Development and validation of a cross-sectional risk screening nomogram for carotid plaque based on routine health examination data and the triglyceride-glucose-waist-to-hip ratio

Figures

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  Figure 1. The flowchart of this study.

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  Figure 2. Subgroup analyses of the associations between TyG/TyG-WHR and carotid plaque. (A) TyG index in the development cohort. (B) TyG-WHR index in the development cohort. (C) TyG index in the temporal validation cohort. (D) TyG-WHR index in the temporal validation cohort. Notes: All models were adjusted for sex, age, body mass index (BMI), history of hypertension, history of diabetes mellitus, systolic blood pressure (SBP), and diastolic blood pressure (DBP), except for the variable being stratified. The size of the square represents the sample size of each subgroup. P for interaction was calculated to test the heterogeneity of associations across subgroups. TyG, triglyceride-glucose index; TyG-WHR, triglyceride-glucose-waist-to-hip ratio index; OR, odds ratio; CI, confidence interval; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure.

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  Figure 3. Dose-response relationships between TyG/TyG-WHR and carotid plaque analyzed by restricted cubic splines. (A) Unadjusted TyG in the development cohort. (B) Unadjusted TyG-WHR in the development cohort. (C) Adjusted TyG in the development cohort. (D) Adjusted TyG-WHR in the development cohort. (E) Unadjusted TyG in the temporal validation cohort. (F) Unadjusted TyG-WHR in the temporal validation cohort. (G) Adjusted TyG in the temporal validation cohort. (H) Adjusted TyG-WHR in the temporal validation cohort. Adjusted models were controlled for sex, age, body mass index (BMI), history of hypertension, history of diabetes mellitus, systolic blood pressure (SBP), and diastolic blood pressure (DBP). The solid line represents the odds ratio (OR), and the shaded area indicates the 95% confidence interval. The reference value (OR=1) is set at the median of the index distribution. P for non-linearity tests the deviation from a linear relationship. TyG, triglyceride-glucose index; TyG-WHR, triglyceride-glucose-waist-to-hip ratio index; RCS, restricted cubic spline; OR, odds ratio; CI, confidence interval.

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  Figure 4. Discriminative performance of TyG and TyG-WHR for carotid plaque in the development cohort and temporal validation cohort. TyG, triglyceride-glucose index; TyG-WHR, triglyceride-glucose-waist-to-hip ratio index; AUC, area under the receiver operating characteristic curve; CI, confidence interval.

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  Figure 5. Correlation heatmap of selected variables and feature selection process based on Recursive Feature Elimination (RFE). (A) Correlation Heatmap of Selected Variables. (B) Recursive Feature Elimination (RFE) Process and Feature Contribution. RFE, Recursive Feature Elimination.

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  Figure 6. Assessment of model performance on the validation set and temporal validation set. (A) Receiver Operating Characteristic (ROC) curves on the Validation Cohort. (B)Calibration curves on the Validation Cohort. (C) Decision Curve Analysis (DCA) on the Validation Cohort. (D) Receiver Operating Characteristic (ROC) curves on the Temporal validation set. (E) Calibration curves on the Temporal validation set. (F) Decision Curve Analysis (DCA) on the Temporal validation set. AUC, area under the curve; CI, confidence interval; XGBoost,eXtreme Gradient Boosting; LightGBM,Light Gradient Boosting Machine; SVM, support vector machine; ANN, artificial neural network.

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  Figure 7. Nomogram for estimating the probability of prevalent carotid plaque. (A) Nomogram for estimating the probability of prevalent carotid plaque based on eight routinely available variables. To use the nomogram, locate a variable’s value on its corresponding axis, draw a vertical line upward to the “Points” axis to obtain the score for that variable, repeat for all eight variables, sum all scores to obtain the total points, and then read the corresponding estimated probability from the “Risk of Outcome” axis. The predicted probability reflects the likelihood of currently having carotid plaque, not the risk of developing future plaque. SBP, systolic blood pressure (mmHg); TyG-WHR, triglyceride-glucose-waist-to-hip ratio; FIB, fibrinogen (g/L); UA, uric acid (μmol/L); eGFR, estimated glomerular filtration rate (mL/min/1.73 m2); MHR, monocyte-to-HDL cholesterol ratio; CHO, total cholesterol (mmol/L).