Triglyceride-glucose index predicts adverse cardiovascular events in patients with diabetes and acute coronary syndrome

Le Wang, Hong-Liang Cong, Jing-Xia Zhang, Yue-Cheng Hu, Ao Wei, Ying-Yi Zhang, Hua Yang, Li-Bin Ren, Wei Qi, Wen-Yu Li, Rui Zhang, Jing-Han Xu, Le Wang, Hong-Liang Cong, Jing-Xia Zhang, Yue-Cheng Hu, Ao Wei, Ying-Yi Zhang, Hua Yang, Li-Bin Ren, Wei Qi, Wen-Yu Li, Rui Zhang, Jing-Han Xu

Abstract

Background: The triglyceride-glucose index (TyG index) has been regarded as a reliable alternative marker of insulin resistance and an independent predictor of cardiovascular outcomes. Whether the TyG index predicts adverse cardiovascular events in patients with diabetes and acute coronary syndrome (ACS) remains uncertain. The aim of this study was to investigate the prognostic value of the TyG index in patients with diabetes and ACS.

Methods: A total of 2531 consecutive patients with diabetes who underwent coronary angiography for ACS were enrolled in this study. Patients were divided into tertiles according to their TyG index. The primary outcomes included the occurrence of major adverse cardiovascular events (MACEs), defined as all-cause death, non-fatal myocardial infarction and non-fatal stroke. The TyG index was calculated as the ln (fasting triglyceride level [mg/dL] × fasting glucose level [mg/dL]/2).

Results: The incidence of MACE increased with TyG index tertiles at a 3-year follow-up. The Kaplan-Meier curves showed significant differences in event-free survival rates among TyG index tertiles (P = 0.005). Multivariate Cox hazards regression analysis revealed that the TyG index was an independent predictor of MACE (95% CI 1.201-1.746; P < 0.001). The optimal TyG index cut-off for predicting MACE was 9.323 (sensitivity 46.0%; specificity 63.6%; area under the curve 0.560; P = 0.001). Furthermore, adding the TyG index to the prognostic model for MACE improved the C-statistic value (P = 0.010), the integrated discrimination improvement value (P = 0.001) and the net reclassification improvement value (P = 0.019).

Conclusions: The TyG index predicts future MACE in patients with diabetes and ACS independently of known cardiovascular risk factors, suggesting that the TyG index may be a useful marker for risk stratification and prognosis in patients with diabetes and ACS.

Keywords: Acute coronary syndrome; Cardiovascular events; Diabetes; Triglyceride-glucose index.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan–Meier survival curve for MACE (major adverse cardiovascular events) across TyG index tertiles

References

    1. Norhammar A, Malmberg K, Diderholm E, Lagerqvist B, Lindahl B, Rydén L, Wallentin L. Diabetes mellitus: the major risk factor in unstable coronary artery disease even after consideration of the extent of coronary artery disease and benefits of revascularization. J Am Coll Cardiol. 2004;43(4):585–591.
    1. Zhou M, Liu J, Hao Y, Liu J, Huo Y, Smith SC, Ge J, Ma C, Han Y, Fonarow GC, Taubert KA, Morgan L, Yang N, Xing Y, Zhao D, CCC-ACS Investigators Prevalence and in-hospital outcomes of diabetes among patients with acute coronary syndrome in China: findings from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome Project. Cardiovasc Diabetol. 2018;17(1):147.
    1. Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, Neumann FJ, Ardissino D, De Servi S, Murphy SA, Riesmeyer J, Weerakkody G, Gibson CM, Antman EM, TRITONTIMI 38 Investigators Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007;357(20):2001–2015.
    1. Cannon CP, Blazing MA, Giugliano RP, McCagg A, White JA, Theroux P, Darius H, Lewis BS, Ophuis TO, Jukema JW, De Ferrari GM, Ruzyllo W, De Lucca P, lm K, Bohula EA, Reist C, et al. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med. 2015;372(25):2387–2397.
    1. Du T, Yuan G, Zhang M, Zhou X, Sun X, Yu X. Clinical usefulness of lipid ratios, visceral adiposity indicators, and the triglycerides and glucose index as risk markers of insulin resistance. Cardiovasc Diabetol. 2014;13:146.
    1. Navarro-Gonzalez D, Sanchez-Inigo L, Pastrana-Delgado J, Fernandez Montero A, Martinez JA. Triglyceride-glucose index (TyG index) in comparison with fasting plasma glucose improved diabetes prediction in patients with normal fasting glucose: the vascular-metabolic CUN cohort. Prev Med. 2016;86:99–105.
    1. Vasques AC, Novaes FS, de Oliveira MD, Souza JR, Yamanaka A, Pareja JC, Tambascia MA, Saad MJ, Geloneze B. TyG index performs better than HOMA in a Brazilian population: A hyperglycemic clamp validated study. Diabetes Res. Clin. Pract. 2011;93(3):98–100.
    1. Lee SH, Kwon HS, Park YM, Ha HS, Jeong SH, Yang HK, Lee JH, Yim HW, Kang MI, Lee WC, Son HY, Yoon KH. Predicting the development of diabetes using the product of triglycerides and glucose: the Chungju Metabolic Disease Cohort (CMC) study. PLoS ONE. 2014;9(2):e9043.
    1. Da SA, Caldas A, Hermsdorf H, et al. Triglyceride-glucose index is associated with symptomatic coronary artery disease in patients in secondary care. Cardiovasc Diabetol. 2019;18(1):89.
    1. Irace C, Carallo C, Scavelli FB, De Franceschi MS, Esposito T, Tripolino C, Gnasso A. Markers of insulin resistance and carotid atherosclerosis. A comparison of the homeostasis model assessment and triglyceride glucose index. Int J Clin Pract. 2013;67:665–672.
    1. Jian S, Su-Mei N, Xue C, Jie Z, Xue-sen W. Association and interaction between triglyceride–glucose index and obesity on risk of hypertension in middle-aged and elderly adults. Clin Exp Hypertens. 2017;39:732–739.
    1. Angoorani P, Heshmat R, Ejtahed HS, Motlagh ME, Ziaodini H, Taheri M, Aminaee T, Goodarzi A, Qorbani M, Kelishadi R. Validity of triglycerideglucose index as an indicator for metabolic syndrome in children and adolescents: the CASPIAN-V study. Eat Weight Disord. 2018;23:877–883.
    1. Lee SB, Ahn CW, Lee BK, Kang S, Nam JS, You JH, et al. Association between triglyceride glucose index and arterial stifness in Korean adults. Cardiovasc Diabetol. 2018;17:41.
    1. Lambrinoudaki I, Kazani MV, Armeni E, Georgiopoulos G, Tampakis K, Rizos D, et al. The TyG index as a marker of subclinical atherosclerosis and arterial stifness in lean and overweight postmenopausal women. Hear Lung Circ. 2018;27:716–724.
    1. Park K, Ahn CW, Lee SB, Kang S, Nam JS, Lee BK, Kim JH, Park JS. Elevated TyG Index Predicts Progression of Coronary Artery Calcification. Diabetes Care. 2019;42(8):1569–1573.
    1. Jin JL, Cao YX, Wu LG, You XD, Guo YL, Wu NQ, Zhu CG, Gao Y, Dong QT, Zhang HW, Sun D, Liu G, Dong Q, Li JJ. Triglyceride glucose index for predicting cardiovascular outcomes in patients with coronary artery disease. J Thorac Dis. 2018;10(11):6137–6146.
    1. Mao Q, Zhou D, Li Y, Wang Y, Xu SC, Zhao XH. The Triglyceride-glucose index predicts coronary artery disease severity and cardiovascular outcomes in patients with non-ST-segment elevation acute coronary syndrome. Dis Markers. 2019;2019:6891537.
    1. Luo E, Wang D, Yan G, Qiao Y, Liu B, Hou J, Tang C. High triglyceride–glucose index is associated with poor prognosis in patients with acute ST-elevation myocardial infarction after percutaneous coronary intervention. Cardiovasc Diabetol. 2019;18(1):150.
    1. Jin JL, Sun D, Cao YX, Guo YL, Wu NQ, Zhu CG, Gao Y, Dong QT, Zhang HW, Liu G, Dong Q, Li JJ. Triglyceride glucose and hemoglobin glycation index for predicting outcomes in diabetes patients with new-onset, stable coronary artery disease: a nested case–control study. Ann Med. 2018;50:7.
    1. Sanchez-Inigo L, Navarro-Gonzalez D, Fernandez-Montero A, Pastrana-Delgado J, Martinez JA. The TyG index may predict the development of cardiovascular events. Eur J Clin Invest. 2016;46(2):189–197.
    1. Li S, Guo B, Chen H, Shi Z, Li Y, Tian Q, Shi S. The role of the triglyceride (triacylglycerol) glucose index in the development of cardiovascular events: a retrospective cohort analysis. Sci Rep. 2019;9(1):7320.
    1. Chamroonkiadtikun P, Ananchaisarp T, Wanichanon W. The triglyceride-glucose index, a predictor of type 2 diabetes development: A retrospective cohort study. Prim Care Diabetes. 2019;14(2):161–167.
    1. Low S, Khoo KCJ, Irwan B, Sum CF, Subramaniam T, Lim SC, Wong TKM. The role of triglyceride glucose index in development of Type 2 diabetes mellitus. Diabetes Res Clin Pract. 2018;143(9):43–49.
    1. Lee SH, Kwon HS, Park YM, Ha HS, Jeong SH, Yang HK, Lee JH, Yim HW, Kang MI, Lee WC, Son HY, Yoon KH. Predicting the development of diabetes using the product of triglycerides and glucose: the Chungju Metabolic Disease Cohort (CMC) study. PLoS ONE. 2014;9(2):e90430.
    1. Ma XT, Dong LS, Shao QY, Cheng YJ, Lv S, Sun Y, Shen H, Wang ZJ, Zhou YJ, Liu XL. Triglyceride glucose index for predicting cardiovascular outcomes after percutaneous coronary intervention in patients with type 2 diabetes mellitus and acute coronary syndrome. Cardiovasc Diabetol. 2020;19(1):31.
    1. Fox KA, Dabbous OH, Goldberg RJ, Pieper KS, Eagle KA, van de Werf F, Avezum A, Goodman SG, Flather MD, Anderson FA, Jr, Granger CB. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE) BMJ. 2006;333(7578):1091.
    1. Laakso M, Kuusisto J. Insulin resistance and hyperglycaemia in cardiovascular disease development. Nat Rev Endocrinol. 2014;10(5):293.
    1. Nishimura M, Tokoro T, Nishida M, Hashimoto T, Kobayashi H, Yamazaki S, Imai R, Okino K, Takahashi H, Ono T. Association of insulin resistance with de novo coronary stenosis after percutaneous coronary artery intervention in hemodialysis patients. Nephron Clin Pract. 2008;109(1):c9–c17.
    1. Uetani T, Amano T, Harada K, Kitagawa K, Kunimura A, Shimbo Y, Harada K, Yoshida T, Kato B, Kato M, Marui N, Nanki M, Hotta N, Ishii H, Matsubara T, Murohara T. Impact of insulin resistance on post-procedural myocardial injury and clinical outcomes in patients who underwent elective coronary interventions with drug-eluting stents. JACC Cardiovasc Interv. 2012;5(11):1159–1167.
    1. Robins SJ, Rubins HB, Faas FH, Schaefer EJ, Elam MB, Anderson JW, Collins D. Veterans Affairs HDL Intervention Trial (VA-HIT) Insulin resistance and cardiovascular events with low HDL cholesterol: the Veterans Afairs HDL Intervention Trial (VA-HIT) Diabetes Care. 2003;26(5):1513–1517.
    1. Bonora E, Formentini G, Calcaterra F, Lombardi S, Marini F, Zenari L, Saggiani F, Poli M, Perbellini S, Raffaelli A, Cacciatori V, Santi L, Targher G, Bonadonna R, Muggeo M. HOMA-estimated insulin resistance is an independent predictor of cardiovascular disease in type 2 diabetic subjects: prospective data from the Verona Diabetes Complications Study. Diabetes Care. 2002;25(7):1135–1141.
    1. Adler AI, Levy JC, Matthews DR, Stratton IM, Hines G, Holman RR. Insulin sensitivity at diagnosis of type 2 diabetes is not associated with subsequent cardiovascular disease (UKPDS 67) Diabet Med. 2005;22(3):306–311.
    1. Stähli BE, Nozza A, Schrieks IC, Buse JB, Malmberg K, Mellbin L, Neal B, Nicholls SJ, Rydén L, Svensson A, Wedel H, Weichert A, Lincoff AM, Grobbee DE, Tardif JC, Schwartz GG. Homeostasis Model Assessment of Insulin Resistance and Survival in Patients with Diabetes and Acute Coronary Syndrome. J Clin Endocrinol Metab. 2018;103(7):2522–2533.
    1. Su WY, Chen SC, Huang YT, Huang JC, Wu PY, Hsu WH, Lee MY. Comparison of the Effects of Fasting Glucose, Hemoglobin A1c, and Triglyceride-Glucose Index on Cardiovascular Events in Type 2 Diabetes Mellitus. Nutrients. 2019;11(11):2838.
    1. Cho YR, Ann SH, Won KB, Park GM, Kim YG, Yang DH, Kang JW, Lim TH, Kim HK, Choe J, Lee SW, Kim YH, Kim SJ, Lee SG. Association between insulin resistance, hyperglycemia, and coronary artery disease according to the presence of diabetes. Sci Rep. 2019;9(1):6129.
    1. Iguchi T, Hasegawa T, Otsuka K, Matsumoto K, Yamazaki T, Nishimura S, Nakata S, Ehara S, Kataoka T, Shimada K, Yoshiyama M. Insulin resistance is associated with coronary plaque vulnerability: insight from optical coherence tomography analysis. Eur Heart J Cardiovasc Imaging. 2014;15(3):284–291.
    1. An X, Yu D, Zhang R, Zhu J, Du R, Shi Y, Xiong X. Insulin resistance predicts progression of de novo atherosclerotic plaques in patients with coronary heart disease: a one-year follow-up study. Cardiovasc Diabetol. 2012;11(1):71.
    1. Lee EY, Yang HK, Lee J, Kang B, Yang Y, Lee SH, Ko SH, Ahn YB, Cha BY, Yoon KH, Cho JH. Triglyceride glucose index, a marker of insulin resistance, is associated with coronary artery stenosis in asymptomatic subjects with type 2 diabetes. Lipids Health Dis. 2016;15(1):155.
    1. Shang J, Yu D, Cai Y, Wang Z, Zhao B, Zhao Z, Simmons D. The triglyceride glucose index can predict newly diagnosed biopsy-proven diabetic nephropathy in type 2 diabetes: a nested case control study. Medicine. 2019;98:46.
    1. Won KB, Park EJ, Han D, Lee JH, Choi SY, Chun EJ, Park SH, Han HW, Sung J, Jung HO, Chang HJ. Triglyceride glucose index is an independent predictor for the progression of coronary artery calcification in the absence of heavy coronary artery calcification at baseline. Cardiovasc Diabetol. 2020;19(1):34.
    1. Chiu H, Tsai HJ, Huang JC, Wu PY, Hsu WH, Lee MY, Chen SC. Associations between Triglyceride-Glucose Index and Micro- and Macro-angiopathies in Type 2 Diabetes Mellitus. Nutrients. 2020;12(2):328.
    1. Zhao S, Yu S, Chi C, Fan X, Tang J, Ji H, Teliewubai J, Zhang Y, Xu Y. Association between macro- and microvascular damage and the triglyceride glucose index in community-dwelling elderly individuals: the Northern Shanghai Study. Cardiovasc Diabetol. 2019;18(1):95.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅