Abstract
BackgroundThe triglyceride glucose (TyG) index is an inexpensive clinical surrogate marker for insulin resistance. However, the relationship between TyG index and atherosclerotic cardiovascular disease (CVD) remains unclear. We evaluated the relationship between TyG index and CVD using a large-scale population dataset from the National Health Information Database (NHID).MethodsWe performed a retrospective observational cohort study of 5,593,134 persons older than 40 years from 2009 to 2017 using the NHID. We divided the participants into TyG index quartiles. Outcome variables were stroke, myocardial infarction, and both. The incidence of outcomes was estimated for each TyG quartile over the total follow-up period. All outcomes were analyzed by Cox proportional hazards regression analysis while controlling for baseline covariates.ResultsDuring 8.2 years of mean follow-up, stroke was diagnosed in 89,120 (1.59%), MI in 62,577 (1.12%), and both stroke and MI in 146,744 (2.62%) participants. Multivariate-adjusted hazard ratios (HRs) for patients in the highest TyG index quartile demonstrated that these patients were at higher risk for stroke (HR = 1.259; 95% confidence interval [CI] 1.233–1.286), for MI (HR = 1.313; 95% CI 1.28–1.346), and for both (HR = 1.282; 95% CI 1.261–1.303) compared with participants in the lowest TyG index quartile. These effects were independent of age, sex, smoking, alcohol consumption, physical activity, body mass index, systolic blood pressure, and total cholesterol.ConclusionsIn our large population study, TyG index, a simple measure reflecting insulin resistance, was potentially useful in the early identification of individuals at high risk of experiencing a cardiovascular event.
Highlights
The triglyceride glucose (TyG) index is an inexpensive clinical surrogate marker for insulin resistance
TyG index quartile was positively associated with Atherosclerotic cardiovascular disease (ASCVD) risk factors and components of metabolic syndrome comprising age, BMI, waist circumference, current smoking, alcohol consumption, systolic and diastolic blood pressure, fasting glucose, total cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, and high prevalence of T2D, hypertension, dyslipidemia, and chronic kidney disease (CKD)
Low socioeconomic status, and high-density lipoprotein (HDL) cholesterol were negatively associated with TyG index quartile
Summary
The triglyceride glucose (TyG) index is an inexpensive clinical surrogate marker for insulin resistance. In the prevention of ASCVD, various conditions, including diabetes, chronic kidney disease, peripheral artery disease, and stroke, have been considered indicative of high risk. We have frequently encountered patients with new ASCVD events who had been misclassified by models based on traditional cardiovascular risk factors. Current risk stratification models do not include measures of insulin resistance that might improve the prediction of ASCVD. Several studies showed that the TyG index is associated with ASCVD risk factors including type 2 diabetes [8, 9], hypertension [10], and metabolic syndrome [11]. A few studies demonstrated that the TyG index is associated with CVD in high-risk patients such as those with diabetes and chronic kidney disease [15, 16]. Few studies have evaluated the relationships among TyG index, insulin resistance, and incident CVD [17, 18]
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