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Multivariable-adjusted hazard ratios for (A) cardiovascular diseases (B) stroke (C) myocardial infarction based on restricted cubic spines with 5 knots at 5th, 25th, 50th, 75th, and 95th percentiles of changes in TyG index. HR hazard ratio, SD standard deviation, TyG triglyceride-glucose. Red line represent references for hazard ratios, and red area represent 95% confidence interval. Model was adjusted for age, sex, TyG index, education, income, smoking status, drinking status, physical activity, body mass index, systolic blood pressure, diastolic blood pressure, a history of hypertension, diabetes mellitus, and dyslipidemia, antidiabetic agents, lipid-lowering agents, antihypertensive agents, high-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and high-sensitivity C-reactive protein at baseline
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Background:
Previous studies has shown a significant relationship between baseline triglyceride-glucose (TyG) index and subsequent cardiovascular disease (CVD). However, the effect of longitudinal changes in TyG index on the risk of CVD remains uncertain. This study aimed to investigate the association between change in TyG index and the risk of C...
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Aims
We investigated the association of fasting triglycerides with cardiovascular disease (CVD) mortality.
Methods and results
This cohort study included US adults from the National Health and Nutrition Examination Surveys from 1988 to 2014. CVD mortality outcomes were ascertained by linkage to the National Death Index records. Cox proportional ha...
Background
Future risk of cardiovascular disease (CVD) and mortality is associated with cumulative amount TyG index (cumTyG) exposure, while whether time course of TyG accumulation modulates the risk remains unclear. This study sought to examine the associations of cumTyG index accumulation time course with the risk of CVD and all-cause mortality....
Background The relationship between the alkaline phosphatase-to-albumin ratio (APAR) and mortality remains unclear. This research looked into the association between APAR levels and cause-specific mortality in US adults.
Methods A cohort of 7561 participants from NHANES (2005-2016) was analyzed, with mortality outcomes collected from National Death...
Background
The triglyceride glucose (TyG) index is a new and low-cost marker to determine insulin resistant which may be a predictor of cardiovascular disease (CVD). Although available evidence showed that its association with CVD mortality (CVM) and all-cause mortality (ACM) may differ in different populations, scarce data are available in this re...
Citations
... The triglyceride-glucose (TyG) index, a composite indicator of triglyceride (TG) and fasting plasma glucose (FBG) levels, has emerged as a cost-effective surrogate for IR [12,13]. Recent studies have shown that the baseline TyG index, cumulative TyG index, and TyG index variability are associated with the incidence of CVD, coronary heart disease (CHD), myocardial infarction, stroke, and major adverse cardiovascular events [14][15][16][17][18][19][20]. ...
... Cumulative TyG-WC, TyG-BMI, and TyG-WHtR, were calculated using the formulas below [16,25] height in metres squared. WHtR was calculated as WC in centimetres divided by height in centimetres. ...
Background
Cardiovascular disease (CVD) is closely associated with the triglyceride glucose (TyG) index and its related indicators, particularly its combination with obesity indices. However, there is limited research on the relationship between changes in TyG-related indices and CVD, as most studies have focused on baseline TyG-related indices.
Methods
The data for this prospective cohort study were obtained from the China Health and Retirement Longitudinal Study. The exposures were changes in TyG-related indices and cumulative TyG-related indices from 2012 to 2015. The K-means algorithm was used to classify changes in each TyG-related index into four classes (Class 1 to Class 4). Multivariate logistic regressions were used to evaluate the associations between the changes in TyG-related indices and the incidence of CVD.
Results
In total, 3243 participants were included in this study, of whom 1761 (54.4%) were female, with a mean age of 57.62 years at baseline. Over a 5-year follow-up, 637 (19.6%) participants developed CVD. Fully adjusted logistic regression analyses revealed significant positive associations between changes in TyG-related indices, cumulative TyG-related indices and the incidence of CVD. Among these changes in TyG-related indices, changes in TyG-waist circumference (WC) showed the strongest association with incident CVD. Compared to the participants in Class 1 of changes in TyG-WC, the odds ratio (OR) for participants in Class 2 was 1.41 (95% confidence interval (CI) 1.08–1.84), the OR for participants in Class 3 was 1.54 (95% CI 1.15–2.07), and the OR for participants in Class 4 was 1.94 (95% CI 1.34–2.80). Moreover, cumulative TyG-WC exhibited the strongest association with incident CVD among cumulative TyG-related indices. Compared to the participants in Quartile 1 of cumulative TyG-WC, the OR for participants in Quartile 2 was 1.33 (95% CI 1.00–1.76), the OR for participants in Quartile 3 was 1.46 (95% CI 1.09–1.96), and the OR for participants in Quartile 4 was 1.79 (95% CI 1.30–2.47).
Conclusions
Changes in TyG-related indices are independently associated with the risk of CVD. Changes in TyG-WC are expected to become more effective indicators for identifying individuals at a heightened risk of CVD.
... Previous studies have shown that TyG is a low-cost, easy, widely applicable method of identifying insulin resistance [27,28], and compared to the euglycemic hyperinsulinemic clamp, it has high sensitivity (96.5%) and specificity (85.0%) [29]. In a prospective cohort study of 62,443 members of the general population who were followed for a median of 7.01 years after surgery, it was shown that for each 1-SD increase in TyG, the risk of cardiovascular disease increased by 16% [30]. In addition, in a retrospective study of 1932 patients with type 2 diabetes who experienced acute myocardial infarction, TyG was found to be an independent predictor of major adverse cardiovascular and cerebrovascular events [15]. ...
Background
Myocardial injury after non-cardiac surgery (MINS) is a common and insidious postoperative complication. This study aimed to evaluate the relationship between the triglyceride-glucose index (TyG) and MINS in advanced-age patients.
Methods
We performed a single-center retrospective study including patients ≥ 65 years of age who underwent non-cardiac surgery. The relationship between TyG and MINS was investigated using univariate and multivariate logistic regression analyses. Multivariate logistic regression analysis involved three models: Model I adjusted for preoperative factors, Model II adjusted for surgery-related factors, and Model III adjusted for both preoperative and surgery-related factors. Propensity score matching (PSM) was used to reduce the confounding effects of covariates. Subgroup analyses were then performed to evaluate the relationship between TyG and MINS in various subsamples.
Results
A total of 7789 patients were studied, among whom 481 (6.2%) developed MINS. A cut-off value of TyG of 8.57 was determined using a receiver operating characteristic (ROC) curve to be associated with the best predictive performance. Participants with TyG ≥ 8.57 were at a higher risk of developing MINS than those with TyG < 8.57 [n = 273 (7.6%) vs. n = 208 (4.9%), respectively; p < 0.001]. The univariate analysis showed that TyG ≥ 8.57 was significantly associated with MINS in elderly patients [odds ratio (OR): 1.58; 95% confidence interval (95%CI): 1.32–1.91; p < 0.001)]. In multivariate logistic regression, adjustments were made for risk factors including age, sex, body mass index (BMI), hypertension, coronary heart disease, and duration of surgery, etc. The adjusted ORs for TyG ≥ 8.57 were 1.46 (95%CI: 1.17–1.82), p = 0.001; 1.46 (95%CI: 1.19–1.77), p < 0.001; and 1.43 (95%CI: 1.13–1.81), p = 0.003, in the three multivariate models, respectively. The relationship remained after PSM (adjusted OR: 1.35, 95% CI: 1.03–1.78, p = 0.029). Furthermore, the relationship between TyG and MINS remained in a number of subgroups in the sensitivity analyses, but not in participants with peripheral vascular stenosis.
Conclusions
A preoperative high TyG (≥ 8.57) is associated with a higher risk of MINS in advanced-age patients undergoing non-cardiac surgery.
... The Kailuan Study is a prospective cohort study conducted in the community of Tangshan, China. The relevant design of the Kailuan study has been described in detail in previous articles [10][11][12]. Here, young and middle-aged participants were defined as males aged less than 55 years or females aged less than 65 years [13]. ...
Background
The association between the triglyceride glucose (TyG) index and the risk of early-onset atherosclerotic cardiovascular disease (ASCVD) events or all-cause mortality in young and middle-aged people is not fully elucidated.
Methods
The present study included 64,489 young and middle-aged people who participated in the 2006 Kailuan Study physical examination. Multivariate Cox proportional hazards models and restricted cubic spline curves were used to assess the association of TyG index with early-onset ASCVD events and all-cause mortality.
Results
During a median of 11-year follow-up, 1984 (3.08%) participants experienced at least one ASCVD event and 1,392 (2.16%) participants experienced all-cause death. A higher TyG index was significantly associated with a higher risk of early-onset ASCVD events (HR: 1.61, 95% CI 1.38–1.89) and all-cause mortality (HR: 1.39, 95% CI 1.17–1.65), respectively. For each unit increase in TyG index, the risk of early-onset ASCVD events increased by 20%. In addition, there was a non-linear association between the TyG index and early-onset ASCVD events (P for non-linear < 0.01), and a linear association between TyG index and all-cause mortality (P for non-linear = 0.476).
Conclusions
A higher TyG index is significantly associated with an increased incidence of early-onset ASCVD events and all-cause mortality in a young and middle-aged population from North China.
... A validated alternative evaluation index is the homeostatic model assessment of insulin resistance (HOMA-IR), which is calculated from fasting blood glucose and insulin concentrations [7]. However, circulating insulin concentrations are not routinely measured in primary care, so various simple and feasible alternative evaluation indices for IR have emerged, such as the triglyceride glucose index (TyG index), triglyceride glucose-body mass index (TyG-BMI index) [8,9]. Some studies have found that the TyG index is associated with in-hospital all-cause mortality in patients with severe CHD [10]. ...
Background
Studies on the relationship between insulin resistance (IR) surrogates and long-term all-cause mortality in patients with coronary heart disease (CHD) and hypertension are lacking. This study aimed to explore the relationship between different IR surrogates and all-cause mortality and identify valuable predictors of survival status in this population.
Methods
The data came from the National Health and Nutrition Examination Survey (NHANES 2001–2018) and National Death Index (NDI). Multivariate Cox regression and restricted cubic splines (RCS) were performed to evaluate the relationship between homeostatic model assessment of IR (HOMA-IR), triglyceride glucose index (TyG index), triglyceride glucose-body mass index (TyG-BMI index) and all-cause mortality. The recursive algorithm was conducted to calculate inflection points when segmenting effects were found. Then, segmented Kaplan–Meier analysis, LogRank tests, and multivariable Cox regression were carried out. Receiver operating characteristic (ROC) and calibration curves were drawn to evaluate the differentiation and accuracy of IR surrogates in predicting the all-cause mortality. Stratified analysis and interaction tests were conducted according to age, gender, diabetes, cancer, hypoglycemic and lipid-lowering drug use.
Results
1126 participants were included in the study. During the median follow-up of 76 months, 455 participants died. RCS showed that HOMA-IR had a segmented effect on all-cause mortality. 3.59 was a statistically significant inflection point. When the HOMA-IR was less than 3.59, it was negatively associated with all-cause mortality [HR = 0.87,95%CI (0.78, 0.97)]. Conversely, when the HOMA-IR was greater than 3.59, it was positively associated with all-cause mortality [HR = 1.03,95%CI (1.00, 1.05)]. ROC and calibration curves indicated that HOMA-IR was a reliable predictor of survival status (area under curve = 0,812). No interactions between HOMA-IR and stratified variables were found.
Conclusion
The relationship between HOMA-IR and all-cause mortality was U-shaped in patients with CHD and hypertension. HOMA-IR was a reliable predictor of all-cause mortality in this population.
... Fasting triglyceride and fasting glucose levels are combined to create the composite index known as the TyG index [17]. Although initially considered a biomarker for assessing insulin resistance (IR) [18], TyG index may be an independent predictor of CVD [19]. In patients with acute MI (AMI), a high TyG index often indicates the occurrence of heart failure and increased mortality risk [20]. ...
Objective
To investigate differences in levels of the triglyceride-glucose (TyG) index between individuals with myocardial infarction (MI) and those without MI, as well as the association between TyG index and risk of MI.
Methods
Data from the National Health and Nutrition Examination Survey (NHANES) for US adults from 2013 to 2018 were included in this study. Using MI as an outcome variable and TyG index as an exposure variable, logistic regression models were employed to analyze relationship between MI and TyG index.
Results
The study included 6,695 participants. Compared to the non-MI group, patients with MI had significantly higher TyG index (8.89 vs. 8.63, P = 0.003). Higher TyG index was significantly associated with an increased risk of MI in US adults (OR: 1.69, 95% CI: 1.26–2.26, P < 0.001). Race, smoking status, and history of chronic obstructive pulmonary disease (COPD) had significant impacts on the association between TyG index and risk of MI (P for interaction < 0.05). Subgroup analysis demonstrated a significant positive correlation between TyG index and MI risk in non-Hispanic Black individuals, non-smokers, and individuals without COPD across multiple models (OR > 1.0, P < 0.05).
Conclusion
US adults with higher TyG index were more susceptible to MI, and TyG index may be used to identify individuals at high risk of MI in the US population.
... The TyG index is a reliable indicator of IR,A clinical study Forest plots of independent factors associated with CHD in NAFLD. enrolling 62,443 Chinese individuals suggests that the TyG index is an independent risk factor for cardiovascular disease and may help identify individuals potentially at high cardiovascular risk (28). Another clinical study, which lasted follow-up 10 years and included 6,095 CVD patients with undiagnosed diabetes mellitus, demonstrated that the TyG index can be used as a clinical. ...
Background
Insulin resistance(IR) and inflammation have been regarded as common potential mechanisms in coronary heart disease (CHD) and non-alcoholic fatty liver disease (NAFLD). Triglyceride-glucose (TyG) index is a novel biomarker of insulin resistance, System immune-inflammation index(SII) and Systemic inflammation response index(SIRI) are novel biomarkers of inflammation, these biomarkers have not been studied in CHD with NAFLD patients. This study investigated the correlation between the TyG index, SII index, and SIRI index and CHD risk among NAFLD patients.
Methods
This cross-sectional study included 407 patients with NAFLD in the Department of Cardiology, The Second Hospital of Shanxi Medical University. Of these, 250 patients with CHD were enrolled in the NAFLD+CHD group and 157 patients without CHD were enrolled as NAFLD control. To balance covariates between groups, 144 patients were selected from each group in a 1:1 ratio based on propensity score matching (PSM). Potential influences were screened using Lasso regression analysis. Univariate and multivariate logistic regression analyses and the Least Absolute Shrinkage and Selection Operator (LASSO) regression were used to assess independent risk and protective factors for CHD. Construction of nomogram using independent risk factors screened by machine learning. The receiver operating characteristic(ROC) curve was used to assess the ability of these independent risk factors to predict coronary heart disease. The relationship between the Gensini score and independent risk factors was reflected using the Sankey diagram.
Results
The LASSO logistic regression analysis and Logistic regression analyses suggest that TyG index (OR, 2.193; 95% CI, 1.242-3.873; P = 0.007), SII index (OR, 1.002; 95% CI, 1.001-29 1.003; P < 0.001), and SIRI index (OR,1.483;95%CI,1.058-2.079, P =0.022) are independent risk factors for CHD. At the same time, Neutrophils, TG, and LDL-C were also found to be independent risk factors in patients, HDL-C was a protective factor for CHD in patients with NAFLD. Further analysis using three machine learning algorithms found these independent risk factors to have good predictive value for disease diagnosis, SII index shows the highest predictive value. ROC curve analysis demonstrated that combining the SII index, SIRI index, and TyG index can improve the diagnostic ability of non-alcoholic liver cirrhosis patients with CHD.ROC curve analysis showed that the combined analysis of these independent risk factors improved the predictive value of CHD(AUC: 0.751; 95% CI: 0.704-0.798; P < 0.001).
Conclusion
TyG index, SII index, and SIRI index are all independent risk factors for CHD in patients with NAFLD and are strongly associated with prediction and the severity of CHD.
... trajectory1, low gradual increase trajectory; trajectory2, medium stable trajectory; trajectory3, high gradual increase trajectory; trajectory4, increase followed by decrease trajectory; trajectory5, decrease followed by increase trajectory of these studies are almost consistent with our findings, both proving the effectiveness of the TyG index on cardiovascular events. Among other studies, the restricted cubic spline curves indicated that TyG index between 8 and 9 could be the reference for assessing diseases, such as stroke in cancer survivorship populations and albuminuria among hypertensive participants [23,24]. These findings are in general agreement with our conclusions. ...
Background
The triglyceride-glucose (TyG) index is regarded as a sophisticated surrogate biomarker for insulin resistance, offering a refined means for evaluating cardiovascular diseases (CVDs). However, prospective cohort studies have not simultaneously conducted baseline and multi-timepoint trajectory assessments of the TyG index in relation to CVDs and their subtypes in elderly participants.
Methods
After excluding data deficiencies and conditions that could influence the research outcomes, this study ultimately incorporated a cohort of 20,185 participants, with data chronicles extending from 2016 to 2022. The TyG index was calculated as Ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. Latent Class Trajectory Model (LCTM) was used to assess the change trends of the TyG index over multiple time points. Utilizing the Cox proportional-hazards models, we assessed the relationship between the baseline quartiles of the TyG index and various trajectories with CVDs and subtypes.
Results
During the mean follow-up time of 4.25 years, 11,099 patients experienced new CVDs in the elderly population. After stratifying by baseline TyG quartiles, the higher TyG level was associated with an increased risk of CVDs; the aHR and 95% CI for the highest quartile group were 1.28 (1.19–1.39). Five trajectory patterns were identified by the LCTM model. The low gradual increase group as the reference, the medium stable group, and the high gradual increase group exhibited an elevated risk of CVDs onset, aHR and 95%CIs were 1.17 (1.10–1.25) and 1.25 (1.15–1.35). Similar results were observed between the trajectories of the TyG index with subtypes of CVDs.
Conclusion
Participants with high levels of baseline TyG index and medium stable or high gradual increase trajectories were associated with an elevated risk of developing CVDs in elderly populations.
... According to research on the population without diabetes in the East China region, the TyG index considerably enhanced the predictive value of CVD in the new model, when it was included in one that previously comprised only the traditional risk variables (40). Wang et al. (41) proved that the addition of the TyG index to a model with conventional risk factors could enhance its predictive ability of the risk of CVD. The results of this study corroborate the findings of the aforementioned studies. ...
Background
This study aimed to assess the association of baseline insulin resistance (IR) surrogates and their longitudinal trajectories with cardiovascular diseases (CVD) to provide a useful reference for preventing CVD.
Methods
This study was a prospective cohort study conducted in the 51st Regiment of the Third Division of Xinjiang Corps. A total of 6362 participants were recruited in 2016 to conduct the baseline survey, and the follow-up surveys in 2019, 2020, 2021, and 2022. The Kaplan–Meier method was used to estimate the cumulative incidence of CVD according to the baseline IR surrogates of metabolic insulin resistance score (METS-IR) and triglyceride-glucose (TyG) index. Cox regression models were used to assess the association between the baseline IR surrogates and CVD. The impact of the longitudinal trajectories of the IR surrogates on CVD was analyzed after excluding those with IR surrogate data measured ≤2 times. Based on the group-based trajectory model (GBTM), the trajectory patterns of IR surrogates were determined. The Kaplan-Meier method was used to estimate the cumulative incidence of CVD in each trajectory group of METS-IR and TyG index. Cox regression models were used to analyze the association between different trajectory groups of each index and CVD. In addition, the Framingham model was utilized to evaluate whether the addition of the baseline IR surrogates increased the predictive potential of the model.
Results
Baseline data analysis included 4712 participants. During a median follow-up of 5.66 years, 572 CVD events were recorded (mean age, 39.42 ± 13.67 years; males, 42.9%). The cumulative CVD incidence increased with the ascending baseline METS-IR and TyG index quartiles (Q1–Q4). The hazard ratio and 95% confidence interval for CVD risk in Q4 of the METS-IR and TyG index were 1.79 (1.25, 2.58) and 1.66 (1.28, 2.17), respectively, when compared with Q1. 4343 participants were included in the trajectory analysis, based on the longitudinal change patterns of the METS-IR and TyG index, the following three trajectory groups were identified: low-increasing, moderate-stable, and elevated-increasing groups. Multivariate Cox regression revealed that the hazard ratio (95% confidence interval) for CVD risk in the elevated-increasing trajectory group of the METS-IR and TyG index was 2.13 (1.48, 3.06) and 2.63 (1.68, 4.13), respectively, when compared with the low-rising group. The C-index, integrated discrimination improvement value, and net reclassification improvement value were enhanced after adding the baseline METS-IR and TyG index values to the Framingham model ( P <0.05).
Conclusions
Elevated baseline IR surrogates and their higher long-term trajectories were strongly associated with a high risk of CVD incidence in Xinjiang’s rural areas. Regular METS-IR and TyG index monitoring can aid in the early detection of CVD-risk groups.
... The participants were recruited from the Kailuan study, which was an ongoing prospective cohort study conducted in Tangshan, China. Details of the study design and procedure have been described previously [19][20][21]. From June 2006 to October 2007, a total of 101,510 participants aged 18-98 years were enrolled in the baseline survey. ...
Background
The risk of cardiovascular disease (CVD) depended on the magnitude and exposure duration of insulin resistance (IR). This study aimed to investigate the associations of cumulative metabolic score for IR (cumMETS-IR) with incident CVD, and to further explore the modulated effects of time course of METS-IR accumulation.
Methods
We enrolled 47,270 participants without CVD and underwent three examinations during 2006–2010 from the Kailuan study. CumMETS-IR from 2006 to 2010 were calculated as the mean values of METS-IR between consecutive examinations multiplying by time intervals between visits. Time course of METS-IR accumulation was calculated as the slope of METS-IR versus time. Hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD risk were calculated with multivariable-adjusted Cox regressions.
Results
During a median follow-up of 10.99 years, we identified 3184 cases of incident CVD. The risk of incident CVD increased with increasing cumMETS-IR (HR, 1.77; 95% CI 1.58–1.98 for the Q4 versus Q1 group), exposure duration (HR, 1.60; 95% CI 1.45–1.77 for 6 years versus 0 years), and cumulative burden (HR, 1.49; 95% CI 1.37–1.61 for burden ≥ 0 versus < 0). A positive slope was associated with 14% higher risk of CVD (HR, 1.14; 95% CI 1.07–1.22). When combining cumMETS-IR and slope, those with cumMETS-IR ≥ median (142.78) and slope ≥ 0 had the highest risk of CVD (HR,1.38; 95% CI 1.25–1.53).
Conclusions
The risk of CVD increased with elevated cumMETS-IR and an increasing trend over time, emphasizing the importance of maintaining optimal METS-IR levels across life span.
... Furthermore, the triglyceride-glucose (TyG) index, a metric for assessing insulin resistance using blood glucose and lipids, has shown its link to the onset and advancement of CVD. As noted by Wang et al., the TyG index proved to be a reliable predictor of CVD in the general population (5). Su et al. put forth the idea that the TyG index has the potential to forecast CVD events in patients diagnosed with type 2 diabetes mellitus (DM) (6). ...
Background
Numerous investigations have demonstrated a strong association between the TyG (triglyceride-glucose) index, which is derived from lipid and glucose levels in the bloodstream, and the onset and progression of cardiovascular diseases (CVD). Blood glucose and blood lipids are affected by nutritional status, and few studies have explored whether the correlation between TyG index and the risk of CVD is affected by nutritional status.
Aims
To investigate the connection between TyG index and the risk of CVD among individuals with varying nutritional statuses.
Method
A total of 19,847 were included in the analysis, of which 15,955 participants were non-malnourished and 3,892 patients were malnourished. According to the TyG index quartile, the patients were categorized into four groups. Logistic regression analysis and restricted cubic spline was used to study the relationship between TyG index and the risk of CVD in normal and malnourished populations.
Results
The results of the restricted cubic spline showed that the TyG index was positively associated with the risk of CVD in the non-malnourished population. The TyG index showed a U-shaped association with the risk of CVD in malnourished people. The result is consistent with that of logistic regression (Malnutrition: Group 2: OR: 1.14; 95% CI: 0.85–1.53; Group 3: OR: 1.36; 95% CI: 1.03–1.79; Group 4: OR: 1.72; 95% CI:1.31–2.25, P for trend <0.001; Non-malnutrition: Group 2: OR: 0.82; 95% CI: 0.46–1.48; Group 3: OR: 0.88; 95% CI: 0.49–1.57; Group 4: OR: 1.45; 95% CI:0.83–2.52, P for trend =0.067).
Conclusions
The association between the TyG index and the risk of CVD varied depending on the nutritional states. When using TyG index to assess the risk of CVD, stratification combined with nutritional status helps to more accurately screen patients at high risk of CVD.
