Associations between an insulin resistance guide, the triglyceride glucose index (TyG) and subclinical atherosclerosis progression in a coronary population

Abstract Background Insulin resistance (IR), with its myriad proatherogenic effects, is a relevant risk factor for atherosclerosis. The triglyceride-glucose index (TyG) is a marker of IR and subclinical atherosclerosis. Its potential in coronary artery disease (CAD) prognostic assessment has little been explored, but the evidence suggests significant potential. Aim Investigate the association between an IR index, triglyceride-glucose index (TyG), and cardiovascular and non-vascular events in a coronary population. Methods We included 1719 coronary patients with at least 70% stenosis in one or more main coronary arteries or their primary branches after coronary angiography. These patients were in the stabilized phase after an appropriate interventional approach (angioplasty with coronary stenting), coronary artery bypass graft (CABG) surgery and suitable medical therapy despite some residual Ischemia. Cardiovascular (CV) events and non-CV mortality were registered throughout an extended follow-up (average 7.3±6.0 years). TyG was calculated through the formula lnTriglyceride mg/dl*fast blood glucose (FBG) mg/dl)/2, which was subsequently stratified into terciles. All analyses were performed using the TyG 3rd tercile relative to the 1st. Bivariate analysis evaluated its association with other markers: pulse wave velocity (PWV), fibrinogen, high sensitivity C reactive protein (hsCRP), and clinical variables. A multivariate Cox regression analysis assessed the variables associated with total events. Results TyG was associated with PWV (p0.0001), hsCRP (p0.0001), kidney failure (p0.0001), peripheral vascular disease (p0.0001), stroke (p0.0001), CV events (p=0.001), and total events (p0.0001) in bivariate analysis. After Cox analysis adjusted to age, gender, diabetes, dyslipidemia, hypertension, smoking, alcohol300/week, obesity, sedentary lifestyle, hsCRP, fibrinogen, lipoprotein(a), PWV and TyG index, this marker remained as a significant and independent risk factor for total events (HR=1.19; p=0.020), together with age (p=0.001), sedentary lifestyle (p0.0001) and hsCRP (p0.0001). Conclusion TyG index, cheap and easy to determine, was strongly associated with residual inflammation, atherosclerosis progression, CV events and mortality. Early identification of patients with higher TyG indices before deleterious events occur may be valuable for predicting disease progression in high-risk patients, allowing timely adoption of appropriate preventive measures.