Independent association between the triglyceride-glucose index and mild mitral annular calcification in a cardiometabolic population

Background Mitral annular calcification (MAC) is no longer regarded as a purely degenerative finding but as a manifestation of systemic cardiometabolic and atherosclerotic burden. Insulin resistance may represent a key pathophysiological driver of early valvular remodeling. The Triglyceride-Glucose (TyG) index is an established surrogate of insulin resistance, yet its relationship with early-stage MAC remains poorly characterized. Purpose To investigate the association between the TyG index and the presence of mild MAC in a cardiometabolic clinical setting. Methods This prospective study included 205 consecutive patients undergoing transthoracic echocardiography. Clinical and metabolic parameters were collected, and the TyG index was calculated from fasting triglyceride and glucose levels. Associations were evaluated using correlation analysis, ROC curves, and logistic regression adjusted for age, sex, BMI, hypertension, type 2 diabetes mellitus (T2D), and statin therapy. Results Among 205 patients, 134 (65.4%) had mild MAC and 71 (34.6%) had no MAC. Patients with MAC were significantly older (65.1 ± 11.8 vs. 57.2 ± 14.7 years; p < 0.001), had higher body mass index (30.7 ± 5.5 vs. 28.7 ± 5.3 kg/m2), and greater waist circumference (105.3 ± 17.4 vs. 99.0 ± 18.7; p = 0.021). Glycemic disturbances were significantly more prevalent in the MAC group: prediabetes was present in 54.4% vs. 43.7%, and T2D in 16.4% vs. 5.6% (p=0.004). TyG values were significantly elevated in the MAC group (8.69 ± 0.52 vs. 8.39 ± 0.56; p<0.001) and correlated with MAC presence (ρ = 0.234; p=0.007). ROC analysis demonstrated moderate discriminative performance (AUC = 0.642; optimal cutoff 8.33; sensitivity 77.6%). In unadjusted logistic regression, TyG was associated with MAC (OR=2.59; 95% CI 2.26 – 2.97). Importantly, the association remained independent after multivariable adjustment (OR=2.01; 95% CI 1.53 – 2.65), with good overall model performance (AUC = 0.755). Conclusions Mild MAC is closely associated with an insulin resistance-driven cardiometabolic phenotype. The TyG index independently correlates with early valvular structural remodeling, supporting the concept that MAC may represent a metabolic-inflammatory continuum rather than a purely age-related process. TyG may serve as a simple tool for early risk stratification and targeted preventive strategies.ROC Curve of TyG Index In Patients With MACMultivariable Logistic Regression for MAC