The impact of triglyceride-glucose index on incident cardiovascular events during 16 years of follow-up: Tehran Lipid and Glucose Study

Abstract

Background To investigate whether the Triglyceride-Glucose index (TyG-index) is associated with increased risk of cardiovascular diseases (CVD)/coronary heart disease (CHD). Methods A total of 7521 Iranians aged ≥ 30 years (male = 3367) were included in the study. Multivariate Cox regression analyses (adjusted for age, gender, waist circumference, body mass index, educational level, smoking status, physical activity, family history of CVD, type 2 diabetes, hypertension, low and high density lipoprotein cholesterol, and lipid lowering drugs) were used to assess the risk of incident CVD/CHD across quintiles and for 1-standard deviation (SD) increase in the TyG-index. The cut off point for TyG-index was assessed by the minimum value of $$\sqrt {\left( {1 - sensitivity} \right)^{2} + \left( {1 - specificity} \right)^{2} }$$ 1 - s e n s i t i v i t y 2 + 1 - s p e c i f i c i t y 2 . We also examined the added value of the TyG-index in addition to the Framingham risk score when predicting CVD. Results During follow-up, 1084 cases of CVD (male = 634) were recorded. We found a significant trend of TyG-index for incident CVD/CHD in multivariate analysis (both Ps for tend ≤ 0.002). Moreover, a 1-SD increase in TyG-index was associated with significant risk of CVD/CHD in multivariate analysis [1.16 (1.07–1.25) and 1.19 (1.10–1.29), respectively]. The cut-off value of TyG-index for incident CVD was 9.03 (59.2% sensitivity and 63.2% specificity); the corresponding value of TyG-index for incident CHD was 9.03 (60.0% sensitivity and 62.8% specificity), respectively. Although no interaction was found between gender and TyG-index for CVD/CHD in multivariate analysis (both Ps for interaction > 0.085), the significant trend of TyG-index was observed only among females for incident CVD (P = 0.035). A significant interaction was found between age groups (i.e. ≥ 60 vs < 60 years) and TyG-index for CVD outcomes in the multivariate model (P-value for interaction = 0.046). Accordingly, a significant association between the TyG-index and outcomes was found only among the younger age group. Among the population aged < 60 the addition of TyG-index to the Framingham risk score (FRS) did not show improvement in the predictive ability of the FRS, using integrated discrimination improvement. Conclusion The TyG-index is significantly associated with increased risk of CVD/CHD incidence; this issue was more prominent among the younger population. However, adding TyG-index to FRS does not provide better risk prediction for CVD.

The Triglyceride-Glucose Index, an Insulin Resistance Marker, Was Non-linear Associated With All-Cause and Cardiovascular Mortality in the General Population

“…Chiu et al and Zhao et al found that TyG index was associated with macrovascular and microvascular damage ( 30 , 31 ). TyG index was also found to associate with CVD incidence ( 14 , 32 ), hypertension, diabetes, as well as metabolic syndrome ( 11 , 12 , 33 ). Our analyses demonstrated the threshold values to detect mortality risk using TyG index.…”

Triglyceride-glucose index and the risk of stroke and its subtypes in the general population: an 11-year follow-up

“…A retrospective cohort study showed that elevated levels of TyG index were associated with an increased risk of cardiovascular disease in participants aged over 60 years [ 6 ]. Higher levels of TyG index were significantly associated with an increased risk of cardiovascular events and coronary heart disease during long-term follow‑up [ 5 ]. TyG index was also an independent predictor of coronary artery calcification progression [ 11 ], coronary artery disease severity and cardiovascular outcomes [ 14 ].…”

“…A reliable surrogate marker of insulin resistance was suggested to be the triglyceride-glucose (TyG) index, which was calculated as ln (fasting triglyceride [mg/dL] × fasting glucose [mg/dL]/2) [ 3 , 4 ]. Some studies showed an association between TyG index and incidence of cardiovascular diseases [ 5 , 6 ]. Current data about associations between TyG index and stroke are limited.…”

Changes in Triglyceride-glucose Index Predict the Risk of Cardiovascular Diseases in the General Population: a Prospective Cohort Study

“…[13] The Tehran Lipid and Glucose Study with 7,521 Iranians revealed that the signi cant relationship between the TyG index and risk of CVD/coronary heart disease was more prominent among the younger population. [14] Similarly, data from the National Health Information Database showed that participants in the highest TyG index quartile were at higher risk for stroke and MI, independently of other traditional cardiovascular risk factors. [15] Of note, the TyG index is calculated based on TG and FBG, both of which vary over time, thus evaluating the TyG index only at baseline was unable to examine the longitudinal association between the dynamic changes in TyG index and CVD risk.…”

“…[9][10][11] Cohort studies have found that TyG index was an importance risk factor for incident CVD. [12][13][14][15][16] However, an inherent limitation of previous studies is the TyG index was evaluated on a single time point, there has been no consideration of how the TyG index varies within individuals over time and the subsequent effect, which may yield a biased estimate of the relationship of the TyG index and CVD risk. While the effect of longitudinal changes in TyG index over time on CVD has not been fully studied up to date.…”