What is the clinical evidence from this study?

Study design: Cohort. Population: Incident stroke (n=8544). Intervention: High TyG index and high non-HDL cholesterol vs. TyG index and non-HDL cholesterol below median. Primary outcome: First incident stroke (HR 1.76, 95% CI 1.41-2.20).

What question did this study set out to answer?

This research investigates how the triglyceride-glucose index and atherogenic cholesterol markers predict the risk of stroke.

June 14, 2026Open Access

Joint association of triglyceride-glucose index and atherogenic lipid markers with incident stroke risk

LYLaiang YaoUniversity of California, Irvine GSGuiling SunLinyi People's Hospital LZLanju ZhangLinyi People's Hospital

Key Result

High TyG index combined with high non-HDL cholesterol was associated with a significantly increased risk of incident stroke compared to having both markers below the median (HR 1.76).

Key Points

This research investigates how the triglyceride-glucose index and atherogenic cholesterol markers predict the risk of stroke.
Included 8,544 participants from the China Health and Retirement Longitudinal Study (CHARLS) with a mean age of 59 years.
Categorized participants based on median triglyceride-glucose index and cholesterol marker values, utilizing Cox proportional hazards models for analysis.
Employed receiver operating characteristic (ROC) curve analyses to examine predictive performance.
TyG index, non-HDL cholesterol, and remnant cholesterol are independently associated with increased stroke risk.
Participants with elevated levels of both TyG and non-HDL cholesterol had a stroke risk with HR of 1.76 (95% CI 1.41–2.20).
Adding these metabolic markers to traditional risk factors modestly improved stroke risk discrimination, with the highest AUC observed for combining TyG and non-HDL cholesterol.

Study Design

Type

Cohort (n=8,544)

Multicenter

Yes

Structured PICO

Do high triglyceride-glucose index and atherogenic lipid markers jointly increase the risk of incident stroke in middle-aged and older adults?

Population

8,544 middle-aged and older Chinese adults aged 45 years and older, free of prior stroke or heart disease, followed for a maximum of 9.0 years.

Exposure

High triglyceride-glucose (TyG) index and high atherogenic cholesterol markers (non-HDL cholesterol or remnant cholesterol) above median values

Comparator

Both TyG index and atherogenic cholesterol markers below median values

Outcome

First incident stroke during follow-up (ascertained through self-reported physician diagnosis)hard clinical

The combination of a high triglyceride-glucose index and high atherogenic cholesterol markers is independently and jointly associated with an increased risk of incident stroke, modestly improving risk discrimination beyond traditional risk factors.

Main Result

Hazard Ratio: 1.76 (95% CI 1.41–2.2)

Limitations

Observational design cannot establish causality.
Possibility of residual or unmeasured confounding, including lifestyle and unmeasured comorbidities.
Lack of detailed information on treatment changes, medication adherence, and interventions during follow-up.
Stroke events were ascertained via self-reported physician diagnosis, which may introduce recall bias and outcome misclassification.
Lack of detailed information on stroke subtype (ischemic vs. hemorrhagic), severity, and imaging confirmation.
Biomarkers were only assessed at baseline, not accounting for changes or trajectories over time.
Potential selection bias due to attrition from loss to follow-up.
Findings in Chinese adults aged ≥45 years may not generalize to younger individuals or other ethnic groups.

Abstract

Abstract The triglyceride-glucose (TyG) index and atherogenic cholesterol markers, including non-HDL cholesterol and remnant cholesterol, are significant predictors of atherosclerotic cardiovascular disease (ASCVD). However, the joint effects and predictive value of TyG and atherogenic cholesterol markers for incident stroke remain insufficiently understood. We included participants from the China Health and Retirement Longitudinal Study (CHARLS) enrolled at baseline in 2011 and followed them through 2020. Participants were categorized into four groups according to the median values of the TyG index and each cholesterol marker, with those having both values below the median serving as the reference group. Cox proportional hazards models were used to evaluate the independent and joint associations of TyG and atherogenic cholesterol markers with incident stroke. Restricted cubic spline models were applied to assess dose–response relationships, and receiver operating characteristic (ROC) curve analyses were used to examine predictive performance. A total of 8,544 participants were included (mean SD age 59.0 9.5 years; 52.1% female). 522 incident stroke events occurred during a maximum follow-up of 9.0 years. TyG, non-HDL cholesterol and remnant cholesterol were all independently associated with stroke risk. Compared with participants with both TyG and cholesterol markers below median, those with both markers above median had the greatest stroke risk in fully adjusted models (HR for high TyG and high non-HDL cholesterol: 1.76 95% CI 1.41–2.20; HR for high TyG and high remnant cholesterol: 1.45 95% CI 1.18–1.77). Adding TyG and each cholesterol marker to traditional risk factors modestly improved risk discrimination, with the model combining TyG and non-HDL cholesterol yielding the highest AUC. The TyG index and atherogenic cholesterol markers were independently and jointly associated with increased stroke risk among middle-aged and older adults. Adding these routinely available metabolic and lipid markers modestly improved discrimination for incident stroke.

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