Glycemic Control and Cardiovascular Outcomes in Patients with Diabetes and Coronary Artery Disease According to Triglyceride-glucose Index: a Large-scale Cohort Study

Overview

Journal Cardiovasc Diabetol

Publisher Biomed Central

Specialties Cardiology & Vascular Diseases
Endocrinology

Date 2024 Jan 6

PMID 38184572

Authors

Zhangyu Lin

Jining He

Sheng Yuan

Chenxi Song

Xiaohui Bian

Min Yang

Kefei Dou

Affiliations

Soon will be listed here.

Abstract

Background: The role of triglyceride-glucose (TyG) index, an insulin resistance indicator, in glycemic management for diabetic patients with coronary artery disease (CAD) was still unknown. Therefore, we aimed to explore the association between glycemic control and cardiovascular (CV) outcomes in patients with diabetes and CAD according to different TyG index levels.

Methods: A total of 9996 diabetic patients with angiograph-proven CAD were consecutively recruited from 2017 to 2018 at Fuwai Hospital. Patients were assigned into 3 groups according to TyG index tertiles (T) (T1: <8.895; T2: 8.895-9.400; T3: ≥9.400). According to American Diabetes Association guidelines, controlled glycemia was defined as targeting glycosylated hemoglobin Alc (HbA1c) < 7%. The primary endpoint was CV events including CV death, nonfatal myocardial infarction, and nonfatal stroke.

Results: During a median 3-year follow-up, 381 (3.8%) CV events occurred. Overall, high TyG index (T3) was associated with increased risk of CV events (hazard ratio [HR]: 1.40; 95% confidence interval [CI]: 1.02-1.94) compared with the lowest TyG index (T1) after multivariable adjustment. Upon stratification by the TyG index, in fully adjusted models, controlled glycemia was associated with reduced risk of CV events in the high TyG index (T3) subgroup (HR: 0.64; 95%CI: 0.42-0.96) but not in the low (T1; HR: 0.79; 95%CI: 0.53-1.16) and moderate (T2; HR: 0.84; 95%CI: 0.56-1.25) TyG index subgroups.

Conclusions: Controlled glycemia was associated with improved CV outcomes in patients with diabetes and established CAD, especially in those with high TyG index levels. Our study, for the first time, provided valuable information that TyG index could help making risk stratification on the glycemic management in diabetic patients with CAD.

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References

Selvin E, Marinopoulos S, Berkenblit G, Rami T, Brancati F, Powe N . Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med. 2004; 141(6):421-31. DOI: 10.7326/0003-4819-141-6-200409210-00007. View

Schiller N, Shah P, Crawford M, DeMaria A, Devereux R, FEIGENBAUM H . Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989; 2(5):358-67. DOI: 10.1016/s0894-7317(89)80014-8. View

Li J, Feng Z, Li Q, He Y, Zhao C, He J . Insulin glargine effectively achieves glycemic control and improves insulin resistance in patients with early type 2 diabetes that exhibit a high risk for cardiovascular disease. Exp Ther Med. 2014; 8(1):147-152. PMC: 4061209. DOI: 10.3892/etm.2014.1688. View

. Intensive Diabetes Treatment and Cardiovascular Outcomes in Type 1 Diabetes: The DCCT/EDIC Study 30-Year Follow-up. Diabetes Care. 2016; 39(5):686-93. PMC: 4839174. DOI: 10.2337/dc15-1990. View

He J, Song C, Wang H, Zhang R, Yuan S, Dou K . Diabetes mellitus with mild or moderate kidney dysfunction is associated with poor prognosis in patients with coronary artery disease: A large-scale cohort study. Diabetes Res Clin Pract. 2023; 200:110693. DOI: 10.1016/j.diabres.2023.110693. View

Lambie M, Bonomini M, Davies S, Accili D, Arduini A, Zammit V . Insulin resistance in cardiovascular disease, uremia, and peritoneal dialysis. Trends Endocrinol Metab. 2021; 32(9):721-730. PMC: 8893168. DOI: 10.1016/j.tem.2021.06.001. View

Rodriguez-Gutierrez R, Gonzalez-Gonzalez J, Zuniga-Hernandez J, McCoy R . Benefits and harms of intensive glycemic control in patients with type 2 diabetes. BMJ. 2019; 367:l5887. DOI: 10.1136/bmj.l5887. View

Guo X, Shen R, Yan S, Su Y, Ma L . Triglyceride-glucose index for predicting repeat revascularization and in-stent restenosis in patients with chronic coronary syndrome undergoing percutaneous coronary intervention. Cardiovasc Diabetol. 2023; 22(1):43. PMC: 9983161. DOI: 10.1186/s12933-023-01779-7. View

Koufakis T, Papanas N, Zebekakis P, Kotsa K . Treatment options following metformin in primary prevention populations with type 2 diabetes: which is the right road to take?. Expert Rev Clin Pharmacol. 2021; 14(10):1189-1192. DOI: 10.1080/17512433.2021.1942843. View

10.

Chaitman B, Thygesen K, Alpert J, White H, Jaffe A, Katus H . Third universal definition of myocardial infarction. Eur Heart J. 2012; 33(20):2551-67. DOI: 10.1093/eurheartj/ehs184. View

11.

Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M . 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018; 39(33):3021-3104. DOI: 10.1093/eurheartj/ehy339. View

12.

Zhang Q, Xiao S, Jiao X, Shen Y . The triglyceride-glucose index is a predictor for cardiovascular and all-cause mortality in CVD patients with diabetes or pre-diabetes: evidence from NHANES 2001-2018. Cardiovasc Diabetol. 2023; 22(1):279. PMC: 10583314. DOI: 10.1186/s12933-023-02030-z. View

13.

Hoshino T, Mizuno T, Ishizuka K, Takahashi S, Arai S, Toi S . Triglyceride-glucose index as a prognostic marker after ischemic stroke or transient ischemic attack: a prospective observational study. Cardiovasc Diabetol. 2022; 21(1):264. PMC: 9714168. DOI: 10.1186/s12933-022-01695-2. View

14.

Zhu Y, Liu K, Chen M, Liu Y, Gao A, Hu C . Triglyceride-glucose index is associated with in-stent restenosis in patients with acute coronary syndrome after percutaneous coronary intervention with drug-eluting stents. Cardiovasc Diabetol. 2021; 20(1):137. PMC: 8268452. DOI: 10.1186/s12933-021-01332-4. View

15.

ElSayed N, Aleppo G, Aroda V, Bannuru R, Brown F, Bruemmer D . 6. Glycemic Targets: Standards of Care in Diabetes-2023. Diabetes Care. 2022; 46(Suppl 1):S97-S110. PMC: 9810469. DOI: 10.2337/dc23-S006. View

16.

Sasso F, Simeon V, Galiero R, Caturano A, De Nicola L, Chiodini P . The number of risk factors not at target is associated with cardiovascular risk in a type 2 diabetic population with albuminuria in primary cardiovascular prevention. Post-hoc analysis of the NID-2 trial. Cardiovasc Diabetol. 2022; 21(1):235. PMC: 9641842. DOI: 10.1186/s12933-022-01674-7. View

17.

Gerstein H, Miller M, Byington R, Goff Jr D, Thomas Bigger J, Buse J . Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008; 358(24):2545-59. PMC: 4551392. DOI: 10.1056/NEJMoa0802743. View

18.

DeFronzo R, Ferrannini E . Insulin resistance. A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care. 1991; 14(3):173-94. DOI: 10.2337/diacare.14.3.173. View

19.

Liang S, Wang C, Zhang J, Liu Z, Bai Y, Chen Z . Triglyceride-glucose index and coronary artery disease: a systematic review and meta-analysis of risk, severity, and prognosis. Cardiovasc Diabetol. 2023; 22(1):170. PMC: 10327356. DOI: 10.1186/s12933-023-01906-4. View

20.

FRIEDEWALD W, Levy R, Fredrickson D . Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972; 18(6):499-502. View