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Restricted cubic splines for the adjusted dose–response association of the TyG index for the primary and secondary endpoints. Data of the TyG index for repeat revascularization was fitted with a linear regression model using restricted cubic spines with three knots at the 5th, 50th, and 95th percentiles of the TyG index. Y-axis represents the odds ratio, and the dashed lines are 95% confidence intervals. a The primary endpoint including repeat revascularization and/or ISR; b repeat revascularization; c ISR. CI confidence interval, ISR in-stent restenosis, OR odds ratio, TyG triglyceride-glucose
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Background
The triglyceride-glucose (TyG) index, a reliable surrogate indicator of insulin resistance, is independently associated with coronary artery disease of various clinical manifestations. This study aimed to investigate the prognostic value of the TyG index in predicting repeat revascularization and in-stent restenosis (ISR) in chronic coro...
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Background
Women’s pregnancy history is associated with incident risk of coronary artery disease with some evidence also suggesting a relevance for prognosis following treatment.
Objectives
To study the associations between maternal history of preterm delivery, a history of small for gestational age infant, parity and age at first delivery with cl...
Citations
... Four studies (11,12,14,27) have examined the association between TyG and ISR. The findings of these studies suggested that the TyG index was associated with the risk of developing ISR significantly (HR = 1.25; 95% CI: 1.15-1.35; ...
Background
Previous research has demonstrated the validity of the triglyceride-glucose (TyG) index as a robust measure of insulin resistance (IR) and its association with coronary artery disease (CAD). The objective of this study is to elucidate the relationship between the TyG index and the prognosis of patients underwent percutaneous coronary intervention (PCI) through a comprehensive systematic review and meta-analysis. Our goal is to provide a thorough analysis of the available evidence to offer more clarity on this association.
Methods
A systematic and thorough search was carried out in the PubMed, Embase, Cochrane Library, and Web of Science databases, covering studies published in English from the beginning until October 1, 2023. The focus of the search was to gather relevant studies pertaining to the occurrence of major adverse cardiovascular events (MACE). To address the variability among the included studies, random or fixed effect models were utilized to summarize the hazard ratios (HR). In cases where heterogeneity was detected, subgroup or sensitivity analyses were performed to explore potential sources. To evaluate publication bias, the Egger or Begg test was employed.
Results
This study incorporated a total of 17 studies. Individuals with the highest TyG index exhibited an elevated risk of major adverse cardiovascular events (MACEs) compared to those with the lowest TyG index (HR = 1.69; 95% CI: 1.47–1.95; P < 0.001). When analyzing the TyG index as a continuous variable, each standard deviation increase was associated with an HR of 1.60 (95% CI: 1.48–1.73; P < 0.001). Moreover, in patients diagnosed with acute coronary syndrome (ACS), higher TyG index levels showed a trend of increased risk of MACE (HR = 1.54; 95% CI: 1.27–1.86; P < 0.001). Furthermore, an elevated TyG index was found to be associated with a higher risk of in-stent restenosis (HR = 1.62; 95% CI: 1.29–2.03; P < 0.001), new-onset atrial fibrillation (HR = 2.97; 95% CI: 2.10–4.06; P = 0.014), and a reduction in quantitative flow ratio (HR = 1.35; 95% CI: 1.101–1.592; P = 0.005). Subgroup analysis indicated the risk of MACE was comparable between varied durations of follow-up ( P = 0.11). Furthermore, regression analysis revealed that the positive association between TyG index and the risk of MACE did not differ between individuals with or without diabetes ( P = 0.23).
Conclusion
An increase in the TyG index may lead to a higher vulnerability to major adverse cardiovascular events (MACE) in patients underwent PCI and there was no significant difference in the risk of major adverse cardiovascular events (MACE) between diabetic and non-diabetic individuals.
... Five observational studies, comprising 3,912 participants who had previously undergone stent implantation and had no ISR at baseline, were included. Among these studies, three were conducted in China [10,19,20] and two in Turkey [9,21]. Participants' ages ranged from 56 to 63 Fig. 1 Flow diagram of study selection years, with male proportions varying from 60 to 80% and diabetes prevalence between 0% and 50%. ...
... Participants' ages ranged from 56 to 63 Fig. 1 Flow diagram of study selection years, with male proportions varying from 60 to 80% and diabetes prevalence between 0% and 50%. All five studies analyzed the TyG index as a continuous variable [9, 10,[19][20][21], with two additionally treating it as a categorical variable [19,20]. All the studies conducted adjustments for confounding factors (Tables 1 and 2). ...
... Participants' ages ranged from 56 to 63 Fig. 1 Flow diagram of study selection years, with male proportions varying from 60 to 80% and diabetes prevalence between 0% and 50%. All five studies analyzed the TyG index as a continuous variable [9, 10,[19][20][21], with two additionally treating it as a categorical variable [19,20]. All the studies conducted adjustments for confounding factors (Tables 1 and 2). ...
Background
Insulin resistance (IR) can lead to cellular metabolic disorders, activation of oxidative stress, and endothelial dysfunction, contributing to in-stent restenosis (ISR). The triglyceride-glucose index (TyG index), a new indicator reflecting IR, is extensively researched in the cardiovascular field. This study, through a meta-analysis, aimed to utilize a larger combined sample size and thereby enhance the overall test efficacy to explore the TyG index-ISR relationship.
Methods
A thorough search was conducted in the PubMed, EMBASE, Web of Science, and Cochrane Library databases to find original papers and their references published between 1990 and January 2024. This search included both prospective and retrospective studies detailing the correlation between the TyG index and ISR in individuals with coronary heart disease (CHD).
Outcomes
The five included articles comprised 3,912 participants, and the odds ratio (OR) extracted from each study was combined using the Inverse Variance method. Results showed that, in the context of CHD patients, each incremental unit in the TyG index, when treated as a continuous variable, corresponded to a 42% elevation in ISR risk (95% CI 1.26–1.59, I²=13%, p < 0.005). When analyzing the TyG index categorically, the results revealed a higher ISR risk in the highest TyG index group compared to the lowest group (OR: 1.69, 95% CI 1.32–2.17, I²=0). Additionally, in patients with chronic coronary syndrome (CCS), each unit increase in the TyG index, the risk of ISR in patients increased by 37% (95% CI 1.19–1.57, I²=0%, p < 0.005). This correlation was also observable in acute coronary syndrome (ACS) patients (OR:1.48, 95% CI 1.19–1.85, I²=0, p < 0.005).
Conclusions
The TyG index, an economical and precise surrogate for IR, is significantly linked with ISR. Furthermore, this correlation is unaffected by the type of coronary heart disease.
... 19 Guo et al. conducted a follow-up study of 1 414 patients with CAD after percutaneous coronary intervention and found that an elevated TyG index was associated with an increased risk of coronary artery revascularisation and in-stent restenosis. 21 Zhu et al. retrospectively enrolled 1 574 ACS patients who were treated with drug-eluting stents and found that the high TyG index group had a higher rate of in-stent restenosis, and a high TyG index was an independent risk factor for in-stent restenosis. 22 The exact mechanism underlying the relationship between the TyG index and MACE of PCAD remains unknown. ...
Objective:
The aim of this study was to investigate the predictive value of the triglyceride-glucose (TyG) index to assess the severity and major adverse cardiovascular events (MACE) of patients in hospital with premature coronary artery disease (PCAD).
Methods:
A total of 300 patients with PCAD, diagnosed by coronary angiography (CAG), were enrolled in this study. According to the tertiles of TyG index, the 300 patients were divided into a T1 (n = 100), T2 (n = 100) and T3 group (n = 100). According to the presence or absence of MACE, the 300 patients were divided into a MACE (n = 80) and a non-MACE group (n = 220). The patients' clinical data were compared between the groups, the relationship between TyG index and the severity of PCAD and MACE were analysed through multivariable logistic regression analysis, and their predictive value was detected using receiver operating characteristic (ROC) curves.
Results:
Multivariable logistic regression analysis showed that the TyG index was an independent risk factor for the severity of PCAD and MACE. The area under the ROC curve was 0.833 and 0.807, respectively (all p < 0.05).
Conclusion:
The TyG index was independently associated with the severity of PCAD and MACE, and had a good predictive value.
... The TyG index is an independent risk factor for MACE in SCAD patients after PCI, particularly in increasing repeat revascularization, which may be primarily associated with the progression of chronic atherosclerosis (5,24), consistent with the notion that IR is a chronic cumulative process. This study found that TyG index is not associated with cardiovascular death, acute myocardial infarction, and stroke, which are acute stress events based on chronic diseases. ...
Background: Insulin resistance (IR) affects prognosis in stable coronary artery disease (SCAD). While triglyceride-glucose (TyG) index assesses IR, glycated hemoglobin (HbA1c) provides long-term glycemic level information. However, the combined predictive value of TyG index and HbA1c is unclear.
Methods: This retrospective cohort study included 944 SCAD patients who underwent percutaneous coronary intervention (PCI). Major adverse cardiovascular events (MACE) were followed up for 31 months. Receiver operating characteristic (ROC) curves assessed the predictive ability of TyG index, HbA1c and their combination. Patients were further grouped based on the optimal cutoff value of the TyG index and clinical abnormal ranges of HbA1c to analyze the impact of different groups.
Results: The TyG index was independently predictive of MACE and repeat revascularization (HR: 1.574, P = 0.021; and HR: 1.379, P = 0.027). Combining TyG index with HbA1c significantly enhanced overall MACE prediction, with the AUC for cardiac death increasing to 0.901 (P = 0.016). The high TyG-low HbA1c group had more than double the cumulative incidence of MACE compared to the low TyG-low HbA1c group (HR: 2.069, P < 0.001), with the high TyG-high HbA1c group showing an even greater risk (HR: 2.463, P < 0.001). Diabetic patients in the high TyG-low HbA1c category had the highest risk increase (HR: 3.375, P = 0.038).
Conclusions: The combined use of TyG and HbA1c improves the predictive ability for MACE in all SCAD patients, with predictive value for chronic outcomes, but not for acute events.
... Similarly, ZHU, GUO et al. reported that for patients with primary lesions, The elevation of TYG index increased the incidence of MACEs after PCI. [10,11] However, no studies have focused on patients with ISR,So this study is conducted to analyze the association between the TyG index and MACEs after PCI in patients diagnose with ISR. ...
... TyG index was calculated as Ln (TG [mg/dL] × FBG [mg/dL]/2) [10].Dyslipidemia was de ned as fasting serum TC levels > 6.22 mmol/L or LDL-C levels > 4.14 mmol/L. Diabetes status was de ned as history of diagnosed diabetes mellitus, receiving hypoglycemic drugs, presenting typical symptoms of diabetes with FBG > 7 mmol/L or HbA1c ≥ 6.5% (i.e., meeting any one of these criteria) [11]. ISR was characterized as the existence of signi cant diameter stenosis (≥ 50%) or a 5 mm margin within the stent segment as determined by angiography [13]. ...
... Based on primary cardiovascular disease, Zhu, Guo, et al. investigated the association between the TYG index and the incidence of ISR in patients who underwent stent implantation via a retrospective study. [10,11] This study, for the rst time demonstrated that the TyG index was signi cantly correlated with the incidence of MACEs via long-term follow-up; thus, the TyG index impacts not only the occurrence of ISR but also its development, prognosis, and severity. ...
The Triglyceride-glucose index(TYG) is a reliable indicator for predicting the prognosis of patients with coronary heart disease after percutaneous coronary intervention (PCI). In patients with stent failure, its influence is unclear. This study was designed to evaluate the association between the TYG index and the occurrence of major adverse cardiovascular events (MACEs) after PCI in patients with in-stent restenosis(ISR).This retrospective study included 1,654 patients who underwent PCI from 2016 to 2023 in Nanjing First Hospital. Patients were stratified into three groups based on their quantile level. The baseline characteristics and follow-up data of these patients were meticulously recorded. The TyG index was determined as Ln(triglycerides [mg/dL] × fasting plasma glucose [mg/dL]/2.As a result, during a median follow-up period of 40 months, 357 patients (21.6%) experienced MACEs. After adjustment for potential confounders, There’ s significant and independent association between TYG index and the primary endpoint. (HR 1.191; 95% CI 1.019–1.412; P = 0.029). Compared to the lowest quantile, the risk of primary endpoint events in the TyG third quantile increased 1.370-fold (HR 1.370; 95% CI 1.052–1.785; P = 0.020). For the male and diabetes subgroups, this trend was even more pronounced (HR 1.269; 95% CI 1.055–1.527; P = 0.011; HR 1.385; 95% CI 1.125–1.706; P = 0.002). Additionally, the incidence of MACEs was greater in ISR patients with the highest TyG indices (P = 0.019).In conclusion, an increased TYG index is significantly associated with an increased risk of MACEs after PCI in patients with ISR, and this trend is more significant in male patients with diabetes. Monitoring TyG index is helpful for improving the postoperative health of patients with ISR.
... 11,12 According to Guo et al., elevated TyG index increases the risk of revascularization and in-stent restenosis following PCI. 13 Regarding arrhythmias, individuals with ST-elevation myocardial infarction who undergo PCI have an elevated risk of developing new-onset atrial fibrillation due to their high TyG index. 14 For individuals with secondary mitral regurgitation following PCI, Huang et al. found that high TyG index is an independent and significant risk factor for worsening heart failure. ...
Percutaneous coronary intervention (PCI) addresses myocardial ischaemia, but a significant subset of patients encounter major adverse cardiovascular events (MACE) post‐treatment. This meta‐analysis investigated the relationship between the post‐PCI triglyceride‐glucose (TyG) index and MACE. Comprehensive searches of the Embase, PubMed, Cochrane Library, and Web of Science databases were conducted up to 3 March 2023, using relevant keywords. The effect size was determined based on I² statistic using random‐effects models. Cluster‐robust standard errors crafted the dose–response curve, and the GRADE Evaluation Scale was employed to rate the quality of evidence. The group with the highest TyG index had significantly higher post‐PCI MACE rates than the lowest index group, with hazard ratios (HRs) of 2.04 (95% CI 1.65–2.52; I² = 77%). Each unit increase in TyG index corresponded to HRs of 1.82 for MACE (95% CI 1.34–2.46; I² = 92%), 2.57 for non‐fatal MI (95% CI 1.49–4.41; I² = 63%), and 2.06 for revascularization (95% CI 1.23–3.50; I² = 90%). A linear relationship between TyG index and MACE risk was established (R² = 0.6114). For all‐cause mortality, the HR was 1.93 (95% CI 1.35–2.75; I² = 50%), indicating a higher mortality risk with elevated TyG index. The GRADE assessment yielded high certainty for non‐fatal MI but low certainty for all‐cause mortality, revascularization, and MACE. The TyG index may predict risks of post‐PCI MACE, all‐cause mortality, non‐fatal MI, and revascularization, with varied levels of certainty. A potential linear association between the TyG index and MACE post‐PCI was identified. Future research should validate these findings.
... Insulin resistance has been suggested as a risk factor for both the progress of type 2 diabetes mellitus and cardiovascular diseases [20,21]. A higher TyG index was associated with poor outcomes in acute coronary syndrome undergoing PCI [22], the severity of coronary artery disease [23], atrial fibrillation [24], and repeat revascularization and in-stent restenosis in patients with chronic coronary syndrome undergoing PCI [25]. Moreover, an elevated level of TyG index was an independent predictor for increased arterial stiffness [26], increased odds of atherosclerosis in coronary arteries [27], and increased carotid atherosclerosis [28]. ...
Background
The triglyceride glucose-body mass index (TyG-BMI index) has been suggested as a novel predictor of insulin resistance. However, its predictive value for slow coronary flow phenomenon (SCFP) in patients with ischemia and nonobstructive coronary arteries (INOCA) remains unclear.
Methods
We consecutively recruited 1625 patients with INOCA from February 2019 to February 2023 and divided them into two groups based on thrombolysis in myocardial infarction (TIMI) frame counts (TFCs): the SCFP group (n = 79) and the control group. A 1:2 age-matched case–control study was then performed. The TyG-BMI index was calculated as ln [plasma triglyceride (mg/dL) × fasting blood glucose (mg/dL)/2] × BMI.
Results
TyG-BMI index in the SCFP group (218.3 ± 25.2 vs 201.0 ± 26.5, P < .001) was significantly higher than in the normal controls. TyG-BMI index also increased with the number of coronary arteries involved in the SCFP. Multivariate logistic regression analysis showed that TyG-BMI, BMI, and TG were independent predictors for SCFP. Receiver operating characteristic (ROC) curve analysis showed that when the TyG-BMI index was above 206.7, the sensitivity and specificity were 88.6% and 68.5%, respectively, with an AUC of 0.809 (95% CI: 0.756–0.863, P = .027). Combined BMI with TG, the TyG-BMI index had a better predictive value for SCFP than BMI and TG (P < .001).
Conclusion
The TyG-BMI index was an independent predictor for SCFP in INOCA patients, and it had a better predictive value than BMI and TG.
... b MACE was defined as a composite of CV death and nonfatal MI. c HR with 95%CI was estimated by multivariable Cox regression models adjusted for age, male sex, BMI, ACS presentation, family history of CAD, previous MI, previous revascularization, hypertension, previous stroke, PAD, current smoker, LVEF, serum creatinine, TC, HDL-C, LDL-C, hsCRP, SYNTAX score, CTO lesion, aspirin use, statins use and insulin use. Abbreviations as in Tables 1 and 3 revascularization and in-hospital mortality [32,33]. For diabetic patients, one previous study has indicated TyG index was associated with the all-cause mortality risk in patients with diabetes or pre-diabetes [34]. ...
Background
The role of triglyceride-glucose (TyG) index, an insulin resistance indicator, in glycemic management for diabetic patients with coronary artery disease (CAD) was still unknown. Therefore, we aimed to explore the association between glycemic control and cardiovascular (CV) outcomes in patients with diabetes and CAD according to different TyG index levels.
Methods
A total of 9996 diabetic patients with angiograph-proven CAD were consecutively recruited from 2017 to 2018 at Fuwai Hospital. Patients were assigned into 3 groups according to TyG index tertiles (T) (T1: <8.895; T2: 8.895-9.400; T3: ≥9.400). According to American Diabetes Association guidelines, controlled glycemia was defined as targeting glycosylated hemoglobin Alc (HbA1c) < 7%. The primary endpoint was CV events including CV death, nonfatal myocardial infarction, and nonfatal stroke.
Results
During a median 3-year follow-up, 381 (3.8%) CV events occurred. Overall, high TyG index (T3) was associated with increased risk of CV events (hazard ratio [HR]: 1.40; 95% confidence interval [CI]: 1.02–1.94) compared with the lowest TyG index (T1) after multivariable adjustment. Upon stratification by the TyG index, in fully adjusted models, controlled glycemia was associated with reduced risk of CV events in the high TyG index (T3) subgroup (HR: 0.64; 95%CI: 0.42–0.96) but not in the low (T1; HR: 0.79; 95%CI: 0.53–1.16) and moderate (T2; HR: 0.84; 95%CI: 0.56–1.25) TyG index subgroups.
Conclusions
Controlled glycemia was associated with improved CV outcomes in patients with diabetes and established CAD, especially in those with high TyG index levels. Our study, for the first time, provided valuable information that TyG index could help making risk stratification on the glycemic management in diabetic patients with CAD.
... Study population. The present study followed the methods of Guo et al (15). A total of 25,776 patients admitted with suspected CAD were retrospectively screened in Fuwai Hospital, Chinese Academy of Medical Sciences, from January 2017 to December 2017. ...
Inflammation and disorders in lipid metabolism play pivotal roles in the development and progression of in-stent restenosis (ISR). The present study aimed to investigate the association between the high-density lipoprotein (HDL)-related inflammatory indices and the risk of developing ISR among patients undergoing elective percutaneous coronary intervention (PCI). A sum of 1,471 patients undergoing elective PCI were retrospectively included and classified by tertiles of HDL-related inflammatory indices. The study endpoint was ISR. The multivariable Cox proportional hazards regression analysis with restricted cubic splines (RCS) was used to assess the associations. During a median follow-up of 62.27 months, 251 (17.06%) patients experienced ISR. The incidence of ISR increased with the increasing white blood cell-to-HDL ratio (WHR) tertiles (log-rank test, overall P=0.0082). After full adjustment, the highest tertile of WHR was significantly associated with a 1.603-fold risk of ISR (hazard ratio, 1.603; 95% confidence interval, 1.152-2.231; P=0.005) in contrast to the lowest tertile of the WHR. Results of RCS further indicated that the association between WHR and ISR was in a non-linear and dose-dependent manner (non-linear P=0.034; P overall=0.019). The lymphocyte-to-HDL ratio (LHR) and neutrophil-to-HDL ratio (NHR) were also significantly and positively associated with the risk of ISR, of which the third tertiles were at increased risk of 41.2 and 44.7% after full adjustment, respectively. Overall, lipid metabolism disorders and inflammation were interconnected in the development of ISR; therefore, HDL-related inflammatory indices, including WHR, LHR and NHR, might be potential predictors in the prognosis of elective PCI.
... It is now understood that patients with insulin resistance are at increased risk of various metabolic disorders, including abnormalities in blood sugar, blood lipids, and blood pressure [5]. Consequently, numerous investigations are currently underway to explore the relationship between the TyG index and conditions such as cardiovascular and cerebrovascular diseases and their prognoses [6][7][8][9]. However, studies involving the general population have produced inconsistent findings regarding the associations between the TyG index and all-cause and cardiovascular mortality. ...
Objective
The Triglyceride-glucose (TyG) index, a novel indicator of insulin resistance, has been associated with mortality from coronary artery diseases, ischemic stroke, and heart failure. In recent years, much emphasis has been placed on the relationship between the TyG index and mortality in the general population. However, the impact of age on the association between TyG and all-cause and cardiovascular mortality remains controversial. This study investigated the link between the TyG index and all-cause and cardiovascular mortality, emphasizing differences between older and non-older populations.
Methods
Data from the National Health and Nutrition Examination Survey (2009–2018), encompassing 20,194 participants, were analyzed. The baseline TyG index was calculated as Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Multivariate Cox proportional hazards regression models with restricted cubic splines and trend tests were employed to explore the association between the TyG index and all-cause and cardiovascular mortality, with emphasis on age-specific analysis. Subgroup analysis was conducted to examine whether the TyG index's association with mortality varied across different subgroups. Additionally, receiver operating characteristic curves were used to compare the predictive ability of the TyG index with the homeostasis model assessment of insulin resistance (HOMA-IR) for all-cause and cardiovascular mortality.
Results
Over a median follow-up period of 105 months, all-cause mortality accounted for 13.345% of cases, and cardiovascular mortality accounted for 3.387%. Kaplan–Meier curves showed a significant increase in all-cause and cardiovascular mortality with higher TyG index values (both P for log-rank test < 0.001). However, during Cox proportional hazards regression analysis, no linear trend was observed between the TyG index and all-cause or cardiovascular mortality after adjusting for confounding factors (all-cause mortality: P for trend = 0.424; cardiovascular mortality: P for trend = 0.481). Restricted cubic splines revealed a non-linear association between the baseline TyG index and all-cause and cardiovascular mortality in the overall population (all-cause mortality: Non-linear P = 0.003; cardiovascular mortality: Non-linear P = 0.034). The effect of the TyG index was consistent across most subgroups in terms of all-cause and cardiovascular mortality, with no significant interaction with randomized factors (all-cause mortality: P for interaction = 0.077–0.940, cardiovascular mortality: P for interaction = 0.173–0.987), except for the age subgroup (all-cause mortality: P for interaction < 0.001, cardiovascular mortality: P for interaction < 0.001). Further age-specific analysis revealed that the association between the TyG index and all-cause and cardiovascular mortality remained significant in patients aged < 65 but not in those aged ≥ 65. Interestingly, a non-linear association was observed between the TyG index and all-cause mortality in individuals aged < 65 (Non-linear P = 0.011), while a linear relationship was observed with cardiovascular mortality, showing an upward trend (Non-linear P = 0.742, P for trend = 0.010). Further stratification according to age yielded similar results only in patients aged 45–64 (all-cause mortality: Non-linear P = 0.001 and cardiovascular mortality: Non-linear P = 0.902, P for trend = 0.015). Compared to HOMA-IR, the TyG index demonstrated superior predictive performance for all-cause and cardiovascular mortality (all-cause mortality: 0.620 vs. 0.524, P < 0.001; cardiovascular mortality: 0.623 vs. 0.537, P < 0.001).
Conclusions
This study established a significant association between the TyG index and all-cause and cardiovascular mortality in the general population, particularly among individuals aged < 65. Notably, a non-linear association with all-cause mortality was observed in those aged < 65, while a linear relationship with cardiovascular mortality was found.
