Distinct Triglyceride-Glucose Trajectories are associated with Different Risks of Incident Cardiovascular Disease in Normal-Weight Adults

BackgroundRisk of cardiovascular disease (CVD) is increased in metabolically obese normal weight adults. However, we have limited knowledge of how to prevent CVD in normal-weight people. The triglyceride-glucose index (TyG index) has been considered as a contributor of CVD, while long-term patterns of the triglyceride-glucose index (TyG index) and their effects on CVD among normal-weight adults are poorly characterized. Therefore, this study aimed to identify TyG index trajectories in normal-weight adults and to determine their association with the risk of incident CVD.MethodsThis prospective cohort study included 40,473 normal-weight participants who were free of stroke and myocardial infarction prior to or in 2012. The TyG index was calculated as ln [fasting triglyceride (mg/dL)×fasting glucose (mg/dL)/2], and the TyG index trajectories during 2006-2012 were identified by latent mixture modeling. Cox proportional hazards models were used to examine the associations between TyG index trajectories and incident CVD.Results We identified five distinct TyG index trajectories according to TyG index range and changing pattern over time: low-stable (n=9,806; mean TyG index 7.84-7.93), moderate-stable (n=22,066; mean TyG index 8.43-8.52), elevated-decreasing (n=1,469; mean TyG index 9.83-8.75), moderate-increasing (n=5,842; mean TyG index 8.98-9.26), and elevated-stable (n=1,290; mean TyG index 9.91-10.07). During 6.74 years of follow-up, we documented 1,577 incident CVD events. Compared with the low-stable pattern, the highest risk of CVD was observed in the elevated-stable pattern (hazard ratio [HR], 2.24; 95% confidence interval [CI]: 1.73-2.90), followed by the moderate-increasing pattern (HR, 1.70; 95% CI, 1.43-2.04), the elevated-decreasing pattern (HR, 1.45; 95% CI, 1.11-1.89), and the moderate-stable pattern (HR, 1.25; 95% CI, 1.08-1.44). Similar results were also observed for stroke and myocardial infarction. Consistently, annual increment of the TyG index during 2006-2012 also predicted future risk of CVD.ConclusionsDistinct TyG index trajectories were significantly associated differently subsequent risk of CVD in normal-weight individuals. These observations suggested that long-term trajectories of TyG index may be useful for predicting CVD among normal-weight adults.