Associations of the TyG index, remnant cholesterol levels, and the severity of coronary artery disease: findings from a retrospective study

Q: What are the key findings of this study?

Patients with both a high triglyceride-glucose (TyG) index and high remnant cholesterol had significantly higher odds of multi-vessel coronary artery disease (OR 3.53) compared to those with low levels.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Coronary artery disease (n=592). Intervention: High TyG index and high remnant cholesterol vs. Low TyG index and low remnant cholesterol. Primary outcome: Multi-vessel coronary artery disease (OR 3.53, 95% CI 2.040-6.258, p=<0.001).

Q: What does this research mean for the field?

The triglyceride-glucose (TyG) index partially mediates the association between remnant cholesterol and coronary artery disease severity, and their combined elevation significantly increases the odds of multi-vessel disease. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate whether the triglyceride-glucose (TyG) index mediates the link between remnant cholesterol (RC) and coronary artery disease (CAD) severity, and to assess their joint association with multi-vessel disease.

Xi Meng; Yibo Duanmu; Xiaoyi Yu; Lu Liu; Cui Yuhui; Zhimin Chen; 纪桂元; Dantao Zhang; X H Yang; Xilong Liu; Wei Wu

doi:10.3389/fcvm.2026.1786243

June 19, 2026Frontiers in Cardiovascular MedicineOpen Access

Associations of the TyG index, remnant cholesterol levels, and the severity of coronary artery disease: findings from a retrospective study

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Key result

High TyG index and remnant cholesterol linked to ~253% higher odds of multi-vessel CAD.

OR 3.53
95% CI 2.040-6.258
P<0.001
n=592

Figures

Why the study?

Are the TyG index and remnant cholesterol levels associated with multi-vessel coronary artery disease in patients undergoing coronary angiography?

Key Points

To evaluate whether the triglyceride-glucose (TyG) index mediates the link between remnant cholesterol (RC) and coronary artery disease (CAD) severity, and to assess their joint association with multi-vessel disease.
Analyzed retrospective data from 592 CAD patients (64.7% male; mean age, 62 years) undergoing coronary computed tomography angiography (CCTA) or coronary angiography (CAG) between 2019 and 2022.
Categorized patients into single-vessel (N=263) or multi-vessel (N=329) CAD groups.
Assessed relationships using multivariate logistic regression adjusted for LASSO-selected variables, restricted cubic spline (RCS) modeling, and mediation analysis.
Each 1-SD increase in the TyG index was associated with higher odds of multi-vessel CAD (OR = 1.724; 95% CI, 1.323–2.247; P < 0.001), as was each 1-SD increase in RC (OR = 1.491; 95% CI, 1.024–2.171; P = 0.037).
Patients with both high TyG index and high RC had significantly greater odds of multi-vessel CAD compared with those with lower levels (OR = 3.53; 95% CI, 2.040–6.258; P < 0.001).
Mediation analysis revealed that the TyG index significantly mediated 33% of the association between RC levels and multi-vessel CAD (P = 0.024).

Study Design

Type

Cross-Sectional (n=592)

Multicenter

No

Structured PICO

Are the TyG index and remnant cholesterol levels associated with multi-vessel coronary artery disease in patients undergoing coronary angiography?

P

Population

592 patients with coronary artery disease (CAD) undergoing coronary computed tomography angiography (CCTA) or coronary angiography (CAG) between 2019 and 2022, mean age 62 years, 64.7% male.

I

Intervention

High triglyceride-glucose (TyG) index and high remnant cholesterol (RC) levels

C

Comparator

Lower TyG index and RC levels

O

Outcome

Multi-vessel coronary artery disease (CAD severity)surrogate

Main Result

Effect estimate: OR 3.53 (95% CI 2.040-6.258)

p-value: p=<0.001

Limitations

Retrospective cross-sectional design cannot establish causal relationships.
Single-center study involving hospitalized patients may introduce selection bias and limit generalizability.
Remnant cholesterol was calculated using a conventional formula rather than directly measured, which may introduce measurement error.
Potential residual and unmeasured confounding factors such as lifestyle behaviors and genetic susceptibility.
Subgroup and interaction analyses may have been underpowered in certain smaller strata.

Implication

The TyG index and remnant cholesterol are independently and synergistically associated with multi-vessel CAD, suggesting their combined assessment may improve metabolic risk stratification.

Abstract

Background This study aimed to investigate whether the triglyceride-glucose (TyG) index mediates the association between remnant cholesterol (RC) and coronary artery disease (CAD) severity and to evaluate their combined association with multi-vessel CAD. Methods In this retrospective study, anonymized data from CAD patients undergoing coronary computed tomography angiography (CCTA) or coronary angiography (CAG) between 2019 and 2022 were analyzed . Patients were classified into single-vessel or multi-vessel disease groups. Insulin resistance was estimated using the TyG index, and RC was calculated. Multivariate logistic regression, restricted cubic spline (RCS) modeling, and mediation analysis were utilized to explore the relationships among the TyG index, RC, and CAD severity. Results A total of 592 patients (64.7% male; mean age, 62 years) were included in the analysis. The TyG index was positively correlated with RC ( r = 0.52, P < 0.001). After adjustment for confounding factors, each 1-SD increase in the TyG index was associated with higher odds of multi-vessel CAD (OR = 1.724; 95% CI, 1.323–2.247; P < 0.001), and each 1-SD increase in the RC was similarly associated with higher odds of multi-vessel CAD (OR = 1.491; 95% CI, 1.024–2.171; P = 0.037). Patients with both high TyG index and high RC had significantly higher odds of multi-vessel CAD (OR = 3.53; 95% CI, 2.040–6.258; P < 0.001). Mediation analysis demonstrated that the TyG index mediated 33% of the association between RC and multi-vessel CAD. Conclusions The TyG index is positively correlated with RC and is significantly associated with CAD severity. Furthermore, the TyG index partially mediates the association between RC and CAD severity. Combined assessment of the TyG index and RC may improve metabolic risk stratification in patients with CAD.

Discussion

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Cite This Study

Meng et al. (2026) conducted a cross-sectional in Coronary artery disease (n=592). High TyG index and high remnant cholesterol vs. Low TyG index and low remnant cholesterol was evaluated on Multi-vessel coronary artery disease (OR 3.53, 95% CI 2.040-6.258, p=<0.001). Patients with both a high triglyceride-glucose (TyG) index and high remnant cholesterol had significantly higher odds of multi-vessel coronary artery disease (OR 3.53) compared to those with low levels.

synapsesocial.com/papers/6a3c233cd15afadd906f9e21 https://doi.org/10.3389/fcvm.2026.1786243

Topics

Coronary artery disease

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Associations of the TyG index, remnant cholesterol levels, and the severity of coronary artery disease: findings from a retrospective study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Associations of the TyG index, remnant cholesterol levels, and the severity of coronary artery disease: findings from a retrospective study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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