May 13, 2019Open Access

The role of the triglyceride (triacylglycerol) glucose index in the development of cardiovascular events: a retrospective cohort analysis

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiovascular disease (n=6078). Intervention: Triglyceride glucose (TyG) index (Quartile 4) vs. Triglyceride glucose (TyG) index (Quartile 1). Primary outcome: Cardiovascular disease (CVD) events (SHR 1.72, 95% CI 1.37-2.16, p=<0.001).

Key Result

The highest quartile of the triglyceride glucose index was associated with a significantly increased risk of cardiovascular disease events compared to the lowest quartile (SHR 1.72).

Study Design

Type

Cohort (n=6,078)

Multicenter

Yes

PICO

Population

Cardiovascular disease (n=6,078)

Intervention / Comparator

Triglyceride glucose (TyG) index (Quartile 4) vs Triglyceride glucose (TyG) index (Quartile 1)

Primary Outcome

Cardiovascular disease (CVD) events — SHR 1.72 (1.37-2.16), p=<0.001

Main Result

Effect estimate: SHR 1.72 (95% CI 1.37-2.16)

Absolute Event Rate: 18.37% vs 7.94%

p-value: p=<0.001

Limitations

Cannot exclude influence due to unmeasured and residual confounding variables
Did not measure insulin levels to generate a homeostatic model assessment (HOMA) or assess glucose tolerance
Recall error in self-reported confounders
Lack of information on history of lipid-lowering therapy or antidiabetic drugs
Missing follow-up data may affect statistical power or bias the findings

Abstract

This study aimed to evaluate the role of the triglyceride (triacylglycerol) glucose (TyG) index in predicting and mediating the development of cardiovascular disease (CVD). This cohort study included 6078 participants aged over 60 years who participated in a routine health check-up programme from 2011 to 2017. The competing risk model, cox regression model and multimediator analyses were performed. TyG was calculated as ln fasting triglyceride (mg/dl) × fasting plasma glucose (mg/dl)/2. During a median 6 years of follow-up, 705 (21.01/1000 person-years) CVD events occurred. In fully adjusted analyses, quartiles 3 and 4 versus quartile 1 of TyG index (adjusted subhazard ratios SHRs 1.33 95% CI: 1.05-1.68 and 1.72 1.37-2.16) were associated with an increased risk of CVD events. The continuous time-dependent TyG remained significant in predicting CVD events (adjusted hazard ratios HR 1.43 1.24-1.63). The adverse estimated effects of body mass index (BMI) or resting heart rate (RHR) on CVD mediated through the joint effect of the baseline and follow-up TyG index. In addition, an effect mediated only through the follow-up TyG existed (P < 0.05). Thus, it is necessary to routinely measure the TyG. The TyG index might be useful for predicting CVD events in clinical practice.

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