Triglyceride-glucose index and cardiovascular disease by cardiovascular-kidney-metabolic syndrome and socioeconomic status among postmenopausal women

BACKGROUND AND AIMS The triglyceride-glucose (TyG) index (ln fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2) is a novel, simple, and inexpensive biomarker of insulin resistance with growing evidence in support of its diagnostic and prognostic value for cardiovascular disease (CVD). We examined the relationship of baseline TyG index with incident CVD, coronary heart disease (CHD), and cerebrovascular disease during up to 32 years of follow-up among postmenopausal women, before and after stratifying by the cardiovascular-kidney-metabolic (CKM) syndrome and socioeconomic status (SES) at baseline. METHODS 11,769 participants from Women's Health Initiative (5074 with CKM vs. 6695 without CKM; 4149 low SES vs. 5958 medium SES vs. 1662 high SES) were analyzed. RESULTS On average, the TyG index increased with decreasing SES and was higher in women with vs. without CKM. Cox regression and multistate Markov models adjusting for demographic, lifestyle, and health characteristics at baseline were constructed to estimate hazard ratios (HR) and 95 % confidence intervals (CI). A 1-unit increase in the TyG index was associated with greater CVD risk (CVD: HR = 1.54, 95 % CI: 1.39, 1.71; CHD: HR = 1.74, 95 % CI: 1.52, 1.99; Cerebrovascular disease: HR=1.32, 95% CI: 1.15, 1.53). The TyG index was positively associated with probabilities of transitions from a healthy state to CHD, cerebrovascular disease, and death, as well as transitions between CHD or cerebrovascular disease and death. These relationships did not vary by CKM syndrome or SES. CONCLUSIONS Among postmenopausal women, irrespective of CKM syndrome or SES, the TyG index is a valuable diagnostic and prognostic tool for CVD outcomes.