Comparison of Triglyceride Glucose Index and Modified Triglyceride Glucose Indices in Predicting Cardiovascular Diseases Incidence Among Populations with Cardiovascular-kidney-metabolic Syndrome Stages 0-3: a Nationwide Prospective Cohort Study

Overview

Journal Cardiovasc Diabetol

Publisher Biomed Central

Specialties Cardiology & Vascular Diseases
Endocrinology

Date 2025 Feb 28

PMID 40022122

Authors

Jianan Hong

Ruiying Zhang

Haoxian Tang

Shiwan Wu

Yequn Chen

Xuerui Tan

Affiliations

Soon will be listed here.

Abstract

Background: Cardiovascular-kidney-metabolic (CKM) syndrome has been recently proposed by American Heart Association recently. The triglyceride glucose (TyG) index and TyG-related indices combined with obesity indicators have proven to be associated with the incidence of cardiovascular diseases (CVD). However, there are few studies to explore whether these associations exist among people with CKM syndrome stages 0-3.

Methods: A total of 7,364 participants from the China Health and Retirement Longitudinal Study were included. Cox hazard regression and restricted cubic spline regression were used to analyze the associations of these indices with CVD incidence. To compare predictive performance, time-dependent Harrell's C-indices, net reclassification index and integrated discrimination improvement were conducted.

Results: The CVD incidence was 20.55% over nine years. The TyG single index and all the modified TyG indices were capable of predicting CVD incidence. RCS regression analyses showed that all indicators had linear relationships with CVD incidence and these linear relationships of TyG combined with waist circumference (TyG-WC) or waist-to-height ratio (TyG-WHtR) still existed in CKM stage 1, stage 2 and stage 3. TyG-WC (C-index: 0.621, p < 0.001) and TyG-WHtR (C-index: 0.621, p < 0.001) almost had the highest C-indices in predicting CVD incidence, compared to single TyG index (C-index: 0.611, p < 0.001) and TyG combined with body mass index (C-index: 0.616, p < 0.001).

Conclusion: The TyG index and all the modified TyG indices were independent predictors of CVD incidence among people with CKM syndrome stages 0-3. It was found that modified indices had better predictive performance, especially TyG combined with waist circumference or waist-to-height ratio.

References

Bornfeldt K, Tabas I . Insulin resistance, hyperglycemia, and atherosclerosis. Cell Metab. 2011; 14(5):575-85. PMC: 3217209. DOI: 10.1016/j.cmet.2011.07.015. View

Avagimyan A, Pogosova N, Fogacci F, Aghajanova E, Djndoyan Z, Patoulias D . Triglyceride-glucose index (TyG) as a novel biomarker in the era of cardiometabolic medicine. Int J Cardiol. 2024; 418:132663. DOI: 10.1016/j.ijcard.2024.132663. View

Lim J, Kim J, Koo S, Kwon G . Comparison of triglyceride glucose index, and related parameters to predict insulin resistance in Korean adults: An analysis of the 2007-2010 Korean National Health and Nutrition Examination Survey. PLoS One. 2019; 14(3):e0212963. PMC: 6405083. DOI: 10.1371/journal.pone.0212963. View

Ndumele C, Neeland I, Tuttle K, Chow S, Mathew R, Khan S . A Synopsis of the Evidence for the Science and Clinical Management of Cardiovascular-Kidney-Metabolic (CKM) Syndrome: A Scientific Statement From the American Heart Association. Circulation. 2023; 148(20):1636-1664. DOI: 10.1161/CIR.0000000000001186. View

Ke Z, Wen H, Huang R, Xu X, Yang K, Liu W . Long-term insulin resistance is associated with frailty, frailty progression, and cardiovascular disease. J Cachexia Sarcopenia Muscle. 2024; 15(4):1578-1586. PMC: 11294012. DOI: 10.1002/jcsm.13516. 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

Zhang R, Shi S, Chen W, Wang Y, Lin X, Zhao Y . Independent effects of the triglyceride-glucose index on all-cause mortality in critically ill patients with coronary heart disease: analysis of the MIMIC-III database. Cardiovasc Diabetol. 2023; 22(1):10. PMC: 9838037. DOI: 10.1186/s12933-023-01737-3. View

Tao L, Xu J, Wang T, Hua F, Li J . Triglyceride-glucose index as a marker in cardiovascular diseases: landscape and limitations. Cardiovasc Diabetol. 2022; 21(1):68. PMC: 9078015. DOI: 10.1186/s12933-022-01511-x. View

von Elm E, Altman D, Egger M, Pocock S, Gotzsche P, Vandenbroucke J . The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008; 61(4):344-9. DOI: 10.1016/j.jclinepi.2007.11.008. View

10.

Song K, Park G, Lee H, Choi Y, Oh J, Choi H . Prediction of Insulin Resistance by Modified Triglyceride Glucose Indices in Youth. Life (Basel). 2021; 11(4). PMC: 8066260. DOI: 10.3390/life11040286. View

11.

Zheng D, Cai J, Xu S, Jiang S, Li C, Wang B . The association of triglyceride-glucose index and combined obesity indicators with chest pain and risk of cardiovascular disease in American population with pre-diabetes or diabetes. Front Endocrinol (Lausanne). 2024; 15:1471535. PMC: 11412814. DOI: 10.3389/fendo.2024.1471535. View

12.

DAgostino Sr R, Vasan R, Pencina M, Wolf P, Cobain M, Massaro J . General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008; 117(6):743-53. DOI: 10.1161/CIRCULATIONAHA.107.699579. View

13.

Osude N, Granger C . PREVENT equations predicted risk for incident CVD in adults aged 30 to 79 y. Ann Intern Med. 2024; 177(6):JC71. DOI: 10.7326/ANNALS-24-00208-JC. View

14.

Malik S, Wong N, Franklin S, Kamath T, LItalien G, Pio J . Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation. 2004; 110(10):1245-50. DOI: 10.1161/01.CIR.0000140677.20606.0E. View

15.

Tian X, Chen S, Xu Q, Xia X, Zhang Y, Wang P . Magnitude and time course of insulin resistance accumulation with the risk of cardiovascular disease: an 11-years cohort study. Cardiovasc Diabetol. 2023; 22(1):339. PMC: 10720129. DOI: 10.1186/s12933-023-02073-2. View

16.

Li W, Shen C, Kong W, Zhou X, Fan H, Zhang Y . Association between the triglyceride glucose-body mass index and future cardiovascular disease risk in a population with Cardiovascular-Kidney-Metabolic syndrome stage 0-3: a nationwide prospective cohort study. Cardiovasc Diabetol. 2024; 23(1):292. PMC: 11308445. DOI: 10.1186/s12933-024-02352-6. View

17.

Wu Y, Yang Y, Zhang J, Liu S, Zhuang W . The change of triglyceride-glucose index may predict incidence of stroke in the general population over 45 years old. Cardiovasc Diabetol. 2023; 22(1):132. PMC: 10257314. DOI: 10.1186/s12933-023-01870-z. View

18.

Martyn J, Kaneki M, Yasuhara S . Obesity-induced insulin resistance and hyperglycemia: etiologic factors and molecular mechanisms. Anesthesiology. 2008; 109(1):137-48. PMC: 3896971. DOI: 10.1097/ALN.0b013e3181799d45. View

19.

Cui C, Qi Y, Song J, Shang X, Han T, Han N . Comparison of triglyceride glucose index and modified triglyceride glucose indices in prediction of cardiovascular diseases in middle aged and older Chinese adults. Cardiovasc Diabetol. 2024; 23(1):185. PMC: 11138075. DOI: 10.1186/s12933-024-02278-z. View

20.

Zheng H, Chen G, Wu K, Wu W, Huang Z, Wang X . Relationship between cumulative exposure to triglyceride-glucose index and heart failure: a prospective cohort study. Cardiovasc Diabetol. 2023; 22(1):239. PMC: 10476374. DOI: 10.1186/s12933-023-01967-5. View