Background: Triglyceride-glucose index (TyG index) has been regarded as a reliable alternative marker of insulin resistance and an independent predictor of cardiovascular outcomes. Whether TyG index predicts adverse cardiovascular events in patients with diabetes and acute coronary syndrome (ACS) remains uncertain. The aim of the present study was to investigate the prognostic value of TyG index in patients with diabetes and ACS.Methods: A total of 2531 consecutive patients with diabetes who underwent coronary angiography for ACS were enrolled in the study. Patients were divided into 3 tertiles according to TyG index. The primary outcomes included the occurrence of major adverse cardiovascular events (MACE), defined as all-cause death, non-fatal myocardial infarction and non-fatal stroke. The TyG index was calculated as ln (fasting triglyceride level (mg/dL) ×fasting glucose level (mg/dL)/2).Results: The incidence of MACE increased with TyG index tertiles after 3-year follow-up. Kaplan-Meier curves showed significant differences in event-free survival rates among TyG index tertiles (P=0.005).Multivariate Cox hazards regression analysis revealed that TyG index was an independent predictor of MACE (95% CI 1.201-1.746; P<0.001). The optimal TyG index cut-off for predicting MACE was 9.323 (sensitivity 46.0% ; specificity 63.6%; area under the curve 0.560; P=0.001 ).Furthermore, adding TyG index to the prognostic model for MACE improved the C-statistic value (P=0.010), the integrated discrimination improvement value(P=0.001) and the net reclassification improvement value(P=0.019).Conclusions TyG index predicts future recurrent cardiovascular events in patients with diabetes and ACS, independently of known cardiovascular risk factors suggesting that TyG index may be a useful marker for risk stratification and prognosis in patients with diabetes and ACS.

To evaluate the effect of the methylation of osteoprotectin (OPG)/receptor activator of nuclear factor-κB ligand (RANKL)/receptor activator of nuclear factor-κB (RANK) pathway on aortic valve calcification, the aortic valve tissue was collected from 38 aortic stenosis (AS) patients who underwent valve replacement. OPG and RANKL gene methylation, RT-PCR, and ELISA were performed. Hematoxylin-eosin staining (HE), alizarin red-S staining, and immunohistochemically staining of OPG, RANKL, and CD68 were simultaneously performed. The patients were divided into noncalcified group ( n = 21 ) and calcified group ( n = 17 ). The methylation rate of OPG gene in noncalcified group was higher than that in calcified group ( P = 0.027 ). The methylation degree of RANKL gene was generally lower, but the noncalcified group was still higher than that in the calcified group ( P = 0.025 ). RT-PCR analysis showed that the mRNA expression of OPG and RANKL was higher in calcified group than in noncalcified group ( P = 0.007 and P = 0.036 , respectively), and the mRNA expression was negatively correlated with the gene methylation rate. The protein expression of OPG and RANKL was detected by immunohistochemistry and ELISA, showing significantly increased in calcified group ( P = 0.004 and P = 0.042 , respectively). Soluble RANKL (sRANKL) in CD68-positive group was significantly different from that in negative group ( 0.1243 ± 0.0321 vs 0.0984 ± 0.0218   pg/mL, P = 0.007 ). There was no significant difference in OPG value between positive group ( 1.9411 ± 0.4554   ng/mL) and negative group ( 1.8422 ± 0.5218   ng/mL, P = 0.587 ). In conclusion, the degree of methylation of OPG and RANKL genes may play an important role in regulating valve calcification in AS patients.

Background For a decade, the global burden of coronary heart disease (CHD) has increased in the young population. To identify the characteristics and to determine the risk factors of premature CHD and multivessel disease (MVD) patients. Methods A total of 2846 patients were enrolled in this retrospective, cross-sectional study. Premature CHD is defined as men < 45 years and women < 55 years. Demographic and clinical data were collected from the database of patient medical records. Logistic regression models were applied to analyse the risk factors of premature CHD and MVD. Results Most traditional factors and the TyG index between premature and mature CHD patients were not statistically significant. A significantly higher rate of dyslipidaemia was found in female premature CHD patients (OR = 1.412, 95%CI:1.029–1.936). In the crude models, female patients with the highest TyG index level were more likely to have premature MVD (OR = 2.065, 95%CI:1.426–2.991) or mature MVD (OR = 1.837, 95%CI:1.104–3.056) than those with the lowest TyG index group instead of premature single-vessel disease. Among male patients, the same trend was observed in mature MVD of CHD (OR = 2.272, 95%CI:1.312–3.937). The significance of the TyG index was not revealed in the multivariate analyses; however, hypertension, diabetes, obesity, smoking, OMI, and Lp(a) showed a positive association with MVD. Conclusion Dyslipidaemia should be used as an effective factor for the prediction and prevention of premature CHD in women. The TyG index could be a simple auxiliary indicator to be applied in population-based cardiovascular disease screening for the initial identification of vascular disease severity.

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WPAI (assessed via the WPAI-GH instrument) and self-reported healthcare resource utilization in the past 6 months. A secondary analysis was conducted to compare between respondents with ≥ 2 bone fractures (N= 172) and those with 1 bone fracture (N= 242) to assess the association between estimated burden and incremental fractures. Comparisons were made using one-way ANOVAs with a significance level of p< 0.05. Results: Total 414 osteoporosis patients reported prior fractures (female: 92%; mean age: 66.6). Comparing to those without prior fractures, respondents with prior fractures reported significant lower PCS (46.1 vs. 48.7), MCS (47.2 vs. 49.0), health utilities (0.69 vs. 0.72), and significant greater productivity loss due to presenteeism (26.6% vs. 18.8%), activity impairment (34.6% vs. 28.9%), physician visits (13.4 vs. 10.8) and hospitalizations (3.0 vs. 1.1). Similar results were observed for respondents with ≥ 2 bone fractures compared with those with 1 bone fracture. ConClusions: Fractures in osteoporosis patients were associated with poorer health status, greater work productivity loss due to presenteeism and greater healthcare resource utilization. A significant greater burden with incremental fractures was also identified.