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September 17, 2026BMC Cardiovascular DisordersOpen Access

Predictive value of triglyceride-glucose-related indices for major adverse cardiovascular events in individuals with cardiovascular-kidney-metabolic syndrome stage 0–3: a prospective cohort study based on CHARLS

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Key result

Higher TyG-CVAI index linked to ~21% greater non-fatal MI and stroke risk in early-stage CKM syndrome.

  • HR 1.21
  • 95% CI 1.12-1.31
  • P<0.001
  • n=6,782

Why the study?

Simple risk stratification tools for individuals with early-stage cardiovascular-kidney-metabolic syndrome (stages 0–3) remain limited despite the critical early intervention window.

Population

6,782 participants aged ≥ 45 years with CKM stages 0–3 from CHARLS

Comparison

Comparison of 7 triglyceride-glucose-derived indices for predicting MACE

Design

Prospective cohort study

Follow-up

Median 7 years

Authors

ZZZhe ZhangXLXiupeng Long

Discussion

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Implication

Prospective cohort study reveals triglyceride-glucose indices predict adverse cardiac events in early cardiovascular-kidney-metabolic syndrome, highlighting their value for risk stratification.

Key Points

  • To evaluate and compare the predictive performance of seven triglyceride-glucose-derived indices for major adverse cardiovascular events and identify mediating biological pathways in early-stage cardiovascular-kidney-metabolic syndrome.
  • Prospective cohort analysis of 6,782 participants aged ≥ 45 years with stage 0–3 cardiovascular-kidney-metabolic syndrome from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2018) followed for a median of 7 years.
  • Evaluated seven triglyceride-glucose-derived indices using multivariable Cox proportional hazards models, integrated discrimination improvement (IDI), continuous net reclassification improvement (cNRI), and counterfactual mediation analysis.
  • During follow-up, 1,441 major adverse cardiovascular events occurred, with TyG-CVAI showing favorable discriminative performance for composite events (C-statistic = 0.639, IDI = 0.0025, cNRI = 0.092).
  • TyG-CVAI was independently associated with non-fatal myocardial infarction (HR = 1.21, 95% CI 1.12–1.31, P < 0.001) and non-fatal stroke (HR = 1.30, 95% CI 1.15–1.46, P < 0.001), whereas CTI most strongly predicted all-cause mortality (HR = 1.55, 95% CI 1.25–1.91, P < 0.001).
  • Systolic blood pressure mediated 14.5%–23.4% of the association between the indices and cardiovascular outcomes, alongside modest but consistent mediation by C-reactive protein across six indices.

Study Design

Type

Cohort (n=6,782)

Multicenter

Yes

PICO

P
Population
6,782 Chinese adults aged ≥ 45 years with early-stage cardiovascular-kidney-metabolic syndrome (stages 0-3), followed for a median of 7 years.
E
Exposure / Comparator
Triglyceride-glucose (TyG)-derived indices
O
Primary Outcome
non-fatal myocardial infarction — HR 1.21 (1.12-1.31), p=<0.001

Main Result

Hazard Ratio: 1.21 (95% CI 1.12–1.31)

p-value: p=<0.001

Cite This Study

Zhang et al. (2026) conducted a cohort in Cardiovascular-kidney-metabolic (CKM) syndrome stage 0-3 (n=6,782). Triglyceride-glucose (TyG)-derived indices was evaluated on non-fatal myocardial infarction (HR 1.21, 95% CI 1.12-1.31, p=<0.001). The TyG-CVAI index was independently associated with non-fatal myocardial infarction (HR 1.21; 95% CI 1.12-1.31; P<0.001) and non-fatal stroke in adults with early-stage CKM syndrome.

synapsesocial.com/papers/6aabb61e5f706d05830e4968https://doi.org/10.1186/s12872-026-06605-y
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Relationship between nine triglyceride-glucose-related indices and cardiometabolic multimorbidity incidence in patients with cardiovascular-kidney-metabolic syndrome stage 0–3: a nationwide prospective cohort study2026 · 23 citations
  2. 2Comparative analysis of 16 baseline obesity and lipid-related indices for cardiovascular disease risk prediction in adults with cardiovascular-kidney-metabolic syndrome stages 0–3: a nationwide prospective cohort study2025 · 14 citations
  3. 3Comparison of triglyceride-glucose index and triglyceride-glucose related indexes in predicting cardiovascular disease incidence among populations with cardiovascular-kidney-metabolic syndrome stages 0-3: a nationwide prospective cohort study2025 · 13 citations
  4. 4Optimizing early triage for subclinical cardiovascular-kidney-metabolic syndrome: longitudinal associations, incremental value, and clinical utility of nine insulin resistance surrogates2026 · 2 citations
  5. 5Association between triglyceride-glucose-related indices and cardiovascular disease risk in population with cardio-kidney-metabolic syndrome stages 0–3: a systematic review and meta-analysis2026