Influence of the Triglyceride-Glucose Index on Adverse Cardiovascular and Cerebrovascular Events in Prediabetic Patients With Acute Coronary Syndrome.

Qianyun Guo,Dongmei Shi,Yuyang Liu,Yujie Zhou,Bin Zhang,Jiaqi Yang,Xunxun Feng,Guangyao Zhai,Yang Liu

doi:10.3389/fendo.2022.843072

Abstract

BackgroundCardiovascular disease and insulin resistance are closely related. The triglyceride-glucose (TyG) index is frequently used as an indicator of insulin resistance. However, there is scant information on the TyG index in the prediabetic population, nor is the prognostic significance of the index known for prediabetes and acute coronary syndrome (ACS) patients.MethodsThe clinical endpoint was a major adverse cardiovascular and cerebrovascular event (MACCEs), including cardiac-related death, non-fatal myocardial infarction, ischemia-driven revascularization, and stroke. The TyG index was calculated as = ln [(triglyceride level, mg/dL) × (glucose level, mg/dL)÷2] under fasting conditions.ResultsThe study included 2,030 prediabetic patients with ACS. Patients were followed up for 2.5 years, during which the total incidence of MACCEs was 12%. After adjustment for covariates, the TyG index was found to be predictive of prediabetes with ACS (HR 4.942, 95%CI: 3.432-6.115, P<0.001). Using propensity score matching, 574 pairs were successfully matched, and the two groups were analyzed in terms of survival. This showed that there was a significantly greater incidence of MACCEs in patients with high TyG indices (HR 3.526, 95%CI: 2.618-4.749, P<0.001), mainly due to ischemia-driven revascularization and stroke.ConclusionsThe TyG index independently predicts future MACCEs and may be an important prognostic indicator for patients with prediabetes and ACS.

Highlights

Cardiovascular disease and insulin resistance are closely related
After adjustment for covariates, the TyG index was found to be predictive of prediabetes with acute coronary syndrome (ACS) (HR 4.942, 95%confidence level (CI): 3.432-6.115, P
Using stratification based on major adverse cardiovascular and cerebrovascular event (MACCEs) occurrence, the baseline clinical characteristics of the overall population were grouped into MACCEs and non-MACCEs (Table 1)

Summary

Introduction

Cardiovascular disease and insulin resistance are closely related. The triglyceride-glucose (TyG) index is frequently used as an indicator of insulin resistance. Most patients go through a prediabetic stage before they develop diabetes [1, 2]. The prevalence of prediabetes is rising globally. Research shows that by 2030, more than 470 million people will suffer from prediabetes. Prediabetes is associated with co-existing insulin resistance (IR) and b-cell dysfunction, and these abnormalities begin before blood sugar changes are detected. Prediabetes is a complex, multi-factorial metabolic disorder, and its pathophysiology centers around IR, impaired incretin action, and high insulin secretion. Observational evidence has linked prediabetes with an elevated risk of nephropathy, diabetic retinopathy, and cardiovascular diseases (CVDs) [3,4,5]

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