U-shaped association between the triglyceride-glucose index and atrial fibrillation incidence in general people without known cardiovascular disease

Objective: The triglyceride-glucose (TyG) index has been shown to bea new alternative measure for insulin resistance. However, no study has attempted to investigate the association of the TyG index with incident atrial fibrillation (AF) in the general population without known cardiovascular diseases. Methods: Individuals without known cardiovascular diseases (heart failure, coronary heart disease, or stroke) from the Atherosclerosis Risk in Communities (ARIC) cohort were recruited. The baseline TyG index was calculated as the Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. The association between the baseline TyG index and incident AF was examined using Cox regression. Results: Of 11,851 participants, the mean age was 54.0 years; 6586 (55.6%) were female. During a median follow-up of 24.26 years, 1925 incidents of AF cases (0.78/per 100 person-years) occurred. An increased AF incidence with a graded TyG index was found by Kaplan‒Meier curves ( P <0.001). In multivariable-adjusted analysis, both low (adjusted hazard ratio [aHR]=1.15, 95% confidence interval [CI] 1.02, 1.29) and high levels (aHR 1.18, 95% CI 1.03, 1.37) of the TyG index were associated with anincreased risk of AF compared with the middle TyG index category (8.80-9.20). The exposure-effect analysis confirmed the U-shaped association between the TyG index and AF incidence ( P =0.041). Further sex-specific analysis showedthat aU-shaped association between the TyG index and incident AF still existed in females but not in males. Conclusion: A U-shaped association between the TyG index and AF incidence was observed in Americans without known cardiovascular diseases. Sex may be a modifier in the association between the TyG index and AF incidence.