The change of triglyceride-glucose index may predict incidence of stroke in the general population over 45 years old

Triglyceride glucose index and mortality in tracheally intubated patients: a MIMIC-IV retrospective cohort study

Tracheal intubation is crucial in ICU treatment but poses risks of complications and mortality. Simple and effective indicators for assessing mortality risk in intubated ICU patients are needed. This study analyzed 5,915 intubated ICU patients from the Medical Information Mart for Intensive Care 3.0 database. Multivariable Cox regression and two-stage linear regression models were used to assess the relationship between triglyceride glucose (TyG) index levels and ICU and in-hospital mortality rates. High TyG levels significantly correlated with increased mortality risk (HR range 1.34-1.44, p < 0.01). The association was linear with ICU mortality but nonlinear with in-hospital mortality. TyG levels ≥9.2 significantly increased in-hospital mortality risk (HR: 1.277, 95% CI: 1.114-1.464, p < 0.001). Higher TyG indices were associated with a higher risk of ICU and in-hospital mortality, emphasizing the importance of these findings for early prevention or timely intervention in intubated ICU patients.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

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

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

Longitudinal changes and patterns in cardiometabolic index and the natural course of prediabetes in the China health and retirement longitudinal study

BACKGROUND

Prediabetes is one of the most common metabolic disorders in the aging process. This study aims to investigate the longitudinal changes in the Cardiometabolic Index (CMI) and their relationship with the natural course of prediabetes in middle-aged and elderly populations.

METHODS

This study used longitudinal data from the China Health and Retirement Longitudinal Study. The natural course of prediabetes was used to describe the trend in glycemic development during follow-up, defined as progression to diabetes or regression to normoglycaemia. Longitudinal changes in CMI were categorized into CMI transition patterns (consistently-low, low-to-high, high-to-low, and consistently-high) and cumulative CMI (CumCMI) exposure. CumCMI was calculated as the ratio of the mean CMI values measured during the longitudinal surveys to the total duration of exposure.

RESULTS

According to the inclusion and exclusion criteria, a total of 2,544 prediabetic participants from the China Health and Retirement Longitudinal Study cohort were included in the study. During a median follow-up of 3 years, the rates of progression and regression of prediabetes were as follows in the consistently-low, low-to-high, high-to-low, and consistently-high CMI pattern groups: 9.94%, 16.55%, 11.72%, 20.32% for progression; and 24.97%, 22.37%, 23.81%, 20.42% for regression, respectively. Regarding prediabetes progression, our results found that a high baseline CMI level and high CumCMI exposure during follow-up significantly increased the risk of developing diabetes in prediabetic patients. Furthermore, during follow-up, compared to the low-to-high CMI pattern group, the consistently-low CMI pattern was protective for prediabetic patients. Concerning prediabetes regression, we only observed a negative correlation between baseline CMI and follow-up CumCMI exposure with outcomes in the elderly (age ≥ 60 years). Specifically, high baseline CMI levels and high follow-up CumCMI exposure significantly hindered prediabetes regression in the elderly.

CONCLUSION

In this prospective cohort study of middle-aged and elderly populations, we found that longitudinal changes in CMI were associated with the progression and regression of prediabetes. High CumCMI exposure during follow-up significantly increased the risk of diabetes events and hindered the recovery of normoglycaemia in the elderly. Moreover, maintaining a consistently-low CMI pattern during follow-up reduced the risk of diabetes in prediabetic patients.

Association between C-reactive protein-triglyceride glucose index and stroke risk in different glycemic status: insights from the China Health and Retirement Longitudinal Study (CHARLS)

OBJECTIVE

C-reactive protein-triglyceride-glucose index (CTI) has been proposed as a novel biomarker for insulin resistance and inflammation. However, the association between CTI and the risk of stroke, particularly in individuals with different glycemic status, remains unclear.

METHODS

A total of 10,443 middle-aged and elderly participants were enrolled from the China Health and Retirement Longitudinal Study (CHARLS). The primary endpoint was the occurrence of stroke events. The CTI was calculated using the formula 0.412* Ln (CRP [mg/L]) + Ln (TG [mg/dl] × FPG [mg/dl])/2. The Kaplan-Meier curves, Cox proportional hazard models, and restricted cubic spline analysis were applied to explore the association between CTI and the risk of stroke according to gender, age and glycemic status.

RESULTS

During a median follow-up of 9 years, 960 (9.2%) participants experienced a stroke. Our findings revealed a significant positive linear relationship between CTI and the occurrence of stroke. The association was similar between male and female, despite the HR tended to be higher in females (HR 1.22, 95% CI 1.09, 1.36) than males (HR 1.15, 95% CI 1.02, 1.29), and similar in middle-aged (HR 1.25, 95% CI 1.11, 1.41) and elderly participants (HR 1.12, 95% CI 1.00, 1.26). In different glycemic status, high levels of CTI were found to be linked to an increased risk of stroke in individuals with normal glucose regulation (NGR) (HR 1.33, 95% CI 1.11, 1.59) and prediabetes mellitus (Pre-DM) (HR 1.20, 95% CI 1.04, 1.39). However, this association was not observed in individuals with diabetes mellitus (DM).

CONCLUSIONS

Our findings revealed a significant positive linear relationship between CTI and the occurrence of stroke. The association between CTI and stroke was similar between male and female, and similar in middle-aged and elderly participants. In different glycemic status, the association was significant in individuals with NGR and Pre-DM.

Association of triglyceride-glucose index trajectories with the risk of worsening heart failure in elderly patients with chronic heart failure and type 2 diabetes: a competing risk analysis

BACKGROUND

The triglyceride-glucose index serves as a dependable biomarker for gauging insulin resistance linked to cardiovascular disease. Our study was designed to investigate how the trajectory of the triglyceride-glucose index relates to the risk of worsening heart failure and overall mortality in patients aged 60 years and older with chronic heart failure and type 2 diabetes.

METHODS

This study enrolled 466 patients who had ≥ 3 medical exams. The formula for calculating the triglyceride-glucose index was ln (fasting triglycerides [mg/dL] × fasting blood glucose [mg/dL]/2). The trajectory of the triglyceride-glucose index in longitudinal analysis was analyzed via linear mixed models. The relationships between the trajectory of the TyG index and the risk of worsening heart failure and overall mortality were analyzed via competing Cox regression analysis and mixed-effects Cox regression analysis.

RESULTS

After the variables adjustment, compared with the first quartile group, the adjusted hazard ratios for worsening heart failure in top quartile group were 2.40 (1.35-3.28) for 10-year follow-up, and 2.09 (1.22-3.58) for overall follow-up duration. The adjusted hazard ratios for overall mortality in top quartile group were 1.99 (1.56-3.14) for 10-year follow-up, and 1.87 (1.22-2.88) for overall follow-up duration. Compared with the low decreasing trajectory, adjusted hazard ratios for worsening heart failure of high decreasing trajectory were 1.37 (1.10-1.71) for the 5-year follow-up, 1.78 (1.10-2.88) for 10-year follow-up, and 1.67 (1.04-2.68) for overall follow-up duration. The adjusted hazard ratios for overall mortality were 2.16 (1.39-3.35) for 10-year follow-up, and 2.23 (1.46-3.40) for overall follow-up duration.

CONCLUSION

During follow-up, a higher baseline level of TyG index and a high decreasing trajectory were independently associated with long-term worsening heart failure and an increased risk of overall mortality.

Association between TyG index with obesity indicators and coronary heart disease: a cohort study

The potential of utilizing the Triglyceride Glucose Index (TyG), along with its combination with obesity indicators, for predicting the risk of coronary heart disease (CHD) in the middle-aged and elderly population remains uncertain. This research aims to conduct a cohort study to assess the predictive capacity of the TyG and its combination with obesity indicators in forecasting the 10-year incidence of new-onset CHD among the middle-aged and elderly population in the Luzhou region. The study population was derived from the The China Cardiometabolic Disease and Cancer Cohort (4C) Study, comprising 8647 ordinary residents meeting specific criteria. The subjects were grouped based on quartiles of TyG, TyG-WC, TyG-WtHR, TyG-BMI, and TyG-WHR, and the occurrence of new-onset coronary heart disease was observed over a 10-year period. The study comprised 8647 participants, with 484 developing new-onset CHD, resulting in an incidence rate of 5.5% of the overall follow-up population. The comparison of new-onset CHD across quartiles of different indicators revealed a statistically significant difference (P < 0.001), with the order being the 4th quartile > 3rd quartile > 2nd quartile > 1st quartile. Cox proportional hazards regression analysis results indicated that, after adjusting for multiple influencing factors, the risk of new-onset CHD gradually increased with the quartiles of the 5 indicators. Specifically, when grouped according to TyG and TyG-WC quartiles, a statistically significant difference (P < 0.05) was observed between the 3rd and 4th quartiles compared to the 1st quartile. The ROC curve analysis results demonstrate that TyG-WC (area under the curve 0.608, P < 0.001) and TyG-WtHR (area under the curve 0.608, P < 0.001) exhibit superior predictive value for new-onset coronary heart disease compared to TyG (area under the curve 0.568, P < 0.001), TyG-BMI (area under the curve 0.576, P < 0.001), and TyG-WHR (area under the curve 0.595, P < 0.001). 1. TyG, TyG-WC, TyG-WtHR, TyG-BMI, and TyG-WHR demonstrate varying degrees of correlation with the incidence of new-onset coronary heart disease in the middle-aged and elderly population. 2. Specifically, TyG-WC may serve as a significant predictive factor for the occurrence of coronary heart disease in the elderly population.

Association between the triglyceride glucose-Chinese visceral adiposity index and new-onset stroke risk: a national cohort study

BACKGROUND

Numerous studies have investigated the effect of an integrated index that combines the triglyceride‒glucose (TyG) index with various obesity indicators on stroke incidence. However, how to use the TyG index and the Chinese Visceral Adiposity Index (CVAI) for stroke prevention remains unclear. This study examined the associations between dynamic changes in the TyG-CVAI index and cumulative, baseline, and new-onset stroke risk.

METHODS

Data from 3,769 participants in the China Health and Retirement Longitudinal Study(CHARLS) were analyzed, concentrating on the baseline TyG-CVAI, TyG-CVAI in 2015, and the cumulative TyG-CVAI derived from these. The fluctuations of the TyG-CVAI index were grouped into three clusters using K-means clustering analysis. Logistic regression models were used to examine the relationship between the TyG-CVAI index and new-onset stroke risk. Restricted cubic splines (RCS) were employed to investigate potential nonlinear relationships while assessing the predictive capability by receiver operating characteristic curve.

RESULTS

During the follow-up period, 181 participants experienced stroke events. The stroke incidence rates in Clusters 1, 2, and 3 were 2.42%, 8.72%, and 4.37%, respectively. After adjustment for confounding factors, Cluster 2 with high and increasing TyG-CVAI index (OR = 3.16, 95% CI 1.94-5.22), the Q3 group with high cumulative TyG-CVAI index (OR = 2.53, 95% CI 1.60-4.02), and the Q3 group with high baseline TyG-CVAI index (OR = 2.49, 95% CI 1.57-3.95),which were all correlated with an elevated risk of new-onset stroke. The RCS analysis disclosed a U-shaped relationship between cumulative and baseline TyG-CVAI index and stroke risk.

CONCLUSION

The fluctuations in and baseline, and cumulative TyG-CVAI index are independently correlated with an increased risk of stroke. The TyG-CVAI index is anticipated to be a more efficient and significant indicator for evaluating early stroke.

Joint assessment of abdominal obesity and non-traditional lipid parameters for primary prevention of cardiometabolic multimorbidity: insights from the China health and retirement longitudinal study 2011-2018

BACKGROUND

Obesity and abnormal lipid metabolism increase the risk of various cardiometabolic diseases, including diabetes, heart disease, and stroke. However, the impact of abdominal obesity (AO) and non-traditional lipid parameters on the risk of cardiometabolic multimorbidity (CMM) remains unclear. This study aims to investigate the separate and combined effects of AO and non-traditional lipid parameters on the incidence risk of CMM.

METHODS

This study enrolled 7,597 eligible participants from the China health and retirement longitudinal study (CHARLS). Cox proportional hazards models were used to perform adjusted regression analyses and mediation analyses, with Kaplan-Meier analysis used for cumulative hazards. Restricted cubic splines were utilized to evaluate the nonlinear relationship between non-traditional lipid parameters and the risk of CMM among participants with AO. Subgroup analyses were conducted with stratification by age, gender, BMI, smoking status, drinking status, and hypertension to investigate interaction effects across different populations. Additionally, sensitivity analyses were further performed to evaluate the impact of various subgroups on diabetes, heart disease, and stroke.

RESULTS

During the 7-year follow-up period, a total of 699 participants (9.20%) were newly diagnosed with CMM. Kaplan-Meier curves revealed that the subgroup with both AO and high levels of non-traditional lipid parameters had the highest cumulative hazard for developing CMM. In the fully adjusted model, Cox regression analysis revealed that participants with both high levels of non-traditional lipid parameters and AO exhibited the highest risk of developing CMM. Subgroup and sensitivity analyses further confirmed the robustness of these findings, showing consistent results across different demographic groups and under various analytical conditions. Furthermore, AO was found to significantly mediated the associations between non-traditional lipid parameters and the risk of developing CMM.

CONCLUSION

The separate and combined effects of AO and non-traditional lipid parameters were significantly associated with the risk of developing CMM. Notably, AO may induce CMM by partially mediating the effects of serum lipids in human metabolism. The findings highlighted the importance of joint evaluation of AO and non-traditional lipid parameters for primary prevention of CMM.

Estimated Pulse Wave Velocity and Stroke Among Middle-Aged and Older Population: Insights From 3 Prospective Cohorts

BACKGROUND

Arterial stiffness is recognized as a new risk factor for stroke. However, the association between estimated pulse wave velocity (ePWV), a well-established indirect measure of arterial stiffness and stroke among older adults, remains incompletely investigated.

METHODS

This study utilized data from 3 prospective, nationally representative cohorts: the Health and Retirement Study in the United States, the English Longitudinal Study of Aging in the United Kingdom, and the China Health and Retirement Longitudinal Study in China. ePWV was calculated based on age and mean arterial pressure. Cox proportional hazard models were used to compute hazard ratios and 95% CIs.

RESULTS

The final analysis included 6458 participants from the Health and Retirement Study (mean age: 66.99 years; 40.4% men), 6458 from the English Longitudinal Study of Aging (mean age: 66.32; 44.4% men), and 12 415 from the China Health and Retirement Longitudinal Study (mean age: 58.60; 46.2% men). Over follow-up periods of 10.28 years in the Health and Retirement Study, 9.95 years in the English Longitudinal Study of Aging, and 6.30 years in the China Health and Retirement Longitudinal Study, 624 (9.7%), 374 (5.8%), and 656 (5.3%) participants developed stroke, respectively. Fully adjusted Cox regression analysis revealed a significant association between ePWV and incident stroke across all cohorts (Health and Retirement Study: hazard ratio, 1.29 [95% CI, 1.24-1.35]; English Longitudinal Study of Aging: hazard ratio, 1.37 [95% CI, 1.28-1.46]; China Health and Retirement Longitudinal Study: hazard ratio, 1.20 [95% CI, 1.15-1.25]).

CONCLUSIONS

This study demonstrated that higher levels of ePWV were associated with increased risks of incident stroke among middle-aged and older populations. Arterial stiffness assessment through ePWV could potentially improve primary prevention and treatment strategies for stroke.

Spatial analysis of air pollutant exposure and its association with metabolic diseases using machine learning

BACKGROUND

Metabolic diseases (MDs), exemplified by diabetes, hypertension, and dyslipidemia, have become increasingly prevalent with rising living standards, posing significant public health challenges. The MDs are influenced by a complex interplay of genetic factors, lifestyle choices, and socioeconomic conditions. Additionally, environmental pollutants, particularly air pollutants (APs), have attracted increasing attention for their potential role in exacerbating these MDs. However, the impact of APs on the MDs remains unclear. This study introduces a novel machine learning (ML) pipeline, an Algorithm for Spatial Relationships Analysis between Exposome and Metabolic Diseases (ASEMD), to analyze spatial associations between APs and MDs at the prefecture-level city scale in China.

METHODS

The ASEMD pipeline comprises three main steps: (i) Spatial autocorrelation between APs and MDs is evaluated using Moran's I statistic and Local Indicators of Spatial Association (LISA) maps. (ii) dimensionality reduction and spatial similarities identification between APs and MDs clusters using Principal Component Analysis (PCA), k-means clustering, and Jaccard index calculations, further validated through spatial maps. (iii) AP exposure is adjusted by demographic and lifestyle confounders to predict MDs using machine learning models (e.g., eXtreme Gradient Boosting (XGBoost), Random Forest (RF), Decision Tree (DT), LightGBM, and Multi-Layer Perceptron (MLP)). SHAP values are employed to identify key adjusted APs that are linked to MDs. Model performance is evaluated through 10-fold cross-validation using five different metrics. The data utilized include CHARLS (2015) and meteorological data (2013-2015).

RESULTS

Significant spatial correlations were found between APs and the prevalence of diabetes, dyslipidemia, and hypertension, with higher prevalence rates observed in alignment with elevated APs concentrations. By adjusting for demographic and lifestyle confounders, APs effectively predicted the risk of developing MDs (AUROC=0.890, 0.877, 0.710 for diabetes, dyslipidemia, and hypertension, respectively). The results showed that C O , P M 2.5 , and A Q I were strongly correlated with diabetes, whereas N O 2 , P M 2.5 , and P M 10 were significantly associated with dyslipidemia. For hypertension, C O , O 3 , and A Q I were mostly correlated. Sensitivity analyses across different regions and different types of APs underscored the robustness of our conclusions.

CONCLUSION

The ASEMD pipeline successfully integrates ML models, epidemiological methods, and spatial analysis techniques, providing a robust framework for understanding the complex interactions between APs and MDs. We also identified specific APs, including P M 10 , C O , and S O 2 , as being strongly linked to higher rates of diabetes, dyslipidemia, and hypertension in central and northern cities. Future region-specific public health strategies or interventions, especially in those areas with high pollutant levels, are needed to mitigate air pollution's impact on metabolic health.

Comparison of triglyceride glucose index and modified triglyceride glucose indices in predicting cardiovascular diseases incidence among populations with cardiovascular-kidney-metabolic syndrome stages 0-3: a nationwide prospective cohort study

BACKGROUND

Cardiovascular-kidney-metabolic (CKM) syndrome has been recently proposed by American Heart Association recently. The triglyceride glucose (TyG) index and TyG-related indices combined with obesity indicators have proven to be associated with the incidence of cardiovascular diseases (CVD). However, there are few studies to explore whether these associations exist among people with CKM syndrome stages 0-3.

METHODS

A total of 7,364 participants from the China Health and Retirement Longitudinal Study were included. Cox hazard regression and restricted cubic spline regression were used to analyze the associations of these indices with CVD incidence. To compare predictive performance, time-dependent Harrell's C-indices, net reclassification index and integrated discrimination improvement were conducted.

RESULTS

The CVD incidence was 20.55% over nine years. The TyG single index and all the modified TyG indices were capable of predicting CVD incidence. RCS regression analyses showed that all indicators had linear relationships with CVD incidence and these linear relationships of TyG combined with waist circumference (TyG-WC) or waist-to-height ratio (TyG-WHtR) still existed in CKM stage 1, stage 2 and stage 3. TyG-WC (C-index: 0.621, p < 0.001) and TyG-WHtR (C-index: 0.621, p < 0.001) almost had the highest C-indices in predicting CVD incidence, compared to single TyG index (C-index: 0.611, p < 0.001) and TyG combined with body mass index (C-index: 0.616, p < 0.001).

CONCLUSION

The TyG index and all the modified TyG indices were independent predictors of CVD incidence among people with CKM syndrome stages 0-3. It was found that modified indices had better predictive performance, especially TyG combined with waist circumference or waist-to-height ratio.

The triglyceride-glucose index is a promising predictor for the risk of cardiovascular disease in the diabetic population aged ≥60 years in the United States: a retrospective cohort study from NHANES (2007-2016)

Background

The predictive value of triglyceride-glucose index (TyG) for cardiovascular disease (CVD) in the US elderly diabetic patients is ambiguous. This study aimed to investigate the association between TyG index and the risk of CVD in an older US population with diabetes.

Methods

The study examined data from the 2007-2016 National Health and Nutrition Examination Survey (NHANES). Univariate and multivariate regression analysis models were obtained to explore the association between baseline TyG index and the risk of CVD. Non-linear association were investigated using restricted cubic spline (RCS) regression. Subgroup analyses and interaction tests were constructed and a sensitivity analyses was carried out. The 10 - year CVD risk were evaluated via the Framingham Risk Score (FRS). Mediation analysis explored the mediating role of glycated hemoglobin in the above relationships.

Results

A total of 2987 subjects were included (977 CVD patients and 2010 non-CVD persons). CVD patients had higher TyG values (9.01 ± 0.58 vs. 8.94 ± 0.56, P=0.003), and the prevalence of CVD increased with TyG index (P=0.015). In a multifactorial regression model with gradual adjustment for all covariates, the risk of CVD associated with TyG increased by 48.0% in the highest quartile group (OR 1.480, 95% Cl 1.171-1.871, P=0.001). The RCS curves showed a U-shaped association between TyG index and CVD risk (P for overall=0.013, P for nonlinear=0.043). Subgroup analyses showed that in the highest quartile group, individuals with body mass index (BMI) ≥24 kg/m2, an estimated glomerular filtration rate (eGFR) <90 mL/1.73m2/min, individuals without chronic kidney disease, and those with hypertension had significantly higher risks of CVD. Sensitivity analyses indicated that these associations were not associated with other significant confounders. Under different adjustment models, the TyG index exhibited significant correlations with the 10 - year risk of CVD (all P values < 0.05). Glycated hemoglobin mediated in the above relationships.

Conclusion

In a sample of US elderly diabetic patients, there is the U-shaped association of TyG index with CVD risk. This implies that TyG index can be regarded as an extremely important predictor for screening people at high risk of cardiovascular disease among elderly diabetic patients.

Triglyceride-glucose index predicts adverse cardiovascular events in patients with H-type hypertension combined with coronary heart disease: a retrospective cohort study

BACKGROUND

The triglyceride‒glucose index (TyG index) is a reliable surrogate for insulin resistance (IR) in individuals with type 2 diabetes mellitus and is associated with cardiovascular disease. Recent studies have reported that H-type hypertension is likewise a predictor of adverse events in patients with coronary heart disease (CHD). However, the relationship between the TyG index and prognosis in patients with H-type hypertension combined with CHD has not yet been reported. In this study, we investigated the relationship between the TyG index and adverse outcomes in patients with H-type hypertension combined with CHD.

METHODS

This was a single-center retrospective cohort study that included patients who were diagnosed with H-type hypertension combined with CHD between 2018 and 2023 at Beijing Anzhen Hospital of Capital Medical University. The TyG index was divided into three groups according to tertiles. Kaplan-Meier curves were used to analyze the cumulative risk of major adverse cardiovascular events (MACEs), and ROC curve analysis was performed by the log-rank test. Cox proportional hazards regression models were adopted to explore the relationship between the TyG index and MACEs. C-statistics, NRI, and IDI were used to evaluate the incremental predictive ability of the TyG index.

RESULTS

A total of 546 patients were included, with a median follow-up time of 39.00 ± 0.69 months, and 73 MACEs occurred, with higher tertiles of the TyG index associated with a higher cumulative risk of MACEs (log-rank, P = 0.001). After adjusting for confounders, the fully adjusted ORs (95% CI) for T2 and T3 of the TyG index, with the lowest tertile as reference, were 1.64 (0.80-3.36) and 2.43 (1.19-4.97), respectively. The addition of the TyG index led to a significant improvement in the overall predictive power of the baseline model. [C-statistic increased from 0.63 to 0.66, p = 0.031; continuous NRI (95% CI) 0.13 (0.001-0.276), p = 0.038; IDI (95% CI) 0.01 (0.000-0.031), p = 0.047].

CONCLUSION

The TyG index may be an independent risk factor for predicting adverse postoperative cardiovascular events in patients with H-type hypertension combined with CHD, indicating its potential significance in improving risk stratification strategies.

Association between the hemoglobin A1c/High-density lipoprotein cholesterol ratio and stroke incidence: a prospective nationwide cohort study in China

BACKGROUND

Stroke has emerged as an escalating public health challenge among middle-aged and older individuals in China, closely linked to glycolipid metabolic abnormalities. The Hemoglobin A1c/High-Density Lipoprotein Cholesterol (HbA1c/HDL-C) ratio, an integrated marker of glycolipid homeostasis, may serve as a novel predictor of stroke risk.

METHODS

Our investigation utilized data from the China Health and Retirement Longitudinal Study cohort (2011-2018). Stroke cases were identified based on self-reported, physician-confirmed diagnoses. Logistic regression models were established to determine the correlation between HbA1c/HDL-C and stroke prevalence (2011) as well as between cumulative mean HbA1c/HDL-C (2011-2015) and new stroke incidence (2015-2018). Additionally, smoothed curve fitting, subgroup analyses, and interaction tests were conducted to ensure the robustness of the findings.

RESULTS

In the cross-sectional analysis, 8,502 participants were enrolled, of whom 189 had a history of stroke. Our findings revealed a significant positive linear relationship between HbA1c/HDL-C and stroke prevalence after adjusting for covariates (OR: 1.26, 95% CI: 1.09-1.45). When HbA1c/HDL-C was categorized into tertiles, only the highest tertile (T3) showed a significant correlation with stroke prevalence compared to the lowest tertile (T1) (OR:1.71, 95% CI: 1.05-2.77). In the longitudinal analysis of 5,165 participants, 336 cases of new-onset stroke were identified over a follow-up period of 7 years. Adjusting for confounders, individuals with higher cumulative mean HbA1c/HDL-C exhibited an increased likelihood of new stroke incidence (OR: 1.14, 95% CI: 1.01-1.29). Using the T1 of cumulative mean HbA1c/HDL-C as a reference, the fully adjusted OR for stroke was 1.65 (95% CI: 1.21-2.24) in T2 and 1.54 (95% CI: 1.08-2.19) in T3. The predictive value of the HbA1c/HDL-C in stroke risk assessment have been significantly improved compared to the traditional HDL-C and HbA1c. Consistent associations were observed across most stratified subgroups.

CONCLUSIONS

Elevated baseline and cumulative mean HbA1c/HDL-C levels are significantly associated with an increased risk of stroke among middle-aged and older individuals in China, underscoring the potential of HbA1c/HDL-C as a clinical marker for long-term stroke risk assessment and prevention strategies.

The prognostic association of triglyceride-glucose index and its derived indicators with stable coronary artery disease patients undergoing percutaneous coronary intervention

Aims

Research on the triglyceride-glucose (TyG) index in patients with stable coronary artery disease (SCAD) remains relatively limited. Therefore, this study aims to investigate the association of the TyG index and its derived indicators, including the baseline TyG index, the baseline triglyceride glucose-body mass index (TyG-BMI), the mean TyG index, and the triglyceride glucose index-standard deviation (TyG-SD), with the prognosis of SCAD patients undergoing percutaneous coronary intervention (PCI).

Methods

This retrospective study enrolled 2,306 patients. The Cox proportional hazards model was utilized to evaluate the association between the four TyG indicators and major adverse cardiovascular and cerebrovascular events (MACCE). The predictive ability of the four TyG indicators for MACCE was assessed using the time-dependent receiver operating characteristic (ROC) curve. Kaplan-Meier survival analysis was employed to assess the prognostic differences among groups.

Results

After a median follow-up of 26.1 months, a total of 352 patients (15.3%) experienced MACCE. The Cox regression analysis revealed that under a fully adjusted model, when the four TyG indicators were stratified by tertiles, patients in the highest tertile of each TyG indicator had a significantly increased risk of MACCE compared to those in the lowest tertile. Specifically, the hazard ratio for baseline TyG index was 1.653 (95% confidence intervals (CI): 1.234-2.214), for baseline TyG-BMI was 2.467 (95%CI: 1.849-3.293), for mean TyG index was 2.451 (95%CI: 1.794-3.349), and for TyG-SD was 1.896 (95%CI: 1.430-2.513). Time-dependent ROC curve demonstrated that the mean TyG index had the strongest predictive ability for MACCE at each follow-up time point. The Kaplan-Meier analysis results showed that when the four TyG indicators were grouped by tertiles, there were significant differences in the cumulative incidence of MACCE among the three groups for each indicator (P < 0.05).

Conclusion

Higher levels of the TyG index and its derived indicators were each independently and positively associated with the risk of MACCE in SCAD patients undergoing PCI. Among these indicators, the mean TyG index demonstrated the greatest predictive value for the risk of MACCE at each follow-up time point. Consequently, tracking the long-term trends of the TyG index may be prioritized in clinical practice.

Association between non-insulin-based insulin resistance surrogate makers and Helicobacter pylori infection: a population-based study

BACKGROUND

Current evidence on the associations between insulin resistance (IR) and Helicobacter pylori (H. pylori) infection remains limited. This study aimed to investigate the association between non-insulin-based surrogate markers of IR, including the triglyceride glucose (TyG) index, triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, and the metabolic score for IR (METS-IR), and H. pylori infection in U.S.

POPULATIONS

METHODS

This cross-sectional study involving 939 U.S. participants from the National Health and Nutrition Examination Survey (NHANES) 1999-2000. The associations between three IR surrogate markers and H. pylori infection were respectively investigated using logistic regression model, restricted cubic spline (RCS) curve and subgroup analysis.

RESULTS

Three IR surrogate markers levels were significantly elevated in H. pylori infection participants. There was a positive association between three IR surrogate markers and H. pylori infection, even after adjusting for potential confounding variables by three different models. In subgroup analysis, the adjusted association between three IR surrogate markers and H. pylori infection were more likely to be observed in female and Non-Hispanic White. Additionally, the RCS curve revealed a positive linear correlation between TyG index and H. pylori infection across all three models, and between METS-IR and H. pylori infection in Model 3. However, a positive nonlinear correlation was observed between TG/HDL-C ratio and H. pylori infection in all three models.

CONCLUSIONS

These findings suggest that non-insulin-based IR surrogate markers including TyG index, TG/HDL-C ratio, and METS-IR were all positively associated with H. pylori infection. These markers may serve as the potential indicators for identifying the risk of H. pylori infection in U.S.

POPULATIONS

CLINICAL TRIAL NUMBER

Not applicable.

Association between the triglyceride-glucose index and contrast-induced nephropathy in chronic total occlusion patients undergoing percutaneous coronary intervention

OBJECTIVE

The triglyceride glucose (TyG) index is a biomarker of insulin resistance and is associated with an increased risk of cardiovascular events. Contrast-induced nephropathy (CIN) is an important complication that causes poor outcomes in patients undergoing percutaneous coronary intervention (PCI). In this study, we aimed to investigate the relationship between the TyG index and CIN and mortality in patients who underwent PCI due to chronic total coronary occlusion (CTO).

METHODS

Two hundred eighteen individuals from three separate medical centers who underwent procedural PCI between February 2010 and April 2012 and had a CTO lesion in at least one coronary artery were recruited. According to the TyG index, patients were divided into two groups. Patients with a TyG index ≥ 8.65 were included in Group 1, and patients with a TyG index < 8.65 were included in Group 2. Patients were followed up for 96 months. The main outcome was the development of CIN and mortality.

RESULTS

The mean age of the patients (65.8 ± 10.94 vs. 61.68 ± 11.4, P = 0.009), diabetes mellitus (60 [44.8%] vs. 11 [13.1%], P < 0.001), and dyslipidemia rates (52 [38.8%] vs. 21 [25%], P = 0.036) were higher in group 1. In multivariable logistic regression analysis, it was seen that age (OR = 1.04, 95% CI = 1.01-1.08, P = 0.020), chronic kidney disease (OR = 2.34, 95% CI = 1.02-5.33, P = 0.044), peripheral artery disease (OR = 5.66, 95% CI = 1.24-25.91, p = 0.026), LVEF (OR = 0.95, 95% CI = 0.92-0.99, P = 0.005), LDL cholesterol levels (OR = 1.00, 95%CI = 1.00-1.02, P = 0.024) and TyG index (OR = 2.17, 95% CI = 1.21-3.89, P = 0.009) were independent predictors of the development of CIN.

CONCLUSION

Our study demonstrates a correlation between the TyG index and the prevalence of CIN in patients with CTO undergoing PCI. Adding the TyG index to the routine clinical evaluation of patients with CTO undergoing PCI may help protect patients from the development of CIN.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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

Arthritis and Public Health Monitoring: Longitudinal Changes of Triglyceride-Glucose Index Associated with Arthritis in a Cohort of Older Chinese Adults

The current decade 2021-2030 was designated by the United Nations as the decade of healthy aging, which underlines the need for public health innovation for arthritis clinical care. The triglyceride-glucose (TyG) index is a novel and emerging parameter closely associated with diabetes and cardiovascular diseases and has been suggested to indicate the risk of arthritis. This study examined the longitudinal changes of TyG levels in relation to arthritis among a nationwide cohort of older Chinese adults. We recruited 1257 participants from a national cohort of older Chinese adults, the Chinese Longitudinal Healthy Longevity Survey. On the basis of the longitudinal changes in TyG between 2012 and 2014, we performed a k-means clustering analysis to classify the participants into four TyG groups: Class 1 with moderate and stable levels of TyG; Class 2 with low but rising level of TyG; Class 3 with consistently high TyG; and Class 4 with high and TyG-level rise compared with the baseline. After a 2-year follow-up, logistic regression was used to identify the association between TyG and the onset of arthritis. Compared with individuals in Class 1, those in Class 3 and Class 4 experienced a higher risk of arthritis, with an odds ratio (OR) of 2.823 (95% confidence interval [CI]: 1.113-7.160) and 2.848 (95% CI: 1.299-6.246), respectively. To the best of our knowledge, this is the first study exploring the association between dynamic longitudinal changes in TyG and arthritis. Further studies on world populations are called for.

Changes in the metabolic score for insulin resistance index for risk prediction of stroke in middle-aged and older Chinese population

Background

As a major noncommunicable disease, stroke poses a major threat to public health. In the context of predictive, preventative, and personalised medicine (PPPM/3PM), early identification of high-risk individuals is crucial for targeted prevention and personalised treatment for stroke. This study aimed to investigate the association between changes in the Metabolic Score for Insulin Resistance Index (METS-IR) and incident stroke. From the perspective of PPPM/3PM, we hypothesised that monitoring dynamic changes of the METs-IR levels and targeting cumulative METs-IR index contribute to risk prediction, targeted prevention, and personalised management of stroke.

Methods

All data were obtained from the China Health and Retirement Longitudinal Study (CHARLS), a nationwide prospective cohort study. The individuals were categorised into four subgroups based on the quartiles (Q) of the cumulative METS-IR index as a reflection of changes in the METS-IR values from 2012 to 2015. Logistic regression was employed to examine the association between cumulative METS-IR index and stroke incidence. Additionally, restricted cubic spline regression analysis was used to assess potential linearity.

Results

Among the 4288 participants, 275 (6.4%) experienced a stroke. The risk of stroke events increased with higher cumulative METS-IR index levels. Compared with the lowest quartile (Q1), the OR of having a stroke was 1.20 (0.81, 1.78) for Q2, 1.51 (1.04, 2.21) for Q3 and 2.17 (1.52, 3.10) for the highest quartile (Q4). After adjusting for multiple potential confounders, Q4 (OR: 1.57, 95% CI: 1.04, 2.35) remained significantly associated with stroke. The association between the cumulative METS-IR index and stroke incidence was linear in males, females, and the overall population (all P values for nonlinearity > 0.05).

Conclusions

A higher cumulative METS-IR index was associated with an increased risk of incident stroke among middle-aged and older Chinese individuals. In the context of PPPM/3PM, incorporating metabolic health into stroke risk assessment advances the prediction, prevention and personalised management of stroke.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-024-00388-y.

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.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Development and Validation of a New Nomogram for Predicting Early Neurological Deterioration in Young and Middle-Aged Individuals With Stroke in the Neurocritical Care Unit

OBJECTIVE

To analyse risk factors for early neurological damage in young and middle-aged stroke cases.

METHODS

Totally 405 young and middle-aged stroke patients in the neurocritical care unit (NCU) were selected and divided into the developmental (260 patients) and validation (145 patients) sets. The 405 cases were also grouped based on whether early neurological deterioration (END) occurred. The influencing factors of END were analysed by logistic regression, followed by the construction of a nomogram for predicting the risk of END. The Bootstrap method was applied to internally verify the predictive value of the model, using validation set data.

RESULTS

Age, type of stroke, diabetes, mechanical ventilation, pulse, initial National Institute of Health stroke scale (NIHSS), Barthel index (BI), haemoglobin, hypersensitive C-reactive protein (hs-CRP), triglyceride glucose (TyG) index and CONUT showed statistically significant differences (p < 0.05). Logistic regression analysis revealed type of stroke, initial NIHSS, CONUT, TyG index and hs-CRP were risk factors for END in young and middle-aged stroke cases (OR > 1, p < 0.05). The area under the curve (AUC) for the developmental set was 0.842, and internal validation results showed a C-index of 0.843; the AUC for the validation set was 0.843.

CONCLUSION

The nomogram constructed in this study has good predictive efficacy and can provide reference for early clinical prediction of END in young and middle-aged stroke cases.

RELEVANCE TO CLINICAL PRACTICE

The importance of this research lies in shedding light on the significant impact of early neurological deterioration on the health outcomes of young and middle-aged stroke patients, particularly in the short term. To guide clinical workers to identify risk factors early and improve the prognosis of stroke patients.

Changes in the estimated glucose disposal rate and incident cardiovascular disease: two large prospective cohorts in Europe and Asia

BACKGROUND AND AIMS

Previous study found that estimated glucose disposal rate (eGDR) was significantly associated with cardiovascular disease (CVD). However, little is known about the change in eGDR over time and its association with the development of CVD. The aim of this study was to investigate the association of change in eGDR with CVD risk.

METHODS

This study used data of two prospective cohorts: UK Biobank and China Health and Retirement Longitudinal Study (CHARLS) with two measurements of eGDR. Changes in the eGDR were classified using K‑means clustering analysis, and the cumulative eGDR was also calculated. Cox proportional hazard models were used to calculate the hazard ratio (HR) and 95% confidence interval (95% CI) after adjusting for potential confounders.

RESULTS

A total of 11,682 individuals from the UK Biobank, and 4,974 individuals from the CHARLS were included. The median follow-up periods were 9.7 years in the UK Biobank and 3.0 years in the CHARLS. Compared with persistently high level of eGDR (class 1), individuals with low level increasing (class 3) and persistently low level of eGDR (class 4) showed elevated risks of incident CVD in both UK Biobank (HR = 2.79, 95% 2.15-3.62 for class 3; HR = 3.19, 95% 2.50-4.08 for class 4) and CHARLS (HR = 1.66, 95% 1.29-2.13 for class 3; HR = 1.69, 95% 1.34-2.14 for class 4). In addition, lower level of cumulative eGDR were associated with elevated risks of incident CVD. The dose-response curve between cumulative eGDR and CVD risk showed a negative linear relationship.

CONCLUSION

Different changes in eGDR level are associated with different risks of incident CVD. Dynamic monitoring of eGDR level is of significant importance for the CVD prevention and treatment.

Development of a predictive model for the U-shaped relationship between the triglyceride glycemic index and depression using machine learning (NHANES 2009-2018)

Background

At present, the relationship between depression and the triglyceride glycemic (TyG) index remains a topic of debate. This study sought to elucidate the relationship between depression and the TyG index to create a predictive model that would help doctors diagnose patients.

Methods

We conducted a cross-sectional study utilizing the National Health and Nutrition Examination Survey (NHANES) dataset, which comprises data from 2009 to 2018. The analysis involved 11,222 adults with a Patient Health Questionnaire-9 (PHQ-9) score of 5 or higher, indicating the presence of depression. As part of the analysis, multiple regression models were used to test whether a linear relationship existed between the TyG index and depression. A threshold effects analysis was used to generate smoothed curves and detect nonlinear correlations. Additionally, the Least Absolute Shrinkage and Selection Operator (LASSO) regression were employed to identify the key risk factors associated with depression. The factors identified were then used to construct the risk prediction nomogram. Finally, Receiver Operating Characteristic (ROC) curves were used to evaluate the discriminative performance of the model.

Results

Multivariable linear regression analysis indicated a strong positive correlation between depression and the TyG index (β: 0.38, 95 % CI: 0.16-0.60, p = 0.0008). A U-shaped relationship with an inflection point was observed at a TyG index of 8.16. The nomogram model, constructed using risk factors identified by LASSO, exhibited a significant predictive value (AUC = 0.888).

Conclusions

The results of this investigation point to a U-shaped association between depression risk and the TyG index among Americans. Those with a TyG index of over 8.16 are significantly more likely to develop depression. These results suggest a possible causal relationship and emphasize the importance of monitoring the TyG index in depression risk assessment.

Insulin resistance and sarcopenia: a prognostic longitudinal link to stroke risk in middle-aged and elderly Chinese population

BACKGROUND

Stroke is the leading cause of death in middle-aged and elderly people in China. Insulin resistance (IR) and sarcopenia are both closely associated with metabolic diseases. However, the relationship between these two indicators and stroke has not been fully investigated. The aim of this study was to investigate the relationship between IR and sarcopenia and the risk of new-onset stroke.

METHODS

Using longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018, Cox proportional hazards models were used to determine the association between IR surrogate indicators and sarcopenia status with stroke incidence.

RESULTS

In the present study, during a median 7 years of follow-up, we included 7009 middle-aged and elderly residents, of whom 515 presented with stroke incidence. After adjustment for potential confounders, both baseline IR surrogates and sarcopenia independently predicted stroke risk. In addition, co-morbidities had a higher risk of stroke than other groups. The positive association between TyG-WC and sarcopenia on stroke risk was particularly significant [HR (95% CI): 2.03 (1.52, 2.70)]. In subgroups of different ages and sexes, the combination of IR and sarcopenia is associated with the highest risk of stroke.

CONCLUSIONS

We found that IR and sarcopenia synergistically increase the incidence of stroke in older adults. This finding provides new perspectives for stroke detection and intervention and highlights the importance of early detection and management of IR and sarcopenia in older adults.

Association of triglyceride-glucose index with the risk of incident aortic dissection and aneurysm: a large-scale prospective cohort study in UK Biobank

BACKGROUND

Triglyceride-glucose (TyG) index is an emerging surrogate indicator of insulin resistance, which has been demonstrated as a risk factor for various cardiovascular diseases including coronary syndrome, in-stent restenosis, and heart failure. However, association of TyG index with incident aortic dissection (AD) and aortic aneurysm (AA) remains to be investigated.

METHODS

This study included 420,292 participants without baseline AD/AA from the large-scale prospective UK Biobank cohort. The primary outcome was incident AD/AA, comprising AD and AA. Multivariable-adjusted Cox proportional hazards regression models and restricted cubic spline (RCS) analyses were applied to assess the relationship between TyG index and the onset of AD/AA. In addition, the association between TyG index and incident AD/AA was examined within subgroups defined by age, gender, smoking status, drinking status, diabetes, hypertension, and BMI.

RESULTS

Over a median follow-up period of 14.8 (14.1, 15.5) years, 3,481 AD/AA cases occurred. The incidence of AD/AA rose along with elevated TyG index. RCS curves showed a linear trend of TyG index with risk of incident AD/AA. TyG index was positively associated with risk of incident AD/AA after adjusting for age, gender, smoking status, drinking status, BMI, hypertension, LDL-c, and HbA1c, with adjusted HRs of 1.0 (reference), 1.20 (95% CI 1.08-1.35), 1.21 (95% CI 1.08-1.35), and 1.30 (95% CI 1.16-1.45) for TyG index quartiles 2, 3, and 4, respectively. Especially, participants in the highest TyG index quartile had highest risk of developing AA, with an adjusted HR of 1.35 (95% CI 1.20-1.52).

CONCLUSIONS

TyG index is independently associated with a higher risk of incident AD/AA, indicating the importance of using TyG index for risk assessment of AD/AA, especially for AA.

Triglyceride-glucose index and health outcomes: an umbrella review of systematic reviews with meta-analyses of observational studies

BACKGROUND

Numerous meta-analyses have explored the association between the triglyceride-glucose (TyG) index and diverse health outcomes, yet the comprehensive assessment of the scope, validity, and quality of this evidence remains incomplete. Our aim was to systematically review and synthesise existing meta-analyses of TyG index and health outcomes and to assess the quality of the evidence.

METHODS

A thorough search of PubMed, EMBASE, and Web of Science databases was conducted from their inception through to 8 April 2024. We assessed the quality of reviews using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. This study was registered with PROSPERO (CRD: 42024518587).

RESULTS

Overall, a total of 95 associations from 29 meta-analyses were included, investigating associations between TyG index and 30 health outcomes. Of these, 83 (87.4%) associations were statistically significant (P < 0.05) according to the random effects model. Based on the AMSTAR tool, 16 (55.2%) meta-analyses were high quality and none was low quality. The certainty of the evidence, assessed by the GRADE framework, showed that 6 (6.3%) associations were supported by moderate-quality evidence. When compared with the lowest category of the TyG index, the risk of contrast-induced nephropathy (CIN) [relative risk (RR) = 2.25, 95%CI 1.82, 2.77], the risk of stroke in patients with diabetes mellitus (RR = 1.26, 95%CI 1.18, 1.33) or with acute coronary syndrome disease (RR = 1.56, 95%CI 1.06, 2.28), the prognosis of coronary artery disease (CAD)-non-fatal MI (RR = 2.02, 95%CI 1.32, 3.10), and the severity of CAD including coronary artery stenosis (RR = 3.49, 95%CI 1.71, 7.12) and multi-vessel CAD (RR = 2.33, 95%CI 1.59, 3.42) increased with high TyG index.

CONCLUSION

We found that the TyG index was positively associated with many diseases including the risk of CIN and stroke, the prognosis of CAD, and the severity of CAD which were supported by moderate-quality evidence. TyG index might be useful to identify people at high-risk for developing these diseases.

Association between the triglyceride glucose index and atherosclerotic cardiovascular disease in the general population: analysis of the national health and nutrition examination survey 1999-2004

Objective

The triglyceride-glucose (TyG) index, a reliable substitute indicator of insulin resistance (IR), is considered an independent risk factor for long-term outcomes in patients with cardiovascular disease. However, studies investigating the association between TyG and atherosclerotic cardiovascular disease (ASCVD) are limited and lack direct evidence. We aim to examine the relationship between the TyG index and ASCVD through a comprehensive cross-sectional study.

Methods

Overall, 7212 participants from the 1999-2004 National Health and Nutrition Examination Survey were included. The baseline TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting blood glucose (mg/dL)/2]. Restricted cubic spline (RCS) regression, univariate logistic regression, and multivariate logistic regression analysis were used to evaluate the association between the TyG index and ASCVD.

Results

In the overall population, a multivariate logistic regression analysis showed that the TyG level was not only positively associated with ASCVD [OR (95%CI): 1.29 (1.01,1.64), P=0.042], coronary artery disease (CAD) [OR (95%CI): 1.82(1.33,2.48), P<0.001], and stroke [OR (95%CI): 2.68(1.54,4.69), P=0.002], but also linearly correlated with all three (P-overall<0.001; P-non-linear >0.05). Although the TyG index was not associated with peripheral arterial disease (PAD) [OR (95%CI): 1.00 (0.73,1.36), P>0.900], it showed a U-shaped correlation with PAD (P-overall <0.001; P-non-linear= 0.0085), and the risk of PAD was minimized when TyG=8.67. By incorporating the TyG index into the baseline risk model, the accuracy of ASCVD prediction was improved [AUC: baseline risk model, 0.7183 vs. baseline risk model + TyG index, 0.7203, P for comparison=0.034]. The results of the subgroup analysis were consistent with those of the main analysis.

Conclusion

The TyG index was independently associated with ASCVD, CAD, and stroke, suggesting that it may serve as a valid indicator for predicting ASCVD in the entire population.

Association between the triglyceride-glucose index and subclinical left ventricular systolic dysfunction in obese patients

BACKGROUND

The association between the triglyceride-glucose (TyG) index and subclinical left ventricular (LV) systolic dysfunction in obese patients remains unclear. This study aimed to investigate the relationship between the TyG index and LV global longitudinal strain (GLS) in obese patients.

METHODS

A total of 1028 obese patients from January 2019 to January 2024 were included in the present study. Clinical parameters and biochemical and echocardiographic data were obtained from the participants. LV GLS was obtained from the GE EchoPAC workstation for evaluating subclinical LV function. The TyG index was calculated as Ln (fasting TG [mg/dL] × fasting glucose [mg/dL]/2). LV GLS was compared between obese patients with a high TyG index and those with a low TyG index.

RESULTS

Obese patients with a high TyG index had greater incidences of hypertension, diabetes mellitus and hyperlipidaemia. The LV GLS was significantly lower in the high TyG index group than in the low TyG index group (P = 0.01). After adjusting for sex, age, body mass index, heart rate, hypertension, diabetes mellitus, dyslipidaemia, blood urea nitrogen, serum creatinine, LV mass and LV hypertrophy, the TyG index remained an independent risk indicator related to an LV GLS < 20% (OR: 1.520, 95% CI: 1.040 to 2.221; P = 0.031).

CONCLUSIONS

We concluded that an increase in the TyG index is independently associated with subclinical LV systolic dysfunction in obese patients.

Association between triglyceride-glucose index and intracranial/extracranial atherosclerotic stenosis: findings from a retrospective study

OBJECTIVE

The association of the triglyceride-glucose (TyG) index with intracranial atherosclerotic stenosis (ICAS) and extracranial atherosclerotic stenosis (ECAS) is unclear. This study aimed to investigate the relationship of TyG index with the distribution and severity of ICAS and ECAS.

METHOD

Patients who underwent digital subtraction angiography (DSA) for evaluating ICAS/ECAS in Zhongnan Hospital of Wuhan University from January 2017 to October 2021 were retrospectively enrolled in our study. Clinical characteristics, DSA data, blood routine, lipid profile and fasting glucose were recorded. The association of TyG index and ICAS/ECAS status were investigated in four aspects: location and distribution of stenosis, stenosis severity and whether stenosis is symptomatic. Logistic regression models were used to evaluate the association. Restricted cubic splines were constructed to model the non-linear relationship between the TyG index and different arterial stenosis status.

RESULTS

Among 1129 included patients, the median age was 62 (IQR 55-68) years, and 71.3% were male. The median TyG index was 8.81 (8.40, 9.21). Elevated TyG index was significantly associated with ICAS, combined ICAS/ECAS, anterior circulation stenosis, posterior circulation stenosis, combined anterior/posterior circulation stenosis, severe stenosis, both asymptomatic and symptomatic stenosis. This association was maintained after adjusting for age, sex, smoking, drinking, medical history of hypertension and stroke, platelet, total cholesterol, high-density lipoprotein, and low-density lipoprotein. Multivariable-adjusted spline regression models showed that a progressively increasing risk of arterial stenosis was related to an elevated TyG index.

CONCLUSION

Elevated TyG index was associated with ICAS/ECAS. TyG index might be a useful indicator of ICAS and severe stenosis.

Association between the cumulative average triglyceride glucose-body mass index and cardiovascular disease incidence among the middle-aged and older population: a prospective nationwide cohort study in China

BACKGROUND

Findings from earlier research have established that insulin resistance (IR) is implicated in atherosclerosis progression, representing a noteworthy risk factor for cardiovascular disease (CVD). Recently, the triglyceride glucose-body mass index (TyG-BMI) has been introduced as a straightforward and robust alternative indicator for early detection of IR. Nevertheless, there is a scarcity of studies that have examined the capability of TyG-BMI for predicting incident CVD. Consequently, the core objective of this study was to determine whether the cumulative average TyG-BMI correlated with CVD incidence.

METHODS

All data was sourced from the China Health and Retirement Longitudinal Study (CHARLS). The exposure was the cumulative average TyG-BMI, determined by the average of TyG-BMI values for the baseline and follow-up investigations (Wave 1 in 2011, Wave 3 in 2015, respectively). The calculation of TyG-BMI involved a combination of triglyceride, fasting blood glucose, and body mass index. The primary outcome was incident CVD. Logistic regression analyses as well as restricted cubic spline (RCS) regression analyses were performed for examining the association between the cumulative average TyG-BMI and CVD incidence.

RESULTS

In all, 5,418 participants were enrolled in our analysis, with 2,904 (53.6%) being female, and a mean (standard deviation, SD) age of 59.6 (8.8) years. The mean (SD) cumulative average TyG-BMI among all participants was 204.9 (35.7). Totally, during a 4-year follow-up, 543 (10.0%) participants developed CVD. The fully adjusted logistic regression analysis revealed a significant association between the cumulative average TyG-BMI and incident CVD [odds ratio (OR), 95% confidence interval (CI): 1.168, 1.040-1.310, per 1 SD increase]. The RCS regression analysis displayed a positive, linear association of the cumulative average TyG-BMI with CVD incidence (P for overall = 0.038, P for nonlinear = 0.436).

CONCLUSIONS

Our study revealed a noteworthy correlation between the cumulative average TyG-BMI and incident CVD among the middle-aged and older population. The cumulative average TyG-BMI emerges as a valuable tool that may enhance the primary prevention and treatment of CVD.

Trends in baseline triglyceride-glucose index and association with predicted 10-year cardiovascular disease risk among type 2 diabetes patients in Thailand

Triglyceride-glucose (TyG) index is an independent risk factor for cardiovascular diseases (CVD). Our study determined the trends of the TyG index and its relationship to predicted CVD risk among patients with type 2 diabetes (T2D). A serial cross-sectional study was conducted including 63,815 participants with T2D aged 30-74 years without a history of CVD. The predicted CVD risk was based on the Framingham Heart Study (FHS). The receiver operating characteristic (ROC) curve was utilized for identifying the cutoff point of TyG index to predict intermediate-to-high CVD risk. The relationship between TyG index and predicted CVD risk was tested using linear and logistic regression. Decreasing trends of TyG index were observed between 2014 and 2018 (p < 0.001). ROC curve analysis of the TyG index indicated an AUC of 0.57 (95% CI 0.56-0.57, p < 0.001) in predicting intermediate-to-high predicted CVD risk, with a cutoff value of TyG index > 9.2 (sensitivity of 55.7%, specificity of 46.8%). An independent relationship between the TyG index and predicted CVD risk was observed. High TyG index was independently associated with intermediate-to-high predicted CVD risk. From our study, the TyG index was positively related to predicted 10-year CVD risk. However, the predictive ability of the TyG index in predicting the intermediate-to-high predicted 10-year CVD risk among patients with T2D remained questionable.