Endocrinol Metab.  2023 Aug;38(4):406-417. 10.3803/EnM.2023.1703.

Triglyceride-Glucose Index Predicts Future Atherosclerotic Cardiovascular Diseases: A 16-Year Follow-up in a Prospective, Community-Dwelling Cohort Study

• Moon JH
• Kim Y
• Oh TJ
• Moon JH
• Kwak SH
• Park KS
• Jang HC
• Choi SH
• Cho NH

• KMID: 2545273
• DOI: http://doi.org/10.3803/EnM.2023.1703

Abstract

Background
While the triglyceride-glucose (TyG) index is a measure of insulin resistance, its association with cardiovascular disease (CVD) has not been well elucidated. We evaluated the TyG index for prediction of CVDs in a prospective large communitybased cohort.
Methods
Individuals 40 to 70 years old were prospectively followed for a median 15.6 years. The TyG index was calculated as the Ln [fasting triglycerides (mg/dL)×fasting glucose (mg/dL)/2]. CVDs included any acute myocardial infarction, coronary artery disease or cerebrovascular disease. We used a Cox proportional hazards model to estimate CVD risks according to quartiles of the TyG index and plotted the receiver operating characteristics curve for the incident CVD.
Results
Among 8,511 subjects (age 51.9±8.8 years; 47.5% males), 931 (10.9%) had incident CVDs during the follow-up. After adjustment for age, sex, body mass index, diabetes mellitus, hypertension, total cholesterol, smoking, alcohol, exercise, and C-reactive protein, subjects in the highest TyG quartile had 36% increased risk of incident CVD compared with the lowest TyG quartile (hazard ratio, 1.36; 95% confidence interval, 1.10 to 1.68). Carotid plaque, assessed by ultrasonography was more frequent in subjects in the higher quartile of TyG index (P for trend=0.049 in men and P for trend <0.001 in women). The TyG index had a higher predictive power for CVDs than the homeostasis model assessment of insulin resistance (HOMA-IR) (area under the curve, 0.578 for TyG and 0.543 for HOMA-IR). Adding TyG index on diabetes or hypertension alone gave sounder predictability for CVDs.
Conclusion
The TyG index is independently associated with future CVDs in 16 years of follow-up in large, prospective Korean cohort.

Keyword

Atherosclerosis; Cardiovascular diseases; Insulin resistance; Mortality; Triglycerides; Glucose; Risk factors

Figure

• 

  Fig. 1. Cumulative survival for incident cardiovascular disease according to triglyceride-glucose (TyG) index. (A, B) Cumulative survivals for incident cardiovascular disease (n=8,551; 931 [10.9%] developed cardiovascular disease [CVD]) according to quartiles of TyG index in (A) men and (B) women during 16 years of follow-up are depicted using Kaplan-Meier analysis.

• 

  Fig. 2. Receiver operating characteristic (ROC) analysis of triglyceride-glucose (TyG) and other indices for predicting incident cardiovascular disease. (A) The ROC curves are plotted to compare the predictive power for incident cardiovascular disease of indices including TyG index. The estimates of the ROC curves including the area under the curve (AUC), Youden index, Euclidean r, and their corresponding values of each index are presented. (B) The box plots show the distributions of AUC values from 100 iterations of 10-fold cross-validation. First box plot indicates analysis of diabetes only model, second box plot indicates analysis of multiple logistic regression model with diabetes and TyG index, third box plot is with diabetes and hypertension, and fourth box plot is from the multiple regression model with diabetes and hypertension, and TyG index. HOMA-IR, homeostasis model assessment of insulin resistance; LDL, low-density lipoprotein.

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