Comparative associations of the TyG index and METS-IR with arterial stiffness in women: a cross-sectional analysis by menopausal status

Objective To compare the cross-sectional associations of the triglyceride–glucose (TyG) index and the metabolic score for insulin resistance (METS-IR) with brachial–ankle pulse wave velocity (baPWV) in women and to examine whether these associations differed by menopausal status. Methods This cross-sectional secondary analysis included 306 women (134 premenopausal and 172 postmenopausal). baPWV was analyzed as a continuous measure of arterial stiffness. Associations with TyG and METS-IR were examined using Pearson correlation, restricted cubic splines, and multivariable linear regression; the primary adjusted model included age, menopausal status, systolic blood pressure, uric acid, LDL-C, and eGFR and omitted BMI because BMI is a component of METS-IR. Exploratory ROC analyses compared the discrimination of covariate-adjusted TyG and METS-IR models for elevated baPWV (≥1400 cm/s) using the DeLong test. Sensitivity and menopausal-status subgroup analyses were also performed. Results Both METS-IR and TyG were positively correlated with baPWV in unadjusted analyses. After adjustment for menopausal status, age, SBP, uric acid, LDL-C, and eGFR, METS-IR remained associated with baPWV (β = 4.72, 95% CI 1.03–8.41, P = 0.012), whereas TyG did not (β = 26.66, 95% CI −11.49–64.81, P = 0.170). In stratified analyses, METS-IR was associated with baPWV in postmenopausal women (β = 5.68, 95% CI 0.74–10.61, P = 0.025) but not in premenopausal women (β = 4.16, 95% CI −1.22–9.53, P = 0.128); however, the interaction was not significant (P for interaction = 0.722). The TyG and METS-IR models showed similar exploratory discrimination for elevated arterial stiffness (AUC 0.831 vs 0.834; DeLong P = 0.331). Conclusion In this cross-sectional dataset of women, METS-IR retained an adjusted association with baPWV, whereas the corresponding association for TyG was not statistically significant. Menopausal status did not significantly modify either association. The TyG and METS-IR models showed similar exploratory discrimination for elevated baPWV. Prospective external studies are needed to assess temporal associations and clinical utility.