Key result
Each 1-unit TyG-WHtR rise is linked to ~45% higher MACE risk, partially mediated by MBP.
Why the study?
The relationship between changes in TyG-WHtR and incident MACE, along with the potential mediating role of mean blood pressure, remains unclear.
Do changes in the triglyceride glucose-waist height ratio (TyG-WHtR) increase the risk of incident MACE in a community-based population?
Do changes in the triglyceride glucose-waist height ratio (TyG-WHtR) increase the risk of incident MACE in a community-based population?
Increases in the triglyceride glucose-waist height ratio are significantly associated with a higher risk of incident MACE, an effect that is partially mediated by mean blood pressure.
TyG-WHtR changes were associated with MACE in this cohort; extends prior TyG observations but leaves open whether monitoring alters outcomes.
Background The triglyceride-glucose (TyG) index and its combination with waist height ratio (WHtR) can predict cardiovascular diseases (CVD). However, there is limited research on the relationship between changes in the triglyceride glucose-waist height ratio (TyG-WHtR) and incident major adverse cardiovascular event (MACE). The mediation role of mean blood pressure (MBP) in the relationship between the changes of TyG-WHtR and incident MACE remains unclear. Objectives We aimed to investigate the relationship between the changes of TyG-WHtR and incident MACE and the mediation effect of MBP in this relationship. Methods We conducted a prospective cohort study on subjects from a Beijing community in China who were free of stroke or myocardial infarction during the exposure period in 2012 and 2014. The primary outcome was incident MACE (a composite of stroke, myocardial infarction, or cardiovascular death). Cox proportional-hazards regression analyses were performed to explore the associations between the changes of TyG-WHtR and incident MACE. Threshold analysis and mediation analysis were further performed. Results A total of 3,466 participants were included. The mean age was 58.45 ± 8.35 years, and 1,200 (34.6%) were female. During a mean 7.19-year follow-up, a total of 270 (7.8%) cases of MACE were recorded. Multivariable Cox regression analyses revealed that the changes of TyG-WHtR were positively associated with the hazards of incident MACE (per 1 unit increase, HR [95% CI]: 1.45 [1.04-2.03], P =0.029) (Figure 1). The result of the smooth curve illustrating the relationships between the changes of TyG-WHtR and incident MACE is presented in Figure 2. A threshold effect was observed in the association between changes of TyG-WHtR and incident MACE (P for likelihood test = 0.048). Only if changes of TyG-WHtR was ≥ 4.00, change of TyG-WHtR was positively correlated with incident MACE (HR [95%CI]: 3.38 [1.96-5.82], P < 0.001) (Figure 3). In mediation analyses, MBP explained 23.9% of the association between the changes of TyG-WHtR and incident MACE (Figure 4). Conclusions Greater changes of TyG-WHtR are significantly associated with an increased risk of incident MACE. These associations were largely mediated by MBP.
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Luo et al. (2025) studied this question. Each 1 unit increase in TyG-WHtR change raised MACE risk by 45% (HR 1.45); when ≥4.00, risk tripled (HR 3.38); MBP mediated 23.9% of this effect.
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