Dataset Information

An elevated triglyceride-glucose index predicts adverse outcomes and interacts with the treatment strategy in patients with three-vessel disease.

ABSTRACT:

Background

Insulin resistance is a pivotal risk factor for cardiovascular diseases, and the triglyceride-glucose (TyG) index is a well-established surrogate of insulin resistance. This study aimed to investigate the prognostic value of the TyG index and its ability in therapy guidance in patients with three-vessel disease (TVD).

Methods

A total of 8862 patients with TVD with available baseline TyG index data were included in the study. The endpoint was major adverse cardiac events (MACE). All patients received coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or medical therapy (MT) alone reasonably.

Results

An elevated TyG index was defined as the TyG index greater than 9.51. During a median follow-up of 7.5 years, an elevated TyG index was significantly associated with an increased risk of MACE (adjusted hazard ratio 1.161, 95% confidence interval 1.026-1.314, p = 0.018). The elevated TyG index was shown to have a more pronounced predictive value for MACE in patients with diabetes, but failed to predict MACE among those without diabetes, whether they presented with stable angina pectoris (SAP) or acute coronary syndrome (ACS). Meanwhile, the association between an elevated TyG index and MACE was also found in patients with left main involvement. Notably, CABG conferred a significant survival advantage over PCI in patients with a normal TyG index, but was not observed to be superior to PCI in patients with an elevated TyG index unless the patients had both ACS and diabetes. In addition, the benefit was shown to be similar between MT and revascularisation among patients with SAP and an elevated TyG index.

Conclusions

The TyG index is a potential indicator for risk stratification and therapeutic decision-making in patients with TVD.

SUBMITTER: Zhang Y

PROVIDER: S-EPMC10702040 | biostudies-literature | 2023 Dec

REPOSITORIES: biostudies-literature

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Publications

An elevated triglyceride-glucose index predicts adverse outcomes and interacts with the treatment strategy in patients with three-vessel disease.

Zhang Yu Y Zhang Ce C Jiang Lin L Xu Lianjun L Tian Jian J Zhao Xueyan X Wang Dong D Zhang Yin Y Sun Kai K Zhang Channa C Xu Bo B Zhao Wei W Hui Rutai R Gao Runlin R Wang Jizheng J Feng Xinxing X Yuan Jinqing J Song Lei L

Cardiovascular diabetology 20231206 1

<h4>Background</h4>Insulin resistance is a pivotal risk factor for cardiovascular diseases, and the triglyceride-glucose (TyG) index is a well-established surrogate of insulin resistance. This study aimed to investigate the prognostic value of the TyG index and its ability in therapy guidance in patients with three-vessel disease (TVD).<h4>Methods</h4>A total of 8862 patients with TVD with available baseline TyG index data were included in the study. The endpoint was major adverse cardiac events ...[more]

PMID: 38057801

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Project description:BackgroundThe relationship of the first-trimester triglyceride-glucose (TyG) index with GDM (gestational diabetes mellitus) and other adverse pregnancy outcomes has yet to be fully understood. This study aims to investigate the relationship between the first-trimester TyG index and the risk of adverse pregnancy outcomes in pregnant women.MethodsThe data for the retrospective cohort study were derived from the Maternal and Child Health Hospital of Longgang District, Shenzhen, China. To calculate the TyG index, health indicators were measured in the early pregnancy period (<14 gestational weeks), including triglycerides and fasting blood glucose levels in pregnant women. Multivariable regression analysis and subgroup analysis were used to ascertain the independent association between the TyG index and the possibility of adverse pregnancy outcomes. Interaction analysis was performed to assess the potential heterogeneity of associations among subgroups. Nonlinear associations and the predictive value of the TyG index were explored using restricted cubic splines and receiver operating characteristic (ROC) curves. The discrimination and accuracy of the fully adjusted model were evaluated using calibration curves, Brier scores, and decision curve analysis (DCA). Mediation analysis was conducted to assess the impact of GDM (gestational diabetes mellitus) and PE (preeclampsia) as intermediaries on the risk of Preterm delivery.ResultsThe study included a cohort of 11,942 pregnant women, with an average TyG index of 8.36 ± 0.41. Logistic regression analysis showed that after adjusting for covariates, for each 1-unit increase in the TyG index, the risk of GDM increased by 2.21-fold, and this result was significantly different across all quartiles. Compared to the lowest quartile group, the highest TyG index group had the highest risk of PE (OR: 2.89; 95% CI 1.39 ~ 6.50), GH (gestational hypertension) (OR: 1.47; 95% CI 1.07 ~ 2.02), and Preterm delivery (OR: 1.75; 95% CI 1.21 ~ 2.56).The analysis of data stratification and interaction confirmed the validity of our study results. However, the analysis found no statistically significant association between the TyG index and low birth weight and macrosomia. GDM and PE were identified as partial mediating factors between TyG and the risk of preterm delivery, with variance contributions of 7.23% and 20.33%. The TyG index demonstrated the highest area under the curve (AUC) values in the ROC curves for GDM, PE, GH, and preterm delivery, with values of 0.61, 0.67, 0.58, and 0.56, respectively. The combination of the TyG index, maternal age, and pre-pregnancy body mass index predicted outcomes better than the TyG index alone (p < 0.01).After adjustment for confounders, the model showed good accuracy and net benefit in predicting adverse pregnancy outcomes, as supported by calibration curves, Brier scores, and decision curve analysis.ConclusionAn elevated first-trimester TyG index correlates with a heightened risk of GDM, PE, GH and Preterm delivery.The TyG index presents a promising tool for more effectively identifying populations at early risk for adverse pregnancy outcomes.

Project description:BackgroundPrediabetes has become a pandemic. This study aimed to identify a better predictor for the incidence of prediabetes, which we hypothesize to be the triglyceride-glucose (TyG) index, a simplified insulin resistance index. We compared its predictive value with the other common risk factors of prediabetes.MethodsThe participants of this analysis were derived from the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) study. A total of 4543 participants without initial prediabetes or diabetes were followed up for 3.25 years. Using multivariate logistic regression model, the associations between baseline obesity, lipid profiles and non-insulin-based insulin resistance indices with the incidence of prediabetes were analyzed. To assess which is better predictor for the incidence of prediabetes, the area under curves (AUCs) calculated from the receiver operating characteristic curve analyses were used to evaluate and compare with the predictive value of the different indices.ResultsDuring the 3.25 years, 1071 out of the 4543 participants developed prediabetes. Using the logistic regression analysis adjusted for some potential confounders, the risk of incidence of prediabetes increased 1.38 (1.28-1.48) fold for each 1-SD increment of TyG index. The predictive ability (assessed by AUCs) of TyG index for predicting prediabetes was 0.60 (0.58-0.62), which was superior to the indices of obesity, lipid profiles and other non-insulin-based insulin resistance indices. Although the predictive ability of the TyG index was overall similar to fasting plasma glucose (FPG) (P = 0.4340), TyG index trended higher than FPG in females (0.62 (0.59-0.64) vs. 0.59 (0.57-0.61), P = 0.0872) and obese subjects (0.59 (0.57-0.62) vs. 0.57 (0.54-0.59), P = 0.1313). TyG index had superior predictive ability for the prediabetic phenotype with isolated impaired glucose tolerance compared with FPG (P < 0.05) and other indices. Furthermore, TyG index significantly improved the C statistic (0.62 (0.60-0.64)), integrated discrimination improvement (1.89% (1.44-2.33%)) and net reclassification index (28.76% (21.84-35.67%)) of conventional model in predicting prediabetes than other indices.ConclusionsTyG could be a potential predictor to identify the high risk individuals of prediabetes.

Project description:ObjectiveTo explore the relationship between the TyG index and the insulin secretion function of pancreatic β-cells, and to determine the possibility of the TyG index in predicting β-cell dysfunction and the development of diabetes.MethodsA cross-sectional study was performed among 914 participants who took their annual health checkups at the Third Xiangya Hospital. The early- and late-phase pancreatic β-cell secretion was assessed based on the results of the oral glucose tolerance test (OGTT). In addition to anthropometric parameters and laboratory parameters, information about health-related habits and disease histories was obtained from the National Physical Examination Questionnaire. Partial correlation analysis was used to study the relationship between the TyG index and pancreatic β-cell function. The receiver operating characteristic (ROC) curve was used to calculate the cut-off points of the TyG index in predicting β-cell dysfunction. According to the OGTT results and medical history, the participants were categorized into three groups: the normal glucose tolerance group (NGT, n=276), the impaired glucose regulation group (IGT, n=323), and the diabetes group (DM, n=315). The correlation between the TyG index and β-cell function among the three groups and the association between the TyG index and glucose metabolic conditions were further explored.ResultsThe TyG index was negatively correlated with the indexes that reflect the early and late secretory function of β-cells, not only in the NGT group but also in the IGT and DM group. The minimum cut-off values for the TyG index to identify the risk of early- and late-phase β-cell dysfunction are 9.08 and 9.2 respectively. The TyG indexes of the IGT and DM group were higher than that of the NGT group, and with the growth of the TyG index, the risk of prediabetes and diabetes increased significantly.ConclusionIncreased TyG index is associated with impaired β-cell function regardless of the glucose metabolic conditions. The TyG index is an alternative indicator for predicting β-cell dysfunction.

Project description:Background and purposeThe triglyceride-glucose (TyG) index, a novel reliable biomarker for IR that incorporates blood glucose and triglyceride, is linked to intracranial atherosclerotic stenosis (ICAS). In this study, we aimed to further investigate the association between the TyG index and the outcomes of ICAS patients following extracranial-to-intracranial (EC-IC) bypass grafting.Methods489 ICAS patients who underwent EC-IC bypass between Jan 2009 and Jan 2022 at our hospital were retrospectively collected. The major adverse cardiac and cerebrovascular events (MACCEs), and anastomotic restenosis, both of which are critical factors leading to poor prognosis of ICAS patients after EC-IC bypass, were mainly recorded and analyzed. Kaplan-Meier survival curve and Log-rank tests were sequentially conducted. Cox regression model was used to investigate the association between the TyG index and MACCEs & anastomotic stenosis. C-statistics, continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI) evaluated the incremental predictive value of the TyG index.ResultsA higher incidence of MACCEs and anastomotic stenosis was found in higher-tertile TyG index group. The TyG index was significantly associated with an increased risk of MACCEs and anastomotic stenosis, independent of confounding factors, with a value of HR (1.30, 95%CI 1.10-1.51, p < 0.001) and (1.27, 95%CI 1.16-1.40, p < 0.001) respectively. The area under the curve (AUC) in the model with the TyG index for predicting the occurrence of MACCEs and anastomotic stenosis were 0.708 (95%CI 0.665-0.748) and 0.731 (95%CI 0.689-0.770) respectively. The addition of the TyG index significantly improved the global performance of the baseline model according to the C-statistics, NRI, and IDI (All p < 0.05).ConclusionsHigher TyG levels were associated with poorer outcomes in ICAS patients after EC-IC bypass. TyG could be a key factor in managing ICAS risk and standardizing the indications for EC-IC bypass.

Project description:BackgroundThe triglyceride glucose index (TyG index) is a marker of insulin resistance linked to the incidence of major adverse cardiovascular events (MACE) in diverse populations. However, its long-term prognostic role in type 2 diabetes (T2D) remains underexplored. This study evaluated the predictive value of the TyG index for all-cause mortality and MACE in T2D over a period of more than 15 years.MethodsA retrospective analysis was conducted on a cohort of 568 patients with T2D (median age: 67 years, IQR 61-72 years; 54% males; median disease duration: 14 years, IQR 7-21 years; median HbA1c: 7.3%, IQR 6.6-8.0%) and 376 presumably healthy controls (CTR, median age: 65 years, IQR 60-71 years) followed for a median period of 16.8 (IQR, 13.1-16.8) years. Routine biomarkers were measured on serum samples using commercially available methods. One-way ANOVA/ANCOVA, logistic regression, and Spearman's correlations were used to compare the TyG index among groups and to assess its correlations with biochemical variables. The association between TyG index and the follow-up endpoints was investigated by Kaplan-Meier curves and Cox proportional hazards analysis.ResultsPatients with T2D exhibited higher TyG Index values compared to CTR, with significant correlations between the TyG Index and markers of obesity, glucose metabolism, inflammation, and liver function. Patients with preexisting diabetic kidney disease (DKD) or atherosclerotic vascular disease had higher baseline values of TyG index. Sex-specific differences were observed among CTR but not in T2D patients. The TyG Index was predictive of all-cause mortality (HR = 1.39, 95% CI 1.07-1.79) and associated with the onset of complications MACE, DKD, and neuropathy independent of other conventional predictors. Age modified the TyG Index-mortality association, with the strongest effect in individuals aged 57-74.ConclusionThe TyG index is a valuable prognostic marker for long-term risk of all-cause mortality and MACE in patients with T2D, supporting its use in clinical risk stratification.

Project description:BackgroundThe triglyceride-glucose index (TGI), a reliable surrogate indicator of insulin resistance (IR), has been proven to be a predictor of the incidence of ischemic stroke. The role of TGI in predicting the outcomes of stroke patients remains controversial. Susceptibility to IR-related diseases varies among patients of different ages. The study aims to evaluate the predictive value of TGI levels on clinical outcomes of patients with ischemic stroke of different ages.MethodThis was a retrospective cohort study including patients with ischemic stroke in the Department of Neurology at West China Hospital. TGI was calculated as ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. The patients were subdivided into 3 tertiles according to TGI levels. Multivariate logistic regression analyses were conducted to estimate the association between TGI levels and post-stroke outcomes among the whole patients, younger patients (<65), and older patients (>=65). The outcomes included death and unfavorable functional outcome (modified Rankin scale score 3-6) at 3 and 12 months after stroke.ResultsA total of 3,704 patients (men, 65.08%, mean age, 61.44 ± 14.15; women 34.92%, mean age, 65.70 ± 13.69) were enrolled in this study. TGI levels were not associated with 3 month or 12 month death in the whole patients. Patients with higher TGI levels (T2 and T3) had a higher risk of 3 month death than those had lower TGI levels (T1) in the younger group (T2 vs. T1: OR 2.64, 95% CI 1.03-6.79, p = 0.043; T3 vs. T1: OR 2.69, 95% CI 1.00-7.10, p = 0.049) but not in the older group. Additionally, Kaplan-Meier estimate analysis illustrated that the 12 month death risk was significantly higher in the group with the highest TGI among younger patients (p for log-rank test = 0.028) but not among older patients. There was an interactive effect between TGI and age on 3 month death (p for interaction = 0.013) and 12 month death (p for interaction = 0.027). However, TGI was not associated with unfavorable functional outcome at 3 month or 12 month after stroke.ConclusionElevated TGI independently predicts death at 3 months and 12 months in patients under 65 with ischemic stroke. Regulating TGI is expected to be an approach to enhance prognosis in young individuals affected by ischemic stroke.

Project description:BackgroundThe triglyceride-glucose (TyG) index has been suggested as a dependable indicator for predicting major adverse cardiovascular events (MACE) in individuals with cardiovascular conditions. Nevertheless, there is insufficient data on the predictive significance of the TyG index in end-stage renal disease (ESRD) patients with coronary artery disease (CAD).MethodsThis study, conducted at multiple centers in China, included 959 patients diagnosed with dialysis and CAD from January 2015 to June 2021. Based on the TyG index, the participants were categorized into three distinct groups. The study's primary endpoint was the combination of MACE occurring within one year of follow-up, including death from any cause, non-fatal myocardial infarction, and non-fatal stroke. We assessed the association between the TyG index and MACE using Cox proportional hazard models and restricted cubic spline analysis. The TyG index value was evaluated for prediction incrementally using C-statistics, continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI).ResultsThe three groups showed notable variations in the risk of MACE (16.3% in tertile 1, 23.5% in tertile 2, and 27.2% in tertile 3; log-rank P = 0.003). Following complete adjustment, patients with the highest TyG index exhibited a notably elevated risk of MACE in comparison to those in the lowest tertile (hazard ratio [HR] 1.63, 95% confidence interval [CI] 1.14-2.35, P = 0.007). Likewise, each unit increase in the TyG index correlated with a 1.37-fold higher risk of MACE (HR 1.37, 95% CI 1.13-1.66, P = 0.001). Restricted cubic spline analysis revealed a connection between the TyG index and MACE (P for nonlinearity > 0.05). Furthermore, incorporating the TyG index to the Global Registry of Acute Coronary Events risk score or baseline risk model with fully adjusted factors considerably enhanced the forecast of MACE, as demonstrated by the C-statistic, continuous NRI, and IDI.ConclusionsThe TyG index might serve as a valuable and dependable indicator of MACE risk in individuals with dialysis and CAD, indicating its potential significance in enhancing risk categorization in clinical settings.

Dataset Information

An elevated triglyceride-glucose index predicts adverse outcomes and interacts with the treatment strategy in patients with three-vessel disease.

Background

Methods

Results

Conclusions

Publications

An elevated triglyceride-glucose index predicts adverse outcomes and interacts with the treatment strategy in patients with three-vessel disease.

Similar Datasets

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