Triglyceride-glucose index as a prognostic marker after ischemic stroke or transient ischemic attack: a prospective observational study

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

Objective

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

Methods

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

Results

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

Conclusion

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

Associations of triglyceride glucose-body mass index with short-term mortality in critically ill patients with ischemic stroke

BACKGROUND

The triglyceride glucose-body mass index (TyG-BMI) has been established as a convenient and reliable marker for assessing insulin resistance (IR) and has been shown to be significantly correlated with stroke. However, only a few studies have been conducted in this field, with conflicting conclusions.

METHODS

This study based on the eICU database, investigated the association between TyG-BMI and 28-day mortality in critically ill ischemic stroke (IS) patients. Multivariate Cox regression models were employed to analyze the impacts of the TyG-BMI on 28-day hospital and ICU mortality. Restricted cubic splines (RCS) were applied to explore the nonlinear relationship between the TyG-BMI and 28-day mortality. K‒M curves were utilized for outcome comparisons among different TyG-BMI groups. Additionally, interaction and subgroup analyses were performed to validate the robustness of the results.

RESULTS

A total of 1,362 critically ill patients with IS were enrolled, with a mean age of 68.41 ± 14.16 years; 47.50% were male. Multivariate Cox regression analysis revealed that, the high TyG-BMI group had significantly higher 28-day hospital mortality(HR = 1.734, P = 0.032) and ICU mortality (HR = 2.337, p = 0.048). RCS analysis showed a nonlinear positive correlation between the TyG-BMI and 28-day hospital mortality. Below the inflection point of the TyG-BMI = 380.37, each increase of 1 standard deviation (SD) (approximately 25.5 units) in the TyG-BMI was associated with a 37.3% increase in 28-day hospital mortality (HR = 1.373, P = 0.015), and above 380.376, each 1-SD increase in the TyG-BMI resulted in an 87.9% decrease in 28-day hospital mortality (HR = 0.121, P = 0.057). The log-likelihood ratio test P value = 0.004. For 28-day ICU mortality, the TyG-BMI exhibited a significant positive linear correlation in RCS.

CONCLUSIONS

Elevated TyG-BMI is significantly associated with an increased risk of short-term all-cause mortality in patients with critically ill IS in the United States. This result provides compelling evidence to address the existing discrepancies in this research domain, indicating that the TyG-BMI could serve as a straightforward and efficient biomarker for identifying critically ill IS patients at high risk of mortality.

Influence of TyG Index on Large Vascular Occlusive Stroke Following Endovascular Treatment

AIMS

This study aimed to investigate the impact of the triglyceride-glucose index (TyG index) on clinical consequences in individuals with large vascular occlusion (LVO)-induced acute ischemic stroke (AIS) following endovascular treatment (EVT).

METHODS

We conducted a single-center retrospective cohort study, including AIS with LVO who underwent EVT. Patients were categorized into TyG index groups, calculated as "(fasting triglyceride [mg/dL] × fasting blood glucose [mg/dL]/2)." Clinical outcomes were assessed, including poor outcome (modified Rankin Scale [mRS] > 2 [3-6]) at 90 days, early neurological deterioration (END), symptomatic intracranial hemorrhage (sICH), and 90-day mortality after EVT. Logistic regression and restricted cubic splines (RCS) were used to examine the relationship between the TyG index and clinical outcomes. Receiver operating characteristic (ROC) curve was constructed to evaluate the prognostic capacity of the TyG index.

RESULTS

A total of 424 patients were included. Higher TyG levels were associated with worse functional outcome at 90 days (per unit: p = 0.006), sICH (per unit: p = 0.002, T3 versus T1: p = 0.004), and 90-day mortality (T2 versus T1: p = 0.011, T3 versus T1: p = 0.029) in logistic regression. A RCS model revealed a linear association between the TyG index and poor outcome at 90 days, sICH, and 90-day mortality (p for nonlinearity > 0.05). In ROC curve analysis, the traditional risk factors model (area under the curve [AUC]: 0.824, 95% CI: 0.784-0.859) was outperformed by the conventional risk factors + TyG index model (AUC: 0.845, 95% CI: 0.807-0.878) in predicting poor outcome (p = 0.021).

CONCLUSION

A higher TyG index is associated with worse clinical outcomes in LVO-induced AIS patients after EVT. Additionally, the TyG index enhances risk prediction of traditional risk factors for poor outcome.

Evaluation of Triglyceride Glucose Index in Patients with Patent Foramen Ovale Who Experienced Cryptogenic Stroke

Background/Objectives: The prevalence of patent foramen ovale (PFO) has been found to be increased in patients with cryptogenic stroke, suggesting an association between these two clinical settings. Insulin resistance is a risk factor for the occurrence of stroke. The triglyceride glucose (TyG) index is a biomarker that reflects the IR status of the body. Our aim was to evaluate the TyG index values in patients with PFO who experienced cryptogenic stroke. Methods: One hundred and twenty nine patients with PFO who experienced embolic stroke and one hundred and eight control subjects were enrolled. All patients in the study group experienced embolic stroke within 2 weeks of enrollment. The TyG index value of each patient was calculated. Results: Patients with stroke were significantly older, had higher levels of glucose, creatinine, triglyceride (TG), leukocyte, and TyG index and lower high-density lipoprotein-cholesterol values. The TyG index had the highest sensitivity for the prediction of stroke in comparison to TG and glucose values. Comparison of ROC curves showed that the TyG index had the highest AUC compared to that of TG and glucose. The TyG index value of 8.89 predicted stroke occurrence with a sensitivity and specificity of 63.2% and 72.3%, respectively. The results of multivariable regression analyses showed that the TyG index had a higher odds ratio than TG, which indicated that it had a better predictive value. Conclusions: Assessment of the TyG index in cryptogenic stroke patients with PFO might be helpful for the management of these patients.

Correlation between triglyceride-glucose index and early neurological deterioration in patients with acute mild ischemic stroke

Objective

The Triglyceride-glucose Index (TyG) index is a dependable metric for assessing the degree of insulin resistance, serving as a standalone predictor of ischemic stroke risk, but its precise relationship with early neurological deterioration (END) remains incompletely expounded within the context of acute mild ischemic stroke patients. This research is to examine the correlation of the TyG index with END among patients experiencing acute mild ischemic stroke in China.

Methods

This retrospective analysis was conducted to systematically gather data regarding patients experiencing their maiden episode of acute mild ischemic stroke and hospitalized at the Neurology Department of Nanjing Meishan Hospital, located in Nanjing, Jiangsu Province, China, over the period extending from January 2020 to December 2022. The severity of stroke was determined through the utilization of the National Institutes of Health Stroke Scale (NIHSS) scores upon their admission. Demographic characteristics were collected, and measurements of fasting blood glucose, blood lipids, and glycosylated hemoglobin Alc levels were taken. END was defined as a one-point rise in the motor item function score on the NIHSS or a two-point increase in the overall score during the initial 72 h of hospitalization. For evaluating the correlation of the TyG index with END, a multivariate logistic regression analysis was carried out. To investigate whether there is a nonlinear relationship between the TyG index and END, smoothed curves were utilized.

Results

The study included 402 patients diagnosed with acute mild ischemic stroke, with a mean age of 66.15 ± 10.04 years. Within this population, 205 were males (51.00%) and 197 were females (49.00%). Among these patients, 107 (26.62%) experienced END within 72 h of admission. Patients who developed END showed higher levels of the TyG index in comparison to those who remained stable (9.18 ± 0.46 vs. 8.87 ± 0.46, p < 0.001). In a comprehensive multivariate logistic regression analysis, the TyG index positively correlates with END (OR = 3.63, 95% CI: 1.75-7.54, p = 0.001). Furthermore, individuals in the fourth TyG index quartile exhibited a 2.36-fold heightened risk of END compared to those in the first quartile (95% CI: 1.38-8.19, p = 0.008). TyG index has a linear correlation with END in the generalized additive model (Log likelihood ratio test, p = 0.525).

Conclusion

Our findings demonstrate that TyG index has a significant, independent, and positive correlation with END in Chinese individuals diagnosed with acute mild ischemic stroke. This underscores the TyG index's potential usefulness as a valuable risk stratification tool for stroke patients.

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

Aim

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

Methods

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

Results

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

Conclusion

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

Association of triglyceride-glucose index with adverse cardiovascular events in patients with established coronary artery disease according to different inflammatory status

BACKGROUND AND AIMS

This study aimed to investigate the association of the triglyceride-glucose (TyG) index, a simple-but-reliable indicator of insulin resistance, with risk of cardiovascular (CV) events in coronary artery disease (CAD) patients with different inflammation status.

METHODS AND RESULTS

We consecutively recruited 20,518 patients with angiograph-proven-CAD from 2017 to 2018 at Fuwai Hospital. Patients were categorized according to baseline TyG index tertiles (T) (tertile 1: ≤8.624; T2: 8.624-9.902 and T3: >9.902) and further assigned into 6 groups by high-sensitivity C-reactive protein (hsCRP) medians. The primary endpoint was CV events including CV death, nonfatal myocardial infarction and nonfatal stroke. During the 3.1-year-follow-up, 618 (3.0%) CV events were recorded. Overall, patients with high TyG index levels (T2 or T3) showed significantly increased risk of CV events (hazard ratio [HR]: 1.24; 95% confidence interval [CI]: 1.01-1.53; HR: 1.33; 95%CI: 1.05-1.68, respectively) compared with those with lowest Tyg index (T1) after adjusting for confounding factors. Upon stratification by hsCRP levels, elevated TyG index was associated with increased risk of CV events only in patients with hsCRP levels > median (per-1-unit-increase HR: 1.39; 95%CI: 1.11-1.74), rather than in those with hsCRP levels ≤ median. Furthermore, adding the TyG index to the predicting model led to a significant improvement in patients with hsCRP > median rather than in those with hsCRP ≤ median.

CONCLUSIONS

We firstly found that elevated TyG index levels were associated with increased risk of CV events in CAD patients, especially in those with increased inflammatory status, suggesting that it could help in risk stratification and prognosis in this population.

Association between triglyceride glucose body mass index and cardiovascular disease in adults: evidence from NHANES 2011- 2020

BACKGROUND

The association between insulin resistance and cardiovascular diseases (CVD) is of significant interest. However, there is limited published research on the relationship between CVD and the triglyceride glucose-body mass index (TyG-BMI). This study aims to examine the association between TyG-BMI and CVD in US adults.

METHOD

We analyzed data from 11016 adults collected through the 2011-2020 NHANES. Employing weighted generalized linear models, subgroup analysis, sensitivity analysis, and receiver operating characteristic curves, we examined the association between the TyG-BMI index and CVD. Nonlinear associations were investigated using restricted cubic splines.

RESULTS

Higher TyG-BMI values were significantly associated with an increased prevalence of CVD (P<0.001). Weighted generalized linear models consistently demonstrated a positive association across all models. Specifically, individuals in the highest tertile of TyG-BMI had a 38% higher CVD prevalence than those in the lowest quartile (OR=1.380; 95% CI=1.080, 1.763). Unweighted logistic regression models further confirmed these findings. Sex, race, education, family income to poverty ratio, smoking, hypertension, and diabetes did not modify this positive association (P for interaction >0.05). Incorporating the TyG-BMI index into traditional risk factor models marginally improved the prediction of CVD prevalence (P for comparison <0.05).

CONCLUSIONS

The TyG-BMI index, an indicator of insulin resistance, is significantly positive associated with a higher prevalence of CVD. These findings underscore the importance of managing insulin resistance to prevent CVD and highlight the need for further research into the underlying mechanisms of this association.

Non-insulin-based insulin resistance indices predict early neurological deterioration in elderly and middle-aged acute ischemic stroke patients in Northeast China

Insulin resistance (IR) has a strong association with acute ischemic stroke (AIS) occurrence and poor prognosis of afflicted patients. However, the relation between early neurological deterioration (END) risk and IR in elderly and middle-aged patients remains to be thoroughly studied. Here, we investigated the relationship between four indicators of IR and the risk of END in middle-aged patients patients with AIS. The study retrospectively analyzed 1696 elderly and middle-aged patients having AIS between January 2019 and June 2023. Within 7 days of admission, the patients were then stratified relying upon alternations in the National Institutes of Health Stroke Scale. Subsequently, we employed logistic regression analyses for assessing each index correlation with END on the basis of the tertiles of TyG index (TyGI), triglyceride to high-density lipoprotein ratio (TG/HDL), TyG-BMI, alongside IR metabolic score (METS-IR). These four indicators were significantly heightened in the END group (n = 680) in comparison to the non-END group (n = 1016). When grouping using tertiles, the four aforementioned indicators emerged as independent risk factors for END occurrence, whether or not adjusted for confounding factors. The results revealed a progressive elevation in END occurrence risk with the rise in the tertile of each indicator. Finally, we utilized receiver operating characteristic (ROC) curves for assessing the indicators' predictive power. TyG-BMI, TyGI, TG/HDL, and METS-IRs' area under the curve (AUC) were, respectively, 0.736 (95% CI: 0.712-0.761; P < 0.001), 0. 694 (95% CI: 0.668-0.721; P < 0.001), 0.684 (95% CI: 0.658-0.711; P < 0.001), and 0.722 (95% CI: 0.697-0.747; P < 0.001). IR is associated with END risk in middle-aged AIS patients. TyG-BMI, TyGI, TG/HDL, and METS-IR are independent risk factors of END in elderly and middle-aged AIS patients. Simultaneously, these four IR indicators have significant predictive power for END.

Triglyceride-Related Parameters and Symptomatic Atherosclerotic Lesions in Patients With Ischemic Stroke

Objective

Recently, evidence has suggested that the pathophysiology and risk factors of intracranial atherosclerosis (ICAS) differs from those of extracranial atherosclerosis (ECAS). In addition, novel parameters reflecting metabolic conditions, such as insulin resistance or atherogenic dyslipidemia, based on triglycerides (TG) and other biomarkers, have emerged. In this study, we evaluated the association between TG-related parameters and symptomatic cerebral atherosclerosis in patients with acute ischemic stroke resulting from large artery atherosclerosis (LAA).

Methods

We assessed consecutive acute LAA-stroke patients between January 2010 and December 2020. Based on the radiological findings, we classified the relevant symptomatic arteries that caused the index stroke into LAA-ICAS and LAA-ECAS. As TG-related parameters, the atherogenic index of plasma (AIP) and TG-glucose (TyG) index were calculated according to the following formulas: AIP = log10 (TG Level/High-density Lipoprotein Cholesterol Level), TyG Index = Ln (TG Level × Glucose Level/2).

Results

A total of 519 patients with LAA-stroke were evaluated. In multivariable logistic regression analysis to identify predictors of LAA-ICAS, AIP was significantly associated with LAA-ICAS (adjusted odds ratio [aOR], 3.60; 95% confidence interval [CI], 1.60-8.06). TyG index also showed a statistically significant relationship with LAA-ICAS (aOR, 1.60; 95% CI, 1.11-2.32). However, TG per se did not show a statistical association with LAA-ECAS.

Conclusion

TG-related parameters were more closely associated with stroke by ICAS than by ECAS. The metabolic conditions reflected by the AIP or TyG index, rather than hypertriglyceridemia itself, may play a greater role in determining the relevant vessel causally involved in a stroke.

Triglyceride-glucose index and triglyceride to high-density lipoprotein cholesterol ratio predict the prognosis in patients with type B aortic dissection receiving thoracic endovascular aortic repair

Background

The triglyceride-glucose (TyG) index and triglyceride to high-density lipoprotein cholesterol (TG/HDL-c) ratio are both reliable surrogate indicator of insulin resistance and have been shown to be valuable in predicting various cardiovascular diseases. However, few studies have explored its association with the prognosis of type B aortic dissection (TBAD) patients receiving thoracic endovascular aortic repair (TEVAR).

Methods

A total of 1,425 consecutive patients who underwent TEVAR were included. Data from 935 patients were analyzed in the study. The endpoint was defined as 30-day and 1-year aortic-related adverse events (ARAEs), all-cause mortality, and major adverse cardiovascular and cerebrovascular events (MACCEs).

Results

There were 935 patients included during a mean follow-up time of 2.8 years. After adjusting for multiple confounding factors, continuous TG/HDL-c [hazard ratio (HR) =1.07; 95% confidence interval (CI): 1.00-1.15; P=0.041] was independently associated with 1-year all-cause mortality. Both a high (Quintile 5: TG/HDL-c ratio ≥4.11) (HR =4.84; 95% CI: 1.55-15.13; P=0.007) and low TG/HDL-c ratio (Quintile 1: TG/HDL-c ratio <1.44) (HR =4.67; 95% CI: 1.46-14.94; P=0.001) were still independent risk factors for 1-year all-cause mortality.

Conclusions

Elevated baseline TG/HDL-c ratio and TG/HDL-c ≥4.11 were significantly related to a higher risk of 1-year all-cause mortality among TBAD patients undergoing TEVAR. At the same time, the low TG/HDL-c ratio was also independently associated with 1-year all-cause mortality. Special attention should be paid to TBAD patients with a higher or an overly low TG/HDL-c ratio.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Glycemic control and cardiovascular outcomes in patients with diabetes and coronary artery disease according to triglyceride-glucose index: a large-scale cohort study

BACKGROUND

The role of triglyceride-glucose (TyG) index, an insulin resistance indicator, in glycemic management for diabetic patients with coronary artery disease (CAD) was still unknown. Therefore, we aimed to explore the association between glycemic control and cardiovascular (CV) outcomes in patients with diabetes and CAD according to different TyG index levels.

METHODS

A total of 9996 diabetic patients with angiograph-proven CAD were consecutively recruited from 2017 to 2018 at Fuwai Hospital. Patients were assigned into 3 groups according to TyG index tertiles (T) (T1: <8.895; T2: 8.895-9.400; T3: ≥9.400). According to American Diabetes Association guidelines, controlled glycemia was defined as targeting glycosylated hemoglobin Alc (HbA1c) < 7%. The primary endpoint was CV events including CV death, nonfatal myocardial infarction, and nonfatal stroke.

RESULTS

During a median 3-year follow-up, 381 (3.8%) CV events occurred. Overall, high TyG index (T3) was associated with increased risk of CV events (hazard ratio [HR]: 1.40; 95% confidence interval [CI]: 1.02-1.94) compared with the lowest TyG index (T1) after multivariable adjustment. Upon stratification by the TyG index, in fully adjusted models, controlled glycemia was associated with reduced risk of CV events in the high TyG index (T3) subgroup (HR: 0.64; 95%CI: 0.42-0.96) but not in the low (T1; HR: 0.79; 95%CI: 0.53-1.16) and moderate (T2; HR: 0.84; 95%CI: 0.56-1.25) TyG index subgroups.

CONCLUSIONS

Controlled glycemia was associated with improved CV outcomes in patients with diabetes and established CAD, especially in those with high TyG index levels. Our study, for the first time, provided valuable information that TyG index could help making risk stratification on the glycemic management in diabetic patients with CAD.

Association of triglyceride glucose index with all-cause and cardiovascular mortality in the general population

OBJECTIVE

The Triglyceride-glucose (TyG) index, a novel indicator of insulin resistance, has been associated with mortality from coronary artery diseases, ischemic stroke, and heart failure. In recent years, much emphasis has been placed on the relationship between the TyG index and mortality in the general population. However, the impact of age on the association between TyG and all-cause and cardiovascular mortality remains controversial. This study investigated the link between the TyG index and all-cause and cardiovascular mortality, emphasizing differences between older and non-older populations.

METHODS

Data from the National Health and Nutrition Examination Survey (2009-2018), encompassing 20,194 participants, were analyzed. The baseline TyG index was calculated as Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Multivariate Cox proportional hazards regression models with restricted cubic splines and trend tests were employed to explore the association between the TyG index and all-cause and cardiovascular mortality, with emphasis on age-specific analysis. Subgroup analysis was conducted to examine whether the TyG index's association with mortality varied across different subgroups. Additionally, receiver operating characteristic curves were used to compare the predictive ability of the TyG index with the homeostasis model assessment of insulin resistance (HOMA-IR) for all-cause and cardiovascular mortality.

RESULTS

Over a median follow-up period of 105 months, all-cause mortality accounted for 13.345% of cases, and cardiovascular mortality accounted for 3.387%. Kaplan-Meier curves showed a significant increase in all-cause and cardiovascular mortality with higher TyG index values (both P for log-rank test < 0.001). However, during Cox proportional hazards regression analysis, no linear trend was observed between the TyG index and all-cause or cardiovascular mortality after adjusting for confounding factors (all-cause mortality: P for trend = 0.424; cardiovascular mortality: P for trend = 0.481). Restricted cubic splines revealed a non-linear association between the baseline TyG index and all-cause and cardiovascular mortality in the overall population (all-cause mortality: Non-linear P = 0.003; cardiovascular mortality: Non-linear P = 0.034). The effect of the TyG index was consistent across most subgroups in terms of all-cause and cardiovascular mortality, with no significant interaction with randomized factors (all-cause mortality: P for interaction = 0.077-0.940, cardiovascular mortality: P for interaction = 0.173-0.987), except for the age subgroup (all-cause mortality: P for interaction < 0.001, cardiovascular mortality: P for interaction < 0.001). Further age-specific analysis revealed that the association between the TyG index and all-cause and cardiovascular mortality remained significant in patients aged < 65 but not in those aged ≥ 65. Interestingly, a non-linear association was observed between the TyG index and all-cause mortality in individuals aged < 65 (Non-linear P = 0.011), while a linear relationship was observed with cardiovascular mortality, showing an upward trend (Non-linear P = 0.742, P for trend = 0.010). Further stratification according to age yielded similar results only in patients aged 45-64 (all-cause mortality: Non-linear P = 0.001 and cardiovascular mortality: Non-linear P = 0.902, P for trend = 0.015). Compared to HOMA-IR, the TyG index demonstrated superior predictive performance for all-cause and cardiovascular mortality (all-cause mortality: 0.620 vs. 0.524, P < 0.001; cardiovascular mortality: 0.623 vs. 0.537, P < 0.001).

CONCLUSIONS

This study established a significant association between the TyG index and all-cause and cardiovascular mortality in the general population, particularly among individuals aged < 65. Notably, a non-linear association with all-cause mortality was observed in those aged < 65, while a linear relationship with cardiovascular mortality was found.

The relationship between temporal muscle thickness and triglyceride glucose index in sarcopenia with mortality and third-month functional outcomes in patients after acute stroke

Especially in recent years, temporal muscle thickness has been used as an important parameter for sarcopenia in neurological disorders. In addition, triglyceride glucose index was evaluated separately in studies conducted in terms of coronary diseases, diabetes, high blood pressure, body mass index and acute stroke. In this clinical study, unlike the others, both temporal muscle thickness and triglyceride glucose index were evaluated together in acute stroke patients in terms of sarcopenia. We aimed to investigate the relationship between temporal muscle thickness and triglyceride glucose index, which is atherosclerotic index, with mortality and 3rd month functional outcomes in acute stroke patients. In this retrospective study, 147 patients admitted to Ankara City Hospital with the diagnosis of acute ischemic stroke between January 2021 and September 2022 were evaluated. Fasting triglyceride glucose indexes of the patients were calculated. The temporal muscle thickness measurement of the patients was performed by the radiologist using computed tomography images. Those who scored 3 or higher on the modified Rankin Scale (mRS) at the third month were considered to have poor functional outcome. A significant cutoff point was found for estimating mortality for the temporal muscle thickness parameter [area under the curve for a receiver operating characteristic curve (AUC) = 0.636; P = .012]. The cutoff point was obtained as ≤ 5.2. Sensitivity value was 65%, specificity value was 65%, the positive predictive value (PPV) value was 42.62% and the negative predictive value (NPV) value was 82.28%. Similarly, for the triglyceride glucose index parameter, there was a significant cutoff point in estimating mortality (AUC = 0.673; P = .003). The cutoff point was obtained as ≥ 8.23. Sensitivity value was 91.18%, specificity value was 13%, PPV value was 26.96% and NPV value was 81%. Temporal muscle thickness and triglyceride glucose index parameters were found to be statistically important parameters of sarcopenia. It was concluded that the evaluation of these 2 parameters in terms of both mortality and sarcopenia in acute stroke patients is important in the evaluation of neurological and cardiac disorders.

Triglyceride-glucose index as a marker of adverse cardiovascular prognosis in patients with coronary heart disease and hypertension

BACKGROUND

The triglyceride-glucose (TyG) index has been proposed as a potential predictor of adverse prognosis of cardiovascular diseases (CVDs). However, its prognostic value in patients with coronary heart disease (CHD) and hypertension remains unclear.

METHODS

A total of 1467 hospitalized patients with CHD and hypertension from January 2021 to December 2021 were included in this prospective and observational clinical study. The TyG index was calculated as Ln [fasting triglyceride level (mg/dL) × fasting plasma glucose level (mg/dL)/2]. Patients were divided into tertiles according to TyG index values. The primary endpoint was a compound endpoint, defined as the first occurrence of all-cause mortality or total nonfatal CVDs events within one-year follow up. The secondary endpoint was atherosclerotic CVD (ASCVD) events, including non-fatal stroke/transient ischemic attack (TIA) and recurrent CHD events. We used restricted cubic spline analysis and multivariate adjusted Cox proportional hazard models to investigate the associations of the TyG index with primary endpoint events.

RESULTS

During the one-year follow-up period, 154 (10.5%) primary endpoint events were recorded, including 129 (8.8%) ASCVD events. After adjusting for confounding variables, for per standard deviation (SD) increase in the TyG index, the risk of incident primary endpoint events increased by 28% [hazard ratio (HR) = 1.28, 95% confidence interval (CI) 1.04-1.59]. Compared with subjects in the lowest tertile (T1), the fully adjusted HR for primary endpoint events was 1.43 (95% CI 0.90-2.26) in the middle (T2) and 1.73 (95% CI 1.06-2.82) in highest tertile (T3) (P for trend = 0.018). Similar results were observed in ASCVD events. Restricted cubic spline analysis also showed that the cumulative risk of primary endpoint events increased as TyG index increased.

CONCLUSIONS

The elevated TyG index was a potential marker of adverse prognosis in patients with CHD and hypertension.