What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Atrial Fibrillation (n=6171). Intervention: Triglyceride-glucose (TyG) index vs. Non-AF cases. Primary outcome: TyG levels between AF and non-AF cases (SMD 1.23, 95% CI 0.71 to 1.75, p=<0.001).

February 12, 2024Open Access

Assessing the association between triglyceride-glucose index and atrial fibrillation: a systematic review and meta-analysis

Q: What are the key findings of this study?

The triglyceride-glucose index was significantly higher in patients with atrial fibrillation compared to non-AF counterparts (SMD 1.23).

Key Result

The triglyceride-glucose index was significantly higher in patients with atrial fibrillation compared to non-AF counterparts (SMD 1.23).

Study Design

Type

Meta-Analysis (n=6,171)

Structured PICO

Is a higher triglyceride-glucose (TyG) index associated with atrial fibrillation incidence and recurrence in adults?

Population

6,171 adults (>18 years) from 9 observational studies, including 886 with atrial fibrillation (AF) and 5,285 without AF. Mean age 63.46 in AF group and 56.81 in non-AF group.

Intervention

High triglyceride-glucose (TyG) index

Comparator

Low triglyceride-glucose (TyG) index or non-AF counterparts

Outcome

Difference in TyG levels between AF and non-AF cases, AF recurrence after radiofrequency ablation, and post-procedural AFsurrogate

The TyG index, an easy-to-measure surrogate marker of insulin resistance, is significantly higher in patients with AF and is associated with post-procedural AF and post-ablation AF recurrence.

Main Result

Effect estimate: SMD 1.23 (95% CI 0.71 to 1.75)

p-value: p=<0.001

Limitations

High heterogeneity was observed in the analysis
Low number of included studies
Different AF definitions and follow-up durations across studies
Different cut-off values for the TyG index across the included studies
Observational nature of the included studies prevents drawing causal conclusions

Abstract

Abstract Background An essential relationship between insulin resistance (IR) and atrial fibrillation (AF) has been demonstrated. Among the methods used to assess IR, the triglyceride-glucose (TyG) index is the more straightforward, dimensionless, and low-cost tool. However, the possible usage of this index in clinical practice to predict and diagnose AF has yet to be determined and consolidated. Objective and rationale Herein, we performed a systematic review and meta-analysis to assess the association between the TyG index and AF. Methods Databases (PubMed, Embase, Scopus, and Web of Science) were systematically searched for studies evaluating the TyG index in AF. The inclusion criteria were observational studies investigating AF and TyG index correlation in individuals older than 18 years, while preclinical studies and those without the relevant data were excluded. Random effect meta-analyses comparing TyG levels between AF and non-AF cases, AF recurrence after radiofrequency ablation, and post-procedural AF were performed using standardized mean differences (SMD) with their matching 95% confidence intervals (CIs). Results Our screening identified nine studies to be analyzed, including 6,171 participants including 886 with AF. The meta-analysis demonstrated that the TyG index resulted higher in patients with AF than non-AF counterparts (SMD 1.23, 95% CI 0.71 to 1.75, I 2 98%, P < 0.001). Subgroup analysis showed the same results for post-procedure AF (SMD 0.99, 95% CI 0.78 to 1.20, I 2 10%, P < 0.001) and post-ablation AF (SMD 1.25, 95% CI 1.07 to 1.43, I 2 46%, P < 0.001), while no difference was found in population-based cohorts (SMD 1.45, 95% CI − 0.41 to 3.31, I 2 100%, P = 0.13). Publication year ( P = 0.036) and sample size ( P = 0.003) showed significant associations with the effect size, using multivariable meta-regression. Conclusion The TyG index is an easy-to-measure surrogate marker of IR in patients with AF. Further clinical studies are warranted to demonstrate its ability for routine clinical use and as a screening tool.

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