Association Between the Triglyceride-glucose Index and 1-year Major Adverse Cardiovascular Events in Patients with Coronary Heart Disease and Hypertension

Overview

Journal Cardiovasc Diabetol

Publisher Biomed Central

Specialties Cardiology & Vascular Diseases
Endocrinology

Date 2023 Nov 8

PMID 37940943

Authors

Shiyi Tao

Lintong Yu

Jun Li

Li Huang

Xuanchun Huang

Wenjie Zhang

Zicong Xie

Yuqing Tan

Deshuang Yang

Affiliations

Soon will be listed here.

Abstract

Background: The triglyceride-glucose (TyG) index has been proposed as a potential predictor of adverse prognosis of coronary heart disease (CHD). However, its prognostic value in patients with CHD and hypertension remains unclear. This study aimed to evaluate the association between the TyG index and the 1-year risk of major adverse cardiovascular events (MACEs) in patients with CHD and hypertension.

Methods: The data for the study were taken from the Hospital Information System database in China-Japan Friendship Hospital which contained over 10,000 cardiovascular admissions from 2019 to 2022. The Boruta algorithm was performed for feature selection. The study used univariable analysis, multivariable logistic regression analysis, and restricted cubic spline (RCS) regression to evaluate the association between the TyG index and the 1-year risk of MACEs in patients with CHD and hypertension.

Results: After applying inclusion and exclusion criteria, a total of 810 patients with CHD and hypertension were included in the study with a median TyG index of 8.85 (8.48, 9.18). Using the lowest TyG index quartile as the reference, the fully adjusted ORs (95% CIs) for 1-year MACEs for TyG index Q2, Q3, and Q4 were 1.001 (0.986 ~ 1.016), 1.047 (1.032 ~ 1.062), and 1.760 (1.268 ~ 2.444), respectively. After adjusting for all confounders, we found that those with the highest TyG index had a 47.0% increased risk of MACEs over the 1-year follow-up (OR 1.470, 95% CI 1.071 ~ 2.018). The results in the subgroup analysis were similar to the main analyses. RCS model suggested that the TyG index was nonlinearly associated with the 1-year risk of MACEs (P for nonlinear < 0.001).

Conclusion: This study shows that the elevated TyG index is a potential marker of adverse prognosis among patients with CHD and hypertension and informs the development of clinical decisions to improve outcomes.

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References

Ferrannini E, Haffner S, Stern M . Essential hypertension: an insulin-resistant state. J Cardiovasc Pharmacol. 1990; 15 Suppl 5:S18-25. View

Zhang M, Wang B, Liu Y, Sun X, Luo X, Wang C . Cumulative increased risk of incident type 2 diabetes mellitus with increasing triglyceride glucose index in normal-weight people: The Rural Chinese Cohort Study. Cardiovasc Diabetol. 2017; 16(1):30. PMC: 5333419. DOI: 10.1186/s12933-017-0514-x. View

Hill M, Yang Y, Zhang L, Sun Z, Jia G, Parrish A . Insulin resistance, cardiovascular stiffening and cardiovascular disease. Metabolism. 2021; 119:154766. DOI: 10.1016/j.metabol.2021.154766. View

Gerrits A, Koekman C, van Haeften T, Akkerman J . Platelet tissue factor synthesis in type 2 diabetic patients is resistant to inhibition by insulin. Diabetes. 2010; 59(6):1487-95. PMC: 2874710. DOI: 10.2337/db09-1008. View

Kim Y, Kim J, Park J, Baik S, Chun J, Youn Y . Association between triglyceride-glucose index and gastric carcinogenesis: a health checkup cohort study. Gastric Cancer. 2021; 25(1):33-41. DOI: 10.1007/s10120-021-01222-4. View

Hu C, Zhang J, Liu J, Liu Y, Gao A, Zhu Y . Discordance between the triglyceride glucose index and fasting plasma glucose or HbA1C in patients with acute coronary syndrome undergoing percutaneous coronary intervention predicts cardiovascular events: a cohort study from China. Cardiovasc Diabetol. 2020; 19(1):116. PMC: 7379768. DOI: 10.1186/s12933-020-01091-8. View

Zhao Q, Zhang T, Cheng Y, Ma Y, Xu Y, Yang J . Triglyceride-Glucose Index as a Surrogate Marker of Insulin Resistance for Predicting Cardiovascular Outcomes in Nondiabetic Patients with Non-ST-Segment Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. J Atheroscler Thromb. 2020; 28(11):1175-1194. PMC: 8592700. DOI: 10.5551/jat.59840. View

Gao Q, Lin Y, Xu R, Luo F, Chen R, Li P . Positive association of triglyceride-glucose index with new-onset hypertension among adults: a national cohort study in China. Cardiovasc Diabetol. 2023; 22(1):58. PMC: 10022268. DOI: 10.1186/s12933-023-01795-7. View

Gao A, Liu J, Hu C, Liu Y, Zhu Y, Han H . Association between the triglyceride glucose index and coronary collateralization in coronary artery disease patients with chronic total occlusion lesions. Lipids Health Dis. 2021; 20(1):140. PMC: 8543811. DOI: 10.1186/s12944-021-01574-x. View

10.

Wu Z, Liu L, Wang W, Cui H, Zhang Y, Xu J . Triglyceride-glucose index in the prediction of adverse cardiovascular events in patients with premature coronary artery disease: a retrospective cohort study. Cardiovasc Diabetol. 2022; 21(1):142. PMC: 9338459. DOI: 10.1186/s12933-022-01576-8. View

11.

Pan W, Ren Y, Yang F, Wang M, Li X, Yin D . Triglyceride glucose index is associated with obstructive coronary artery disease in hypertensive patients. Cardiovasc Diabetol. 2023; 22(1):9. PMC: 9838016. DOI: 10.1186/s12933-023-01739-1. View

12.

Nishikawa T, Kukidome D, Sonoda K, Fujisawa K, Matsuhisa T, Motoshima H . Impact of mitochondrial ROS production in the pathogenesis of insulin resistance. Diabetes Res Clin Pract. 2007; 77 Suppl 1:S161-4. DOI: 10.1016/j.diabres.2007.01.071. View

13.

Liu S, Zhang C, Wan J . The correlation between T-wave abnormalities and adverse cardiovascular events and echocardiographic changes in hypertensive patients. Clin Exp Hypertens. 2023; 45(1):2185252. DOI: 10.1080/10641963.2023.2185252. View

14.

Zhu B, Liu Y, Zhou W, Du Y, Qi D, Wang C . Clinical characteristics and outcomes of Chinese patients with coronary heart disease and resistant hypertension. J Clin Hypertens (Greenwich). 2023; 25(4):350-359. PMC: 10085807. DOI: 10.1111/jch.14651. View

15.

Tian Y, Sun J, Qiu M, Lu Y, Qian X, Sun W . Association between the triglyceride-glucose index and albuminuria in hypertensive individuals. Clin Exp Hypertens. 2022; 45(1):2150204. DOI: 10.1080/10641963.2022.2150204. View

16.

Li W, Chen D, Tao Y, Lu Z, Wang D . Association between triglyceride-glucose index and carotid atherosclerosis detected by ultrasonography. Cardiovasc Diabetol. 2022; 21(1):137. PMC: 9306166. DOI: 10.1186/s12933-022-01570-0. View

17.

Lee J, Jeon S, Joung B, Lee H, Kwon Y . Associations of Homeostatic Model Assessment for Insulin Resistance Trajectories With Cardiovascular Disease Incidence and Mortality. Arterioscler Thromb Vasc Biol. 2023; 43(9):1719-1728. DOI: 10.1161/ATVBAHA.123.319200. View

18.

Zhang F, Zhang Y, Guo Z, Yang H, Ren M, Xing X . The association of triglyceride and glucose index, and triglyceride to high-density lipoprotein cholesterol ratio with prehypertension and hypertension in normoglycemic subjects: A large cross-sectional population study. J Clin Hypertens (Greenwich). 2021; 23(7):1405-1412. PMC: 8678664. DOI: 10.1111/jch.14305. View

19.

Mottillo S, Filion K, Genest J, Joseph L, Pilote L, Poirier P . The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis. J Am Coll Cardiol. 2010; 56(14):1113-32. DOI: 10.1016/j.jacc.2010.05.034. View

20.

. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020; 396(10258):1223-1249. PMC: 7566194. DOI: 10.1016/S0140-6736(20)30752-2. View