Triglyceride-glucose (TyG) index in cardiovascular risk prediction: Clinical utility, guideline implications, and the need for outcome trials

The triglyceride-glucose (TyG) index, a simple surrogate marker integrating insulin resistance and atherogenic dyslipidemia, has attracted growing attention as a potential tool for addressing residual risk in cardiovascular disease (CVD) prediction. Robust observational evidence consistently links the TyG index to hard cardiovascular endpoints and subclinical atherosclerosis, positioning it as a strong candidate for clinical translation. However, its adoption in mainstream guidelines is constrained by a critical limitation: the current evidence is exclusively observational and lacks interventional data demonstrating that lowering the TyG index improves clinical outcomes. This editorial argues that, although the TyG index represents a practical and readily available risk-stratification adjunct, it has not yet evolved into a validated therapeutic target. We propose a dual-pathway strategy: provisional recognition within guidelines as a risk-enhancing factor, accompanied by a clear call for dedicated cardiovascular outcome trials. Such an approach would capitalize on its present utility while upholding the evidentiary standards required to inform clinical practice.