Dynamic Changes in Triglyceride Glucose‒Waist‒to‒Height Ratio and the Risk of Major Adverse Cardiovascular Events: Role of Concurrent Mean Arterial Pressure Change

Figures

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  FIGURE 1. Kaplan–Meier curves for major adverse cardiovascular events and secondary outcomes by two‐year change in TyG‒WHtR (2014‐2012) (<0.400 vs. ≥0.400). Cumulative hazard curves for (A) major adverse cardiovascular events (MACEs), (B) myocardial infarction, (C) stroke, and (D) cardiovascular death, stratified by changes in triglyceride glucose‒waist‒to‒height ratio (TyG‒WHtR) (<0.400 vs. ≥0.400). The log‒rank test was used to compare event‒free survival between groups.

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  FIGURE 2. Landmark Kaplan–Meier curves for MACEs and myocardial infarction by two‐year change in TyG‒WHtR (2014‐2012). Cumulative hazard curves for major adverse cardiovascular events (Left) and myocardial infarction (Right), stratified by changes in triglyceride glucose‒waist‒to‒height ratio (TyG‒WHtR) (<0.400 vs. ≥0.400), with a landmark set at 2 years. The adjusted hazard ratios (aHRs) displayed on the plots were estimated from multivariable Cox proportional hazards models fitted within each landmark interval, comparing participants with TyG–WHtR change ≥0.400 versus <0.400. The fully adjusted Cox model included age, sex, current smoking, current drinking, estimated glomerular filtration rate (eGFR), hypertension, blood pressure–lowering treatment, diabetes mellitus, glucose‐lowering treatment, HDL‐C, LDL‐C, lipid‐lowering treatment, and baseline TyG–WHtR in 2012. The p‐values are derived from log‒rank tests performed within the 0–2 year and >2 year intervals. p for interaction denotes the p‐value for the group × time‐period interaction from an adjusted Cox model (0–2 years vs. >2 years), testing whether the association differs between early and late follow‐up.

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  FIGURE 3. Mediation analysis of mean arterial pressure change (2014‐2012) in the association between change in TyG‒WHtR (2014‐2012) and MACEs‒free survival time. Path diagrams illustrating the mediation effects of mean arterial pressure (MAP) change on the association between TyG‒WHtR change and MACEs‒free survival time. (Left) Adjusted 1: age, sex, current smoking, current drinking, eGFR, HDL‒C, LDL‒C, the values of MAP in 2012 and the values of TyG‒WHtR in 2012 (excluding clinical diagnoses and medication use) and (Right) Adjusted 2: Adjust 1 + hypertension, blood pressure‒lowering treatment, diabetes mellitus, glucose‒lowering treatment, lipid‒lowering treatment (fully adjusted).