78) and a high-risk CVD (OR = 6.84, 95%CI:1.45-32.12).

CONCLUSIONS

The findings highlight significant cardiometabolic heterogeneity among T2DM patients. The subgroups of T2DM patients characterized by obesity and/or severe insulin resistance with or without poor glycemic control, have increased risk of CVD. This underscores the importance of considering differences in adiposity, insulin secretion, and sensitivity indices when making clinical decisions for patients with T2DM.

Lipidomics-based investigation of its impact on the pathogenesis of coronary atherosclerosis: a Mendelian randomization study

BACKGROUND

Considerable attention has been devoted to investigating the association between lipid metabolites and cardiovascular diseases, particularly coronary atherosclerosis.

METHODS

A two-sample MR framework was used to investigate the relationship between lipid metabolites and the risk of coronary atherosclerosis. Two GWAS datasets were examined to take intersections of SNPs from 51,589 cases and 343,079 controls, and 14,334 cases and 346,860 controls to determine genetic susceptibility to coronary atherosclerosis. Random-effects inverse variance weighted (IVW) MR analyses were performed by a series of sensitivity assessments to measure the robustness of our findings and to detect any violations of MR assumptions.

RESULTS

Through IVW, MR-Egger and weighted median regression methods, we inferred that these six lipid metabolites: cholesterol levels, sterol ester (27:1/18:2) levels, triacylglycerol (52:4) levels, triacylglycerol (52:5) levels, diacylglycerol (18:1_18.2) levels, triacylglycerol (53:4), could directly impact the development of atherosclerosis.

CONCLUSION

In conclusion, our study comprehensively illustrates a causal relationship between lipid metabolites and the risk of coronary atherosclerosis. Furthermore, cholesterol levels, sterol ester (27:1/18:2) levels, triacylglycerol (52:4) levels, triacylglycerol (52:5) levels, diacylglycerol (18:1_18.2) levels, and triacylglycerol (53:4) levels are positively correlated with the risk of coronary atherosclerosis. These six lipid metabolites have the potential as new predictors of the risk of atherosclerosis, providing new insights into the treatment and prevention of cardiovascular diseases.

Association between triglyceride-glucose index and its composite obesity indexes and cardio-renal disease: analysis of the NHANES 2013-2018 cycle

Background

The association between triglyceride-glucose (TYG) and its composite obesity indexes and cardio-renal disease in the American population remains insufficiently researched.

Methods

This study examined a cohort of 11,491 American adults aged 20 years and older from the 2003-2018 National Health and Nutrition Examination Survey (NHANES). To explore the associations between TYG, TyG-Waist-to-Height Ratio (TyG-WHtR), TyG-Body Mass Index (TyG-BMI), TyG-Waist Circumference (TyG-WC), and chronic kidney disease (CKD), cardiovascular disease (CVD), and cardiorenal syndrome (CRS), we utilized weighted multivariate logistic regression, restricted cubic spline (RCS), Receiver operating characteristic (ROC), and subgroup analyses.

Results

Adjusted for confounding factors, there are positive associations between the likelihood of CKD, CVD, and CRS, as well as TYG and its composite obesity indexes. The TYG index was correlated most strongly with CKD (OR 1.42, 95% CI 1.11, 1.82; P = 0.007), while TyG-WHtR had the strongest correlations with CVD (OR 1.63, 95% CI 1.19, 2.22; P = 0.003) and CRS (OR 1.44, 95% CI 1.00, 2.08; P = 0.055). A nonlinear connection was found by RCS analysis between TYG and its composite obesity indexes with CKD (P for overall < 0.001, P for nonlinear < 0.05), while the association with CVD and CRS was predominantly linear (P for overall < 0.001, P for nonlinear > 0.05). Based on ROC curves, TyG-WHtR and TyG-WC emerged as more reliable diagnostic tools than TYG for cardiac and renal diseases. According to subgroup analyses, TyG and its composite obesity measurements were more strongly associated with CKD in younger individuals (≤ 50), males, and those with diabetes mellitus (P for interaction 0.05).

Conclusions

The TyG-WHtR and TyG-WC are associated with an increased risk of cardiac and renal disease, indicating enhanced diagnostic accuracy. These metrics provide an effective tool for identifying early cardiorenal disease and improving risk stratification.

Associations of the triglyceride-glucose index and remnant cholesterol levels with the prevalence of Carotid Plaque in patients with type 2 diabetes: a retrospective study

BACKGROUND

The triglyceride-glucose (TyG) index has been identified as an alternative biomarker for insulin resistance (IR), while residual cholesterol (RC) is a simple, cost-effective, and easily detectable lipid metabolite. However, the associations of these two markers with carotid plaque presence remain unclear. Thus, this study aimed to explore their associations with carotid plaque presence.

METHODS

Participants were chosen from patients with T2DM admitted to The Second Affiliated Hospital of Anhui Medical University from October 2023 to April 2024, and they were separated into two groups (patients without carotid plaque and patients with carotid plaque) based on their carotid ultrasound results. By comparing the general information and biochemical indicators of the two groups, we employed multivariate logistic regression models and RCS regression models to investigate the associations of the TyG index and RC levels with carotid plaque presence, and made adjustments based on multiple confounding factors to identify the differences between subgroups.

RESULTS

This study comprised 278 patients with T2DM in total, including 165 males and 113 females. A multivariate logistic regression study indicated that, after adjusting statistically significant variables screened in LASSO regression, TyG index [OR (95% CI): 1.810 (1.077, 3.113)] and RC [OR (95% CI): 1.988 (1.034, 3.950)] remained the risk factors for carotid plaque presence. According to restricted cubic splines (RCS), RC levels increased linearly with carotid plaque presence (P - nonlinear > 0.05). Conversely, the TyG index and carotid plaque presence did not associate linearly (P - nonlinear < 0.05). Results of subgroup analyses showed no grouping variables exhibited association with TyG index or RC (p for interaction > 0.05).

CONCLUSIONS

In patients with T2DM, both TyG index and RC levels were strongly linked to carotid plaque presence, and could serve as independent risk factors for this presence. Monitoring the TyG index and RC levels can help gain a better understanding and knowledge of carotid plaque presence in patients with T2DM, offering guidance for the clinical prevention and treatment of cardiovascular and cerebrovascular diseases (CCVDs) in patients with T2DM.

Correlation of blood lipids, glucose, and inflammatory indices with the occurrence and prognosis of lesion complexity in unstable angina, a retrospective cohort study

Background

In recent years, novel cardiometabolic biomarkers and related pathogenic genes and their heritability have been examined. However, no multitarget predictive evaluation models exist can identify and predict complex lesions in unstable angina (UA) in the early stages before coronary angiography (CAG) or evaluate the prognosis of patients with UA and complex lesions. In this study, we sought to investigate the correlation between blood lipid, glucose, and inflammatory indices and the occurrence and prognosis of UA with complex lesions, and also the risk factors for major adverse cardiocerebrovascular events (MACCEs).

Methods

Patients with UA who underwent percutaneous coronary intervention (PCI) at Chaoyang Hospital between March 2019 and December 2020 were included. Patients with UA who underwent PCI were divided into complex lesion group and noncomplex lesion group according to the CAG results. The blood lipid and glucose levels, inflammatory indices, Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) scores, and clinical outcome events after 3 years follow-up from both groups were calculated.

Results

A total of 523 patients were included, with 248 and 275 patients in the complex and noncomplex lesion groups, respectively. There were no significant differences between the two groups in terms of sex, age, medical history, or demographic characteristics. After 3 years of follow-up, compared with the noncomplex lesion group, the complex lesion group had a higher incidence of target vessel revascularization (TVR) (8.1% vs. 4.0%; P=0.049) and MACCEs (11.7% vs. 5.8%; P=0.02). High remnant lipoprotein cholesterol (RLP-C) level, high small dense low-density lipoprotein cholesterol (sLDL-C) level, high lipoprotein (a) [Lp(a)] level, high high-sensitivity C-reactive protein (hs-CRP) level, low lymphocyte level, low albumin level, and low hs-CRP:albumin ratio (CAR) were found to be risk factors for the occurrence of UA with complex lesions. High RLP-C level, high sLDL-C level, high Lp(a) level, and high neutrophil:lymphocyte ratio (NLR) were independent risk factors for MACCEs in the complex lesion group, from which a new prediction model was created. The area under the curve (AUC) of the new model for predicting MACCEs events after 3 years of follow-up [AUC =0.935; 95% confidence interval (CI): 0.881-0.989] in the complex lesion group was higher than that of the SYNTAX score (AUC =0.671; 95% CI: 0.584-0.757) (P<0.001).

Conclusions

Blood lipid and glucose levels and inflammatory indices may be associated with the occurrence of UA with complex lesions. The new model for UA with complex lesions constructed using high RLP-C level, high sLDL-C level, high Lp(a) level, and high NLR level had a stronger ability to predicts MACCEs during follow-up than did the SYNTAX score. Our findings could enhance early detection of patients with UA and complex lesions, potentially improving prevention and treatment strategies for perioperative UA-PCI patients.

Association between domain-specific physical activity and triglyceride‑glucose (TyG) index among US adults: Evidence from NHANES 2007-2018

OBJECTIVES

The triglyceride-glucose (TyG) index is not only a reliable marker for insulin resistance, but also has broad applications in assessing the risk of various diseases, including cardiovascular disease, stroke, depression, and Alzheimer's disease. The study aims to investigate the relationship between domain-specific moderate- or vigorous-intensity physical activity (MVPA) and TyG index among US adults.

METHODS

The participants from the US National Health and Nutrition Examination Survey (NHANES) (2007-2018) were included. Different PA domains, including occupation-related MVPA (O-MVPA), transportation-related MVPA (T-MVPA), and leisure-time MVPA (LT-MVPA), were assessed by the Global Physical Activity Questionnaire. Weighted multivariable linear regression and the propensity score matching (PSM) method were used to determine the relationship between domain-specific MVPA and TyG index. Furthermore, stratified and mediation analyses were employed to assess the potential effect modifications and mediators on the association.

RESULTS

A total of 12,069 participants were included. The participants had a weighted mean age of 47.43 ± 16.91 years and a weighted mean TyG index of 8.58 ± 0.67. Weighted multivariable linear regression showed that leisure-time MVPA (LT-MVPA), whether at any amount or achieving physical activity guidelines, was negatively associated with TyG index (β = -0.10, 95%CI: -0.13- -0.07, P < 0.001, and β = -0.13, 95%CI: -0.17- -0.10, P < 0.001, respectively). O-MVPA and T-MVPA were not correlated with the TyG index, even at the recommended amount (β = 0.01, 95%CI: -0.02-0.03, P = 0.59 for O-MVPA, and β = -0.02, 95%CI: -0.07-0.02, P = 0.32 for T-MVPA). After PSM, the results were still robust. Furthermore, the stratified analysis found that the correlation between LT-MVPA and TyG index was stronger in females, those with higher family incomes, and non-smokers. Finally, mediation analyses indicated a significant joint mediation effect of BMI on the relationships between LT-MVPA (≥ 150 min/week) and the TyG index, accounting for 31.48% of the total effect.

CONCLUSIONS

LT-MVPA was associated with a decreased TyG index in US adults, while no such association was observed with O-MVPA or T-MVPA. Specific recommendations for PA categories should be provided, especially for populations at risk of diseases linked to a high TyG index or insulin resistance.

Association between estimated glucose disposal rate and cardiovascular diseases in patients with diabetes or prediabetes: a cross-sectional study

BACKGROUND

Insulin resistance proxy indicators are significantly associated with cardiovascular disease (CVD) and diabetes. However, the correlations between the estimated glucose disposal rate (eGDR) index and CVD and its subtypes have yet to be thoroughly researched.

METHODS

10,690 respondents with diabetes and prediabetes from the NHANES 1999-2016 were enrolled in the study. Three machine learning methods (SVM-RFE, XGBoost, and Boruta algorithms) were employed to select the most critical variables. Logistic regression models were established to evaluate the association between eGDR and CVD. We applied ROC curves, C-statistics, NRI, IDI, calibration curves, and DCA curves to assess model performance. Subgroup analyses were conducted to investigate the association among different subgroups.

RESULTS

Participants in the higher quartile showed a decreased prevalence of CVD. Multivariate logistic regression models and RCS curves demonstrated that eGDR had an independently negative linear correlation with the likelihood of CVD[Q4 vs. Q1: OR 0.24(0.18,0.32)], CAD[OR 0.81(0.78,0.85)], CHF[OR 0.81(0.76,0.86)], and stroke[0.85(0.80,0.90)]. Model evaluation showed better performance in fully adjusted models than basic models[C-statistics(Model 3 vs. Model 1): CVD(0.683 vs. 0.814), CAD(0.672 vs. 0.807), CHF(0.714 vs. 0.839) and stroke(0.660 vs. 0.790)]. The AUCs of eGDR were significantly higher than the values of other IR surrogates in the unadjusted models, and slightly higher in the fully adjusted models. Subgroup analyses indicated that the results were robust.

CONCLUSION

A lower eGDR was significantly associated with a heightened likelihood of CVD and its subtypes in diabetic and prediabetic populations. And eGDR exhibited better performance in evaluating the associations compared to other IR proxies encompassing TyG, HOMA-IR, QCUIKI, METS-IR, etc.

Predictive value of triglyceride-glucose index for the evaluation of coronary artery disease severity and occurrence of major adverse cardiovascular events

The triglyceride-glucose (TyG) index has been proposed as an independent predictor of coronary artery disease (CAD). In this retrospective study, we further examine this association and its utility as a predictor for major adverse cardiovascular events (MACE). A total of 870 patients who underwent coronary angiography between May 2008 and June 2009 were included in this retrospective study. The TyG index was calculated using the formula Ln [fasting TG (mg/dL) × FBG (mg/dL)/2]. The association of the TyG index with the presence and severity of CAD, cardiovascular risk factors, and inflammatory markers was evaluated at baseline. In the longitudinal study, the multivariate-adjusted Cox hazard model was used to investigate the associations of the TyG index with the occurrence of MACE during a 5-yr follow-up, which was defined as the endpoint. The TyG index was significantly associated with the presence and severity of CAD. Multiple linear regression analysis showed that a high TyG index, together with inflammatory markers and dyslipidemia, was independently associated with greater stenotic occlusion of coronary arteries (adjusted R2 = 0.031, P < 0.001). Kaplan-Meier survival curve (free of MACE) by tertiles of the TyG index showed a higher incidence of MACE in the upper tertile (log-rank test, P = 0.02). Multivariate Cox analysis demonstrated that the risk of incident MACE during the follow-up was associated with higher levels of the TyG index, even after adjusting for inflammatory parameters and cardiovascular risk factors: hazard ratio = 1.54 (95% confidence interval: 1.18-2.13; P < 0.01). We conclude that an elevated TyG index is independently associated with a higher risk of CAD and a poor prognosis for MACE.NEW & NOTEWORTHY This retrospective study demonstrates significant associations between the TyG index and the occurrence and severity of CAD, as well as indicates the clinical value of the TyG index as a potential predictor for MACE.

Elevated triglyceride glucose index is associated with advanced cardiovascular kidney metabolic syndrome

The cardiovascular kidney metabolic (CKM) syndrome is a dynamic geriatric condition that has received limited research attention regarding its potential associations with the triglyceride glucose (TyG) index. This study aims to explore the potential association between the TyG index and advanced CKM syndrome. Data for this cross-sectional study were obtained from the National Health and Nutrition Examination Survey (NHANES) conducted between 2011 and 2018. The association between the TyG index and the risk of advanced CKM syndrome was investigated using multivariable logistic regression models. Additionally, a restricted cubic spline (RCS) analysis was employed to assess the dose-response relationship between the TyG index and the risk of advanced CKM syndrome. A total of 7904 participants were included in this study, with a mean TyG index of 5.04 ± 0.41. The prevalence of advanced CKM syndrome among the participants was 14.85%. Our findings indicated that as the TyG index quartiles increased, the risk of advanced CKM syndrome also increased. The results from the three regression analysis models indicated a positive association between the continuous TyG index and advanced CKM syndrome. Furthermore, the quartiles of the TyG index were significantly associated with an increased prevalence of advanced CKM syndrome in the fully adjusted models (TyG index Q4 vs. Q1, OR = 1.94, 95% CI 1.37-2.75, P < 0.001). The results of the RCS analysis indicated a linear and positive association between the TyG index and advanced CKM syndrome. The results indicated that elevated TyG index is associated with an increased prevalence of advanced CKM syndrome. This suggests that the TyG index may be a useful tool for assessing the risk of advanced CKM syndrome.

Adjustment of the ACEF score by the triglyceride glucose index improves the prediction of clinical outcomes in patients undergoing percutaneous coronary intervention

BACKGROUND

The ACEF score (age, creatinine, and left ventricular ejection fraction) and the triglyceride-glucose (TyG) index have been identified as robust risk prediction models for adverse outcomes post-percutaneous coronary intervention (PCI) in coronary atherosclerotic heart disease (CHD) patients. This study aimed to assess whether incorporating the TyG index enhances the predictive ability of the ACEF score and enhances risk stratification for CHD patients undergoing PCI.

METHODS

This observational cohort study enrolled 1248 patients diagnosed with CHD who underwent PCI at the Third People's Hospital of Chengdu, China, between May 2018 and December 2022. Receiver operating characteristic (ROC) curves were employed to establish the optimal cutoff values for the TyG index and ACEF score. The primary endpoint event was defined as major adverse cardiac and cerebrovascular events (MACCEs). Cumulative survival curves were plotted using the Kaplan-Meier method. Univariable and multivariable Cox regression analyses were conducted to identify predictors of MACCEs. The predictive ability of the ACEF score and the TyG index was assessed using the area under the ROC curve, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

RESULTS

Over a median follow-up period of 30.60 months, 214 patients experienced MACCEs. Kaplan-Meier survival analysis demonstrated a significant association between elevated ACEF score (> 1.27) and TyG index levels (> 8.82) with a heightened incidence of MACCEs (HR = 2.018, 95%CI 1.593-2.789; HR = 2.057, 95%CI 1.572-2.691; Log-Rank test, both P < 0.001). Multivariable Cox regression analysis revealed that even after adjusting for multiple confounders, both the ACEF score and TyG index remained as predictors of MACCEs (HR = 1.702, 95%CI 1.210-2.394, P = 0.002; HR = 1.575, 95%CI 1.296-1.916, P < 0.001). Additionally, the addition of the ACEF score and TyG index into the conventional risk model significantly improved the ability to predict MACCEs, as evidenced by the increase in the C-statistic value from 0.664 to 0.703, along with notable improvements in continuous NRI (0.391), categorical NRI (0.107), and IDI (0.033) (all P < 0.001).

CONCLUSION

The combination of the TyG index and the ACEF score enhances the predictive ability for long-term MACCEs in patients with CHD undergoing PCI.

Associations of TyG index with coronary heart disease risk and coronary artery sclerosis severity in OSA

BACKGROUND

Insulin resistance (IR) is involved in the pathogenesis and progression of obstructive sleep apnea (OSA) and coronary heart disease (CHD). The triglyceride glucose(TyG) index, an alternative indicator of IR with high reliability, is linked to CHD development and severity. However, the association of TyG index with CHD in OSA cases remains undefined. This study explores the association of TyG index with CHD risk and coronary artery sclerosis severity in the OSA population.

METHODS

OSA cases with suspected CHD, enrolled at the Department of Hypertension, The First Affiliated Hospital of Xinjiang Medical University between February 2020 and June 2024, were assigned to the OSA and OSA + CHD groups, followed by TyG index assessment. The t-test, Mann-Whitney U-test and one-way analysis of variance were utilized to compare continuous data, while comparisons of categorical data utilized the chi-square test or Fisher's exact test. Logistic regression analysis was conducted to determine factors independently predicting OSA with CHD and Gensini scores. Restrictive cubic spline (RCS) was used to assess potential non-linear associations of TyG index with CHD risk and Gensini score in OSA patients.

RESULTS

Totally 1059 OSA patients were included, with 514 diagnosed with CHD (48.54%). Multivariable logistic regression analysis upon adjustment for age, gender, hypertension, diabetes, and smoking history revealed TyG index as a risk factor for CHD in OSA cases. CHD risk in the high-TyG index group was 1.977 fold higher versus the low-TyG index group (OR = 1.977, 95% CI 1.424-2.800, P < 0.001). In addition, TyG index had a linear relationship with CHD (P for nonlinearity = 0.0709). In moderate to severe OSA cases, the high-TyG index group had a significantly higher CHD risk (OR = 2.430, 95% CI 1.601-3.690, P < 0.001). Gensini score and TyG index (P for non-linearity = 0.0033) had a non-linear relationship, while high TyG index was a risk factor for high Gensini score.

CONCLUSION

TyG index is a risk factor for CHD in OSA cases and reflects the severity of coronary atherosclerosis. TyG, a surrogate indicator for IR evaluation, may help predict CHD in OSA cases, especially in moderate to severe OSA.

The mediating effect of TyG and its derived indices in the association between OSAHS and atherosclerosis in patients with T2DM

OBJECTIVE

Triglyceride-glucose index (TyG) and its derived indices which better reflect metabolic disturbances on atherosclerosis has not been reliably compared in patients with type 2 diabetes mellitus (T2DM). Besides, obstructive sleep apnea hypopnea syndrome (OSAHS), a driver of atherosclerosis (AS), can exacerbate metabolic disturbances strongly. The aim of this study is to explore the mediating effect of glycolipid metabolism on the association between OSAHS and arterial stiffness in T2DM patients.

METHODS

154 T2DM patients were involved in this study and were split into two groups: T2DM and T2DM + AS. Logistic regression analysis determined the accurate effects of different factors on the AS of T2DM patients. The capacity of TyG and the indices it derives to predict AS was assessed using the receiver operating characteristic (ROC) curve. Mediation analysis was employed to investigate the mediating effect of TyG and its derived indices on the association between OSAHS and arterial stiffness in T2DM patients.

RESULTS

OSAHS, TyG, and its derived indices were independent risk factors for AS in T2DM patients. Stratified by age, the hazardous effects of TyG and its derived indices remained significant in T2DM patients aged ≥ 50 years, but not in those aged < 50 years. In T2DM patients aged ≥ 50 years, the novel indices have a high predictive value for AS, with TyG-BMI exhibiting the largest AUC(AUC:0.788;95% CI:0.647 ∼ 0.928; P < 0.001). The mediation analysis results indicated that in T2DM patients aged ≥ 50 years, TyG, TyG-BMI, TyG-WC, and TyG-WHtR acted as potential mediators in the association between OSAHS and AS, with mediation effects of 33.42%, 48.2%, 37.7%, and 40.21%, respectively. However, there was no significant mediating effect observed in the younger patients.

CONCLUSION

TyG and its derived indices are strongly correlated with AS in T2DM patients, of which TyG-BMI has the best predictive performance. Besides, OSAHS partially exerts its atherogenic effect through glucolipid metabolism disorder in the T2DM population aged ≥ 50 years, while it mainly exerts a direct atherogenic effect in patients aged < 50 years.

Correlation between remnant cholesterol and premature coronary artery disease and the severity of coronary artery lesions in men: a retrospective study

Objective

To investigate the correlation between remnant cholesterol (RC) and premature coronary artery disease (PCAD) and the severity of coronary artery lesions in men.

Methods

A total of 630 male subjects who underwent coronary angiography were included in the study. The general data, laboratory tests, and coronary angiography data of each group were statistically analyzed, and RC levels were calculated. According to the Gensini score, PCAD was divided into mild and severe lesion groups. The relationship between RC and PCAD and coronary artery lesions was analyzed using multivariate logistic regression and spearman correlation analysis, and the predictive value of RC for coronary artery lesions was evaluated using receiver operating characteristic (ROC) curves.

Results

The RC levels in the PCAD group were significantly higher than those in the non-PCAD group (p < 0.05), and RC was an independent risk factor for PCAD (p < 0.05).The RC levels in the severe lesion group were higher than those in the mild lesion group (p < 0.05), and RC levels were positively correlated with the Gensini score (r = 0.335, p < 0.001).Multivariate logistic regression analysis showed that RC was an independent risk factor for severe coronary artery lesions (p < 0.05).The ROC curve calculated the value of RC in predicting severe coronary artery lesions, with an area under the curve of 0.693, a cutoff value of 0.485 mmol/L, a sensitivity of 64.7%, and a specificity of 66.2%.

Conclusion

RC is an independent risk factor for PCAD and the severity of coronary artery lesions in adult men. RC levels are positively correlated with the severity of coronary artery lesions and can be used as an auxiliary indicator for clinical assessment of PCAD.

Association between triglyceride glucose index and endometriosis in adults in the United States: A comprehensive study from the National Health and Nutrition Examination Survey (NHANES)

BACKGROUND

The triglyceride glucose (TyG) index has been well recognized as a reliable marker of insulin resistance and substantially correlated with the pathogenesis and progression of hypertension and cardiovascular diseases. However, no study has investigated the association between the TyG index and endometriosis. Therefore, this study aimed to uncover an association between the TyG index and endometriosis.

METHODS

This cross-sectional investigation employed the extensive dataset derived from the National Health and Nutrition Examination Survey (NHANES) (1999-2006). To explore the potential connection between the TyG and endometriosis, a multivariate weighted logistic regression model was established. The nonlinear relationship between the TyG index and the risk of endometriosis was explored using restricted cubic spline models (RCS). Furthermore, subgroup analyses were conducted.

RESULTS

Ultimately, 2,508 individuals were included in this investigation. The findings unveiled a robust positive correlation between the TyG index and the susceptibility to endometriosis (OR [95% CI]: 1.52 [1.024,2.258]; P < 0.05). This positive association remained consistent across diverse subgroups. Age, birthplace, and whether one ovary was removed were identified as significant risk factors. In RCS analysis, the TyG index showed a nearly linear relationship with the risk of endometriosis (P-nonlinear > 0.05).

CONCLUSIONS

The findings indicate a positive association between the TyG index and the risk of endometriosis, exhibiting an approximate non-linear relationship.

Association between triglyceride-glucose index and in-hospital all-cause mortality under different glucose metabolism status among patients with coronary artery disease

BACKGROUND

This current study aimed to investigate the relationship between the triglyceride-glucose (TyG) index and in-hospital all-cause mortality of coronary artery disease (CAD) in patients with different glucose metabolic statuses.

METHODS

Participants were divided into three groups according to tertiles of the TyG index. Glucose metabolic status was classified as normal glucose regulation, pre-diabetes mellitus, and diabetes mellitus (DM). The primary outcome was in hospital all-cause mortality.

RESULTS

We observed a significant relationship between the TyG index and in-hospital deaths of patients with CAD in this study. After adjusting for multiple factors in the logistic regression model, the TyG index was still an independent risk factor, and the T3 group (OR, 2.311; 95% CI = 1.237-4.317; P = 0.009) was correlated with a 2.311-fold risk compared with the T1 group. In the subgroup analysis of different glucose metabolic status, the T3 group (OR, 1.541; 95% CI: 1.013-2.344; P = 0.043) were associated with a significantly higher risk of in-hospital deaths in CAD patients with DM.

CONCLUSIONS

An increased TyG index was correlated with a higher risk of in-hospital all-cause mortality. Our study indicated that TyG index could be a valuable predictor of in-hospital death of CAD patients, especially for individuals with DM.

Environmental Heavy Metal Exposure and Associated Cardiovascular Diseases in Light of the Triglyceride Glucose Index

Cardiovascular diseases (CVD), primarily ischemic heart disease and stroke, remain leading global health burdens. Environmental risk factors have a major role in the development of CVD, particularly exposure to heavy metals. The Triglyceride Glucose Index (TyG), a measure of insulin resistance and CVD risk, is the primary focus of this study, which summarizes the most recent findings on the effects of lead (Pb), arsenic (As), and cadmium (Cd) on CVD risk. A higher risk of CVD is correlated with an elevated TyG index, which has been linked to insulin resistance. Exposure to Cd is associated with disturbance of lipid metabolism and oxidative stress, which increases the risk of CVD and TyG. Exposure reduces insulin secretion and signaling, which raises the TyG index and causes dyslipidemia. Pb exposure increases the risk of CVD and TyG index via causing oxidative stress and pancreatic β-cell destruction. These results highlight the need of reducing heavy metal exposure by lifestyle and environmental modifications in order to lower the risk of CVD. To comprehend the mechanisms and create practical management plans for health hazards associated with heavy metals, more study is required.

Association Between Triglyceride-Glucose Index and Lung Function Parameters in the General Population Undergoing Health Examinations

Purpose

To investigate the relationship between the triglyceride-glucose (TyG) index and pulmonary function metrics among the general population undergoing health examinations.

Materials and Methods

The enrollment totaled 696 participants. Fasting triglycerides and glucose levels were used to calculate the TyG index. Participants were divided into two categories according to their median TyG: one with high TyG and the other with low TyG. A portable spirometer was used to assess lung function. Fundamental clinical features and lung function indicators were compared between the two groups, and the relationship between the TyG index and lung function parameters was explored.

Results

Compared with the low TyG group, the high TyG group exhibited significantly reduced levels of FEV1/FVC, FVC% pred, FEV1% pred, FEV3% pred, FEV3/FVC, FEF75, FEF75% pred, FEF25-75% pred, and MVV% pred, suggesting poor pulmonary function. The TyG index was significantly inversely correlated with multiple pulmonary function metrics, including FVC% pred, FEV1% pred, FEV3% pred, FEV1/FVC, FEV3/FVC, FEF75, FEF75% pred and FEF25-75% pred, which persisted even after accounting for confounding variables.

Conclusion

In summary, the present study establishes a correlation between the TyG index and some lung function indicators, offering a new indicator of metabolic abnormalities related to lung functionality.

The association between triglyceride-glucose index and gallstones: NHANES 2017-2020

Objects

It remains unclear whether the triglyceride-glucose (TyG) index has correlations with gallstones. This study aimed to investigate the association between TyG index and gallstones.

Methods

Data was obtained from the 2017-2020 National Health and Nutrition Examination Survey (NHANES). Participants who provided complete data about TyG index and gallstones were included in the analysis. Multivariable regression analysis and subgroup analysis were preformed to estimate the relationship between TyG index and gallstones. Restricted cubic splines (RSC) was employed to calculate the cut off value.

Results

The TyG index was independently associated with gallstones and demonstrates a clear positive correlation (OR = 1.10; 95% CI: 1.01-1.21; p = 0.033). The threshold value is 8.98, showing a positive correlation between TyG index and gallstones when the TyG index is less than 8.98 (Log likelihood ratio P < 0.001). Subgroup analysis indicates that the correlation between TyG and gallstones is mainly observed in individuals with obesity, females, younger individuals, and those with normal blood sugar levels, with these subgroups all acting as mediators between TyG and gallstones.

Conclusions

Higher TyG index was linked to a higher chance of developing gallstones. Managing insulin resistance (IR) could help reduce the risk of gallstones since the TyG index is an indicator of IR.

Global trends and emerging topics related to triglyceride-glucose index: A bibliometric analysis and visualization from 2000 to 2024

The triglyceride-glucose (TyG) index is a crucial marker of insulin resistance, as evidenced by numerous studies related to metabolic diseases. This bibliometric analysis investigates research trends associated with the TyG index over the past 24 years. We collected data on TyG index publications from January 1, 2000, to January 7, 2024, using the Web of Science database. Analysis was conducted utilizing VOSviewer, Scimago Graphica, and CiteSpace to evaluate publication metrics, citations, countries, institutions, authors, journals, and keywords. A total of 1163 publications from 354 journals authored by 6149 researchers across 60 countries were analyzed. China emerged as the leading contributor, with 654 publications (56.23%). Capital Medical University was the most productive institution, and Wu Shouling was the top author. Cardiovascular Diabetology was identified as the most influential journal. Key emerging research directions include the role of the TyG index as a representative marker for insulin resistance, particularly concerning insulin sensitivity; its association with body mass index and hyperuricemia; and its diagnostic and prognostic value in nonalcoholic fatty liver disease and cardiovascular conditions such as acute coronary syndrome, carotid plaque, and hypertension. Current trends favor cohort studies predominantly involving adult populations. Overall, China leads TyG index research, focusing on its connections to insulin sensitivity, body mass index, and hyperuricemia, while the index's diagnostic and prognostic significance for nonalcoholic fatty liver disease and cardiovascular diseases represents an expanding research frontier.

The association between the triglyceride-glucose index and bone turnover markers in osteoporotic fractures patients aged 50 and above who are hospitalized for surgical intervention: a retrospective cross-sectional study

Objective

To evaluate the correlation between the triglyceride-glucose (TyG) index and bone turnover markers (BTMs) in osteoporotic fractures (OPFs) patients hospitalized for surgical intervention.

Methods

A retrospective cross-sectional study was conducted on 3558 OPFs patients hospitalized for surgical intervention between January 2017 and July 2022. The study obtained baseline values for various biomarkers and covariates, including fasting blood glucose, β-C-terminal telopeptide of type I collagen (β-CTX), procollagen type 1 N-terminal propeptide (P1NP), triglycerides, age, sex, body mass index, smoking, drinking, low-density lipoprotein, high-density lipoprotein, aspartate aminotransferase, uric acid, the score of American society of anesthesiologists, homocysteine, parathyroid hormone, apolipoprotein B, apolipoprotein A, magnesium, phosphorus and calcium. Multiple linear regression, curve fitting, threshold effects, and subgroup analyses were also applied.

Results

After adjusting for covariates in the regression analysis, the results revealed a negative correlation between β-CTX and P1NP levels and the baseline TyG index. Specifically, a one-unit increase in the TyG index was associated with a reduction in β-CTX levels of -0.06 (95% CI: -0.10, -0.01; P-value = 0.012) and a reduction in P1NP levels of -4.70 (95% CI: -9.30, -0.09; P-value = 0.046). Additionally, the inflection points for the nonlinear correlation between the TyG index and β-CTX and P1NP were found to be K = 6.31 and K = 6.63, respectively.

Conclusion

The study demonstrated a negative, non-linear relationship among the TyG index, β-CTX and P1NP in OPFs patients hospitalized for surgical intervention. These findings suggest that elevated TyG index levels may adversely affect bone turnover, potentially contributing to the progression of OP.

Higher triglyceride‑glucose index is associated with increased risk of stroke among middle-aged and elderly Chinese: a national longitudinal study

Stroke is a severe cerebrovascular disease. This study aimed to determine the association between triglyceride‑glucose (TyG) index and stroke among middle-aged and elderly Chinese. Data was extracted from China Health and Retirement Longitudinal Study survey 2015 and survey 2018. Logistic regression, trend test and subgroup analysis were conducted to assess the association. Possible nonlinear relationships were explored with restricted cubic spline (RCS). Propensity score matching (PSM) was conducted to attenuate the effect of confounding factors. ORs of stroke was positively associated with TyG index. The ORs in RCS analysis also increased with the rising TyG, though p for non-linearity was bigger than 0.05. After PSM, the ORs in the full adjusted models were 1.28 (1.01, 1.62). TyG was suggested as an independent risk factor for stroke in the middle aged and elderly Chinese.

An overview of the application and potential mechanism on the triglyceride glucose index with multi-vessel coronary disease

Multi-vessel coronary disease (MVCD) is a severe form of coronary artery disease (CAD) that significantly increases the risk of acute coronary syndrome (ACS) and heart attacks. The triglyceride glucose (TyG) index is a reliable and convenient marker for insulin resistance (IR). Recent studies have demonstrated its predictive value for CAD in patients with MVCD. This review aims to explore the application of the TyG index in managing MVCD and its underlying pathogenesis to enhance risk stratification and improve therapeutic decision-making.

Association of the triglyceride-glucose index with all-cause and cause-specific mortality: a population-based cohort study of 3.5 million adults in China

Background

The triglyceride-glucose (TyG) index has been recognized as a crucial risk factor for cardiovascular diseases. However, the association between the TyG index and mortality in the general population remains elusive.

Methods

Participants were enrolled from the China Health Evaluation And risk Reduction through nationwide Teamwork (ChinaHEART), a nationwide prospective cohort study. The outcomes of interest were all-cause, cardiovascular, and cancer mortality. Restricted cubic splines and Cox regression models were used to assess the associations between the TyG index and outcomes.

Findings

In total, 3,524,459 participants with a median follow-up of 4.6 (IQR, 3.1-5.8) years were included. The associations of the TyG index with all-cause and cardiovascular mortality were reverse L-shaped, with cut-off values of 9.75 for all-cause mortality and 9.85 for cardiovascular mortality. For each 1-unit increase in the TyG index, when below the cut-off values, the TyG index was not significantly associated with all-cause mortality (HR = 1.02, 95% CI: 1.00-1.03) and was only modestly associated with cardiovascular mortality (HR = 1.09, 95% CI: 1.06-1.11). Conversely, when the cut-off values were exceeded, the HRs (95% CI) were 2.10 (1.94-2.29) for all-cause mortality and 1.99 (1.72-2.30) for cardiovascular mortality. However, the association between the TyG index and cancer mortality was linearly negative (HR = 0.97, 95% CI: 0.94-0.99).

Interpretation

The associations of the TyG index with all-cause and cardiovascular mortality displayed reverse L-shaped patterns, while an elevated TyG index showed a slight negative association with cancer mortality. We suggest that <9.75 could be the optimal TyG index cut-off value among the Chinese general population. Individuals at high risk of mortality might benefit from proper management of a high TyG index.

Funding

The National High Level Hospital Clinical Research Funding (2023-GSP-ZD-2, 2023-GSP-RC-01), the Ministry of Finance of China and National Health Commission of China.

Association Between the Triglyceride-Glucose Index and Serum Uric Acid to High-Density Lipoprotein (HDL) Cholesterol Ratio in Type 2 Diabetes Mellitus in Gabes City, Tunisia

Background Type 2 diabetes mellitus (T2DM) is a significant risk factor for cardiovascular diseases (CVD). The triglyceride-glucose index (TyGi) is a novel biomarker for insulin resistance, strongly linked to CVD. Elevated serum uric acid levels and the uric acid to high-density lipoprotein cholesterol ratio (UHR) are emerging as markers of metabolic syndrome and cardiovascular risk in T2DM. This study aimed to explore the association between the TyGi and UHR in T2DM patients. Objectives The aim of this study is to compare metabolic parameters in T2DM patients and assess the association between the TyGi and serum UHR. Methodology A cross-sectional case-control study was conducted at the University Hospital of Gabes, Gabes City, Tunisia with 50 T2DM patients and 50 gender-matched healthy controls. Inclusion criteria included adults aged 30-75 years with a confirmed diagnosis of T2DM on stable medication for at least three months. Exclusion criteria included other types of diabetes, significant liver or kidney disease, recent cardiovascular events, endocrine disorders, and substance abuse. Metabolic and biochemical parameters, including fasting blood sugar, postprandial blood sugar, glycosylated hemoglobin, lipid profile, and renal function, were measured. The TyGi and serum UHR were calculated and analyzed for correlations. Results T2DM patients exhibited significantly higher fasting blood sugar, postprandial blood sugar, glycosylated hemoglobin, TyGi, and serum UHR compared to controls, indicating impaired glycemic control and adverse lipid profiles. The UHR showed a positive correlation with a strong negative correlation with HDL and a positive correlation with uric acid levels. The linear regression analysis indicated a weak positive trend between the TyGi and serum UHR, although not statistically significant. Conclusion This study underscores the importance of the TyGi and serum UHR as biomarkers for evaluating metabolic and cardiovascular risk in T2DM. Further research is needed to explore their combined utility in clinical practice for early detection and management of cardiovascular complications in diabetic patients.

The triglyceride-glucose index is a predictor of major adverse cardiovascular events in patients with coronary artery disease and psoriasis: a retrospective cohort study

BACKGROUND

The association between the triglyceride-glucose (TyG) index and clinical outcomes in patients with both coronary artery disease (CAD) and psoriasis is unclear. This study investigated the association between the TyG index and major adverse cardiovascular events (MACE) in patients with both CAD and psoriasis.

METHODS

This retrospective cohort study included patients diagnosed with both CAD and psoriasis who underwent coronary angiography at the Fuwai Hospital, Beijing, China, between January 2017 and May 2022. The study endpoint was the occurrence of MACE or end of follow-up time. Multivariate Cox proportional analysis and restricted cubic splines (RCS) were used to determine the association between the TyG index and MACE. Receiver operating characteristic (ROC) curves were used to determine the optimal threshold value of the TyG index for predicting MACE.

RESULTS

This study enrolled 293 patients with both CAD and psoriasis, including 258 (88.1%) males with a mean age of 58.89 ± 9.61 years. Patients were divided into four groups based on the TyG quartiles: Q1 (N = 74), Q2 (N = 73), Q3 (N = 73), and Q4 (N = 73). After adjusting for the potential confounders, the TyG index was independently associated with MACE, both as a continuous variable (HR = 1.53, 95% CI = 1.03-2.28, P = 0.035) and as a categorical variable (Q1: reference; Q2: HR = 1.85, 95% CI = 0.88-3.87, P = 0.105; Q3: HR = 2.39, 95% CI = 1.14-5.00, P = 0.021; Q4: HR = 2.19, 95% CI = 1.001-4.81, P = 0.0497; P for trend = 0.039). RCS analysis showed an linear association between the TyG index and MACE (P-overall = 0.027, P-non-linear = 0.589). ROC curve analysis showed that the TyG index of ≥ 8.73 was the optimal threshold value (area under the ROC curve = 0.60, 95% CI 0.53-0.67). TyG index ≥ 8.73 was significantly associated with MACE (HR = 2.10, 95% CI = 1.32-3.34, P = 0.002). After adjustment for confounders, the TyG index showed independent association with MACE (HR = 2.00, 95% CI = 1.17-3.42, P = 0.011).

CONCLUSIONS

The TyG index showed a positive linear correlation with MACE in patients with both CAD and psoriasis. The TyG index of ≥ 8.73 might be the optimal threshold for predicting MACE.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Association of triglyceride glucose-related parameters with all-cause mortality and cardiovascular disease in NAFLD patients: NHANES 1999-2018

BACKGROUND

The relationship between the triglyceride-glucose (TyG) index and its derived index, the triglyceride glucose-waist height ratio (TyG-WHtR), with mortality and cardiovascular diseases (CVDs) in patients with non-alcoholic fatty liver disease (NAFLD) remains unclear.

METHODS

This study enrolled 6627 adults aged 18 and above diagnosed NAFLD from the National Health and Nutrition Examination Survey (NHANES, 1999-2018). Binary weighted logistic regression analyses, cox proportional hazards model and restricted cubic spline (RCS) were used to analyze the relationship between TyG and TyG-WHtR with all-cause mortality, CVD mortality and CVDs. Mediation analysis explored the mediating role of glycohemoglobin, insulin and hypertension in the above relationships. Meanwhile, the incremental predictive value of the TyG index and TyG-WHtR was further assessed.

RESULTS

Except for no significant association between the TyG index and both all-cause mortality and chronic heart failure (CHF), both TyG and TyG-WHtR exhibited significant positive correlations or trends of positive correlation with all-cause mortality, CVD mortality, total-CVD, CHF, coronary heart disease (CHD) and angina pectoris. For all-cause mortality, CVD mortality and CHF, TyG-WHtR was a better predictor than TyG (TyG-WHtR: HR 1.31, 95%CI 1.03-1.66; HR 2.22, 95%CI 1.42-3.47; OR 3.99, 95%CI 1.79-8.93). In contrast, TyG index demonstrated a stronger association with total-CVD, CHD and angina pectoris (TyG index: OR 2.00, 95%CI 1.26-3.18; OR 1.85, 95%CI 1.19-2.91; OR 2.93, 95%CI 1.23-7.00). RCS analysis showed that after adjusting for covariates, most of the aforementioned relationships were linear(P overall < 0.0001, P-nonlinear > 0.05), while the associations of the TyG index and TyG-WHtR with all-cause mortality and CHF were non-linear(P overall < 0.0001, P nonlinear < 0.05). The addition of the TyG index and TyG-WHtR to the basic model for outcomes improved the C-statistics, net reclassification improvement value, and integrated discrimination improvement value.

CONCLUSIONS

The predictive value of TyG or TyG-WHtR for all-cause mortality and cardiovascular risk in NAFLD patients was significant. The TyG index and TyG-WHtR might be valid predictors of cardiovascular outcomes of patients with NAFLD.

Association between glycemia and multi-vessel lesion in participants undergoing coronary angiography: a cross-sectional study

Background

This study aims to elucidate the association between glycemia and the occurrence of multi-vessel lesions in participants undergoing coronary angiography.

Methods

We analyzed 2,533 patients with coronary artery disease who underwent coronary angiography. Of these, 1,973 patients, identified by the endpoint of multi-vessel lesions, were examined using univariate and multivariate logistic regression analyses to determine the relationship between glycemia levels and multi-vessel lesion occurrence.

Results

The analysis included 1,973 participants, among whom 474 patients were identified with coronary multi-vessel lesions. Univariate logistic regression analysis demonstrated a positive correlation between glycemia and the occurrence of coronary multi-vessel lesions (OR 1.04; 95% CI 1.01-1.08; p = 0.02). The adjusted model indicated that for each unit increase in glycemia, the risk of developing coronary multi-vessel lesions increased by 4%, showing a significant correlation (p < 0.05). Subgroup analyses revealed that the impact of glycemia on multi-vessel lesions in patients with PCI varied according to gender, age, and smoking status, with the effect being more pronounced in men, older patients, and smokers.

Conclusion

Our findings establish a significant association between glycemia and the incidence of multi-vessel lesions, particularly pronounced in male patients, individuals over 45, and smokers.

Comprehensive analysis of the association between triglyceride-glucose index and coronary artery disease severity across different glucose metabolism states: a large-scale cross-sectional study from an Asian cohort

BACKGROUND

The triglyceride-glucose (TyG) index is associated with the development and prognosis of coronary artery disease (CAD). However, the impact of the TyG index on CAD severity across different glucose metabolism states exhibits significant disparities in previous research.

METHODS

This cross-sectional study comprised 10,433 participants from a prospective cohort. Participants were categorized into four groups based on glucose metabolism state: normal glucose regulation (NGR), prediabetes (pre-DM), diabetes mellitus (DM) without insulin prescribed (Rx), and DM with insulin Rx. The TyG index was determined by the following formula: Ln [TG (mg/dL) × FPG (mg/dL) / 2], where TG is triglycerides and FPG is fasting plasm glucose. Statistical methods such as binary logistic regression, interaction analysis, restricted cubic spline (RCS), and receiver operating characteristic (ROC) were employed to analyze the relationship between the TyG index and CAD severity across the entire population and glucose metabolism subgroups. Mediation analysis was conducted to examine the mediating effects of glycated hemoglobin (HbA1c) on these relationships. Sensitivity analysis was performed to ensure the robustness of the findings.

RESULTS

Multivariable logistic regression analysis revealed a significant positive association between the TyG index and multi-vessel CAD in the entire population (OR: 1.34; 95% CI: 1.22-1.47 per 1-unit increment). Subgroup analysis demonstrated consistent positive associations in the NGR, pre-DM, and DM non-insulin Rx groups, with the highest OR observed in the NGR group (OR: 1.67; 95% CI: 1.3-2.14 per 1-unit increment). No correlation was found in the DM with insulin Rx subgroup. RCS analyses indicated the distinct dose-response relationships across different glucose metabolism subgroups. Including the TyG index in the established model slightly improved the predictive accuracy, particularly in the NGR group. Mediation analyses showed varying mediating effects of HbA1c among different glucose metabolism subgroups. Sensitivity analysis confirmed the robustness of the aforementioned relationships in the new-onset CAD population and in individuals not using antilipidemic medications.

CONCLUSIONS

The TyG index positively associated with CAD severity across all glucose metabolism states, except for individuals receiving insulin treatment. Moreover, it might serve as a supplementary noninvasive predictor of CAD severity in addition to established factors, especially in NGR patients.

Association of cardiometabolic and triglyceride-glucose index with left ventricular diastolic function in asymptomatic individuals

BACKGROUND AND AIMS

Obesity and insulin resistance are associated with left ventricular diastolic dysfunction (LVDD) and increased risk of heart failure. Cardiometabolic index (CMI) and triglyceride glucose (TyG) are new indexes to assess visceral obesity and insulin resistance, respectively. The study aimed to investigate the clinical usefulness of these indexes for identifying LVDD individuals.

METHODS AND RESULTS

Overall, 1898 asymptomatic individuals were included in this cross-sectional study. Participants underwent anthropometrics, serum biochemical evaluation, and echocardiography. Multiple linear regression analysis revealed that both indexes were independent determinants of diastolic parameters among females; while for males, CMI and TyG were not associated with A velocity. In the multivariate logistic analysis, the proportion of LVDD in the third and fourth quartiles of CMI remained significantly greater than that in the lowest quartile in females (Q3 vs. Q1: odds ratio (OR) = 2.032, 95% confidence interval (CI): 1.181-3.496; Q4 vs. Q1: OR = 2.393, 95% CI: 1.347-4.249); while in males, the incidence of LVDD was significantly greater only in the fourth quartile. For TyG, the presence of LVDD in the fourth quartile was significantly greater in both genders. The discriminant values between the CMI (AUC: 0.704, 95% CI: 0.668-0.739) and TyG (AUC: 0.717, 95% CI: 0.682-0.752) were similar in females. Both indexes performed better in females than in males to identify LVDD.

CONCLUSION

The CMI and TyG might both serve as effective tools to identify LVDD in routine health check-ups in primary care, mainly in females. With simpler parameters, the CMI could be utilized in medically resource-limited areas.

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

Objectives

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

Materials and Methods

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

Results

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

Conclusion

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

The impact of triglyceride-glucose index on the prognosis of post-PCI patients-a meta-analysis

Background

Previous research has demonstrated the validity of the triglyceride-glucose (TyG) index as a robust measure of insulin resistance (IR) and its association with coronary artery disease (CAD). The objective of this study is to elucidate the relationship between the TyG index and the prognosis of patients underwent percutaneous coronary intervention (PCI) through a comprehensive systematic review and meta-analysis. Our goal is to provide a thorough analysis of the available evidence to offer more clarity on this association.

Methods

A systematic and thorough search was carried out in the PubMed, Embase, Cochrane Library, and Web of Science databases, covering studies published in English from the beginning until October 1, 2023. The focus of the search was to gather relevant studies pertaining to the occurrence of major adverse cardiovascular events (MACE). To address the variability among the included studies, random or fixed effect models were utilized to summarize the hazard ratios (HR). In cases where heterogeneity was detected, subgroup or sensitivity analyses were performed to explore potential sources. To evaluate publication bias, the Egger or Begg test was employed.

Results

This study incorporated a total of 17 studies. Individuals with the highest TyG index exhibited an elevated risk of major adverse cardiovascular events (MACEs) compared to those with the lowest TyG index (HR = 1.69; 95% CI: 1.47-1.95; P < 0.001). When analyzing the TyG index as a continuous variable, each standard deviation increase was associated with an HR of 1.60 (95% CI: 1.48-1.73; P < 0.001). Moreover, in patients diagnosed with acute coronary syndrome (ACS), higher TyG index levels showed a trend of increased risk of MACE (HR = 1.54; 95% CI: 1.27-1.86; P < 0.001). Furthermore, an elevated TyG index was found to be associated with a higher risk of in-stent restenosis (HR = 1.62; 95% CI: 1.29-2.03; P < 0.001), new-onset atrial fibrillation (HR = 2.97; 95% CI: 2.10-4.06; P = 0.014), and a reduction in quantitative flow ratio (HR = 1.35; 95% CI: 1.101-1.592; P = 0.005). Subgroup analysis indicated the risk of MACE was comparable between varied durations of follow-up (P = 0.11). Furthermore, regression analysis revealed that the positive association between TyG index and the risk of MACE did not differ between individuals with or without diabetes (P = 0.23).

Conclusion

An increase in the TyG index may lead to a higher vulnerability to major adverse cardiovascular events (MACE) in patients underwent PCI and there was no significant difference in the risk of major adverse cardiovascular events (MACE) between diabetic and non-diabetic individuals.

Association between triglyceride glucose-waist to height ratio and coronary heart disease: a population-based study

BACKGROUND

The Triglyceride glucose (TyG) index-related indicators improve risk stratification by identifying individuals prone to atherosclerosis early in life. This study aimed to examine the relation between TyG-waist circumference-to-height ratio (TyG-WHtR) and coronary heart disease.

METHODS

Data from four National Health and Nutrition Examination Surveys (NHANES) cycles between 2011 and 2018 were used for a cross-sectional study. The association between TyG-WHtR and coronary heart disease risk was examined using a multifactorial logistic regression model, and corresponding subgroup analyses were performed. Nonlinear correlations were analyzed using smooth curve fitting and threshold effects analysis. When nonlinear connections were discovered, appropriate inflection points were investigated using recursive methods.

RESULTS

TyG-WHtR and coronary heart disease were significantly positively correlated in the multifactorial logistic regression analysis. Subgroup analyses and interaction tests revealed that gender, age, smoking status, and cancer were not significantly associated with this correlation (P for interaction > 0.05). Furthermore, utilizing threshold effect analysis and smooth curve fitting, a nonlinear connection with an inflection point of 0.36 was observed between TyG-WHtR and coronary heart disease.

CONCLUSIONS

According to this study, the American population is far more likely to have coronary heart disease if they have higher TyG-WHtR levels.

Homocysteine concentration in coronary artery disease and severity of coronary lesions

Our previous study reckons that the impact of the rs1801133 variant of 5,10-methylenetetrahydrofolate reductase (MTHFR) on coronary artery disease (CAD) is possibly mediated by cardiometabolic disorder. This study is performed to verify this hypothesis. Four hundred and thirty CAD patients and 216 CAD-free individuals were enrolled in this case-control study. The rs1801133 variant was genotyped by PCR-RFLP. Severity of coronary lesions was evaluated by number of stenotic coronary vessels and extent of coronary stenosis. The rs1801133 T allele significantly increased homocysteine levels in patients with CAD and CAD-free individuals. Individuals with the T allele of rs1801133 had an increased risk of developing CAD. In contrast, individuals with the TT genotype of rs1801133 were at high risk of multiple vessel lesions. The carriers of CT genotype had higher levels of systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), and high-sensitivity C-reactive protein (hs-CRP), and lower levels of apolipoprotein A1 (APOA1) than those with CC genotype in male patients with CAD. The receiver operating characteristic (ROC) curve and precision-recall (PR) curve indicated that hyperhomocysteinemia was sensitive to predict the severity of CAD. Multivariate logistic regression revealed that homocysteine, rs1801133, age, smoking, weight, body mass index (BMI), lipoprotein(a) [Lp(a)], and hs-CRP were independent risk factors for CAD. The increased risk of CAD and severity of coronary lesions associated with rs1801133 in the Chinese Han population were attributed, at least partly, to high homocysteine levels. Hyperhomocysteinemia had a high predictive value for severe CAD or multiple vessel lesions.

Triglyceride-glucose index is associated with myocardial ischemia and poor prognosis in patients with ischemia and no obstructive coronary artery disease

BACKGROUND

Ischemia and no obstructive coronary artery disease (INOCA) is increasingly recognized and associated with poor outcomes. The triglyceride-glucose (TyG) index is a reliable alternative measure of insulin resistance significantly linked to cardiovascular disease and adverse prognosis. We investigated the association between the TyG index and myocardial ischemia and the prognosis in INOCA patients.

METHODS

INOCA patients who underwent both coronary angiography and myocardial perfusion imaging (MPI) were included consecutively. All participants were divided into three groups according to TyG tertiles (T1, T2, and T3). Abnormal MPI for myocardial ischemia in individual coronary territories was defined as summed stress score (SSS) ≥ 4 and summed difference score (SDS) ≥ 2. SSS refers to the sum of all defects in the stress images, and SDS is the difference of the sum of all defects between the rest images and stress images. All patients were followed up for major adverse cardiac events (MACE).

RESULTS

Among 332 INOCA patients, 113 (34.0%) had abnormal MPI. Patients with higher TyG index had a higher rate of abnormal MPI (25.5% vs. 32.4% vs. 44.1%; p = 0.012). Multivariate logistic analysis showed that a high TyG index was significantly correlated with abnormal MPI in INOCA patients (OR, 1.901; 95% CI, 1.045-3.458; P = 0.035). During the median 35 months of follow-up, 83 (25%) MACE were recorded, and a higher incidence of MACE was observed in the T3 group (T3 vs. T2 vs. T1: 36.9% vs. 21.6% vs. 16.4%, respectively; p = 0.001). In multivariate Cox regression analysis, the T3 group was significantly associated with the risk of MACE compared to the T1 group (HR, 2.338; 95% CI 1.253-4.364, P = 0.008).

CONCLUSION

This study indicates for the first time that the TyG index is significantly associated with myocardial ischemia and poor prognosis among INOCA patients.