Comprehensive analysis of the association between triglyceride-glucose index and coronary artery disease severity across different glucose metabolism states: a large-scale cross-sectional study from an Asian cohort

• Published in: Cardiovascular diabetology Vol. 23; no. 1; pp. 251 - 18
• Main Authors: Zhao, Sheng, Wang, Zuoxiang, Qing, Ping, Li, Minghui, Liu, Qingrong, Pang, Xuejie, Wang, Keke, Gao, Xiaojin, Zhao, Jie, Wu, Yongjian
• Format: Journal Article
• Language: English
• Published: England BioMed Central 13-07-2024; BMC
• Subjects: Aged; Antidiabetics; Antihypertensives; Asian People; Biomarkers; Biomarkers - blood; Blood Glucose - metabolism; Blood pressure; Blood tests; Body mass index; Cardiovascular disease; Cholesterol; Clinical outcomes; Coronary artery disease; Coronary Artery Disease - blood; Coronary Artery Disease - diagnosis; Coronary Artery Disease - epidemiology; Coronary vessels; Cross-Sectional Studies; Diabetes; Diabetes mellitus; Diabetes Mellitus - blood; Diabetes Mellitus - diagnosis; Diabetes Mellitus - epidemiology; Dose-response effects; Drugs; Female; Glucose; Glucose metabolism; Glucose metabolism state; Glycated Hemoglobin - metabolism; Heart diseases; Hemoglobin; High density lipoprotein; Hospitals; Humans; Hypertension; Hypoglycemic Agents - therapeutic use; Insulin; Insulin - blood; Insulin - therapeutic use; Insulin resistance; Lipoproteins; Male; Medical imaging; Metabolic disorders; Middle Aged; Population; Prediabetic State - blood; Prediabetic State - diagnosis; Prediabetic State - epidemiology; Predictive Value of Tests; Prognosis; Prospective Studies; Regression analysis; Risk Assessment; Risk Factors; Sensitivity analysis; Severity of Illness Index; Triglyceride-glucose index; Triglycerides; Triglycerides - blood; Vein & artery diseases; China; Triglyceride-glucose index; Glucose metabolism state; Coronary artery disease; Diabetes mellitus
• ISSN: 1475-2840; 1475-2840
• DOI: 10.1186/s12933-024-02355-3

The triglyceride-glucose (TyG) index is associated with the development and prognosis of coronary artery disease (CAD). However, the impact of the TyG index on CAD severity across different glucose metabolism states exhibits significant disparities in previous research.
This cross-sectional study comprised 10,433 participants from a prospective cohort. Participants were categorized into four groups based on glucose metabolism state: normal glucose regulation (NGR), prediabetes (pre-DM), diabetes mellitus (DM) without insulin prescribed (Rx), and DM with insulin Rx. The TyG index was determined by the following formula: Ln [TG (mg/dL) × FPG (mg/dL) / 2], where TG is triglycerides and FPG is fasting plasm glucose. Statistical methods such as binary logistic regression, interaction analysis, restricted cubic spline (RCS), and receiver operating characteristic (ROC) were employed to analyze the relationship between the TyG index and CAD severity across the entire population and glucose metabolism subgroups. Mediation analysis was conducted to examine the mediating effects of glycated hemoglobin (HbA1c) on these relationships. Sensitivity analysis was performed to ensure the robustness of the findings.
Multivariable logistic regression analysis revealed a significant positive association between the TyG index and multi-vessel CAD in the entire population (OR: 1.34; 95% CI: 1.22-1.47 per 1-unit increment). Subgroup analysis demonstrated consistent positive associations in the NGR, pre-DM, and DM non-insulin Rx groups, with the highest OR observed in the NGR group (OR: 1.67; 95% CI: 1.3-2.14 per 1-unit increment). No correlation was found in the DM with insulin Rx subgroup. RCS analyses indicated the distinct dose-response relationships across different glucose metabolism subgroups. Including the TyG index in the established model slightly improved the predictive accuracy, particularly in the NGR group. Mediation analyses showed varying mediating effects of HbA1c among different glucose metabolism subgroups. Sensitivity analysis confirmed the robustness of the aforementioned relationships in the new-onset CAD population and in individuals not using antilipidemic medications.
The TyG index positively associated with CAD severity across all glucose metabolism states, except for individuals receiving insulin treatment. Moreover, it might serve as a supplementary noninvasive predictor of CAD severity in addition to established factors, especially in NGR patients.