Association of triglyceride glucose index with all-cause and cardiovascular mortality in the general population

Abstract

Objective The Triglyceride-glucose (TyG) index, a novel indicator of insulin resistance, has been associated with mortality from coronary artery diseases, ischemic stroke, and heart failure. In recent years, much emphasis has been placed on the relationship between the TyG index and mortality in the general population. However, the impact of age on the association between TyG and all-cause and cardiovascular mortality remains controversial. This study investigated the link between the TyG index and all-cause and cardiovascular mortality, emphasizing differences between older and non-older populations. Methods Data from the National Health and Nutrition Examination Survey (2009–2018), encompassing 20,194 participants, were analyzed. The baseline TyG index was calculated as Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Multivariate Cox proportional hazards regression models with restricted cubic splines and trend tests were employed to explore the association between the TyG index and all-cause and cardiovascular mortality, with emphasis on age-specific analysis. Subgroup analysis was conducted to examine whether the TyG index's association with mortality varied across different subgroups. Additionally, receiver operating characteristic curves were used to compare the predictive ability of the TyG index with the homeostasis model assessment of insulin resistance (HOMA-IR) for all-cause and cardiovascular mortality. Results Over a median follow-up period of 105 months, all-cause mortality accounted for 13.345% of cases, and cardiovascular mortality accounted for 3.387%. Kaplan–Meier curves showed a significant increase in all-cause and cardiovascular mortality with higher TyG index values (both P for log-rank test < 0.001). However, during Cox proportional hazards regression analysis, no linear trend was observed between the TyG index and all-cause or cardiovascular mortality after adjusting for confounding factors (all-cause mortality: P for trend = 0.424; cardiovascular mortality: P for trend = 0.481). Restricted cubic splines revealed a non-linear association between the baseline TyG index and all-cause and cardiovascular mortality in the overall population (all-cause mortality: Non-linear P = 0.003; cardiovascular mortality: Non-linear P = 0.034). The effect of the TyG index was consistent across most subgroups in terms of all-cause and cardiovascular mortality, with no significant interaction with randomized factors (all-cause mortality: P for interaction = 0.077–0.940, cardiovascular mortality: P for interaction = 0.173–0.987), except for the age subgroup (all-cause mortality: P for interaction < 0.001, cardiovascular mortality: P for interaction < 0.001). Further age-specific analysis revealed that the association between the TyG index and all-cause and cardiovascular mortality remained significant in patients aged < 65 but not in those aged ≥ 65. Interestingly, a non-linear association was observed between the TyG index and all-cause mortality in individuals aged < 65 (Non-linear P = 0.011), while a linear relationship was observed with cardiovascular mortality, showing an upward trend (Non-linear P = 0.742, P for trend = 0.010). Further stratification according to age yielded similar results only in patients aged 45–64 (all-cause mortality: Non-linear P = 0.001 and cardiovascular mortality: Non-linear P = 0.902, P for trend = 0.015). Compared to HOMA-IR, the TyG index demonstrated superior predictive performance for all-cause and cardiovascular mortality (all-cause mortality: 0.620 vs. 0.524, P < 0.001; cardiovascular mortality: 0.623 vs. 0.537, P < 0.001). Conclusions This study established a significant association between the TyG index and all-cause and cardiovascular mortality in the general population, particularly among individuals aged < 65. Notably, a non-linear association with all-cause mortality was observed in those aged < 65, while a linear relationship with cardiovascular mortality was found.

Exposure to earthquakes and development of ischemic heart disease

“…Patients aged < 24 years were excluded from the stratification analysis because only a small number developed IHD. Age categories (25–44, 45–64, and 65 and above) were selected based on previous cardiovascular epidemiological studies [ 29 , 30 ]. Health insurance premiums (categorized from 1 to 20) vary according to household income in Korea.…”

Association of adiposity-and lipid-related indices with metabolic syndrome among older adults in the coastal city of China: A population-based study

“…A prospective cohort study has demonstrated a J shaped association between BMI and all cause mortality, which can be explained when the two different shapes in mortality risk for fat mass and lean body mass are taken together [35]. The NHANES has demonstrate a Non-linear trend in the relationships between TyG as well as TyG-WC indices with the all-cause mortality of MetS population [22]. This implies that these indices may have different mechanisms of action or interactions at different factors.…”

“…The China Health and Retirement Longitudinal Study (CHARLS) study found that TyG-BMI, TyG-WC, and TyG-WHtR performed better than BMI, WC, and WHtR in predicting MetS in middle-aged and early older adults (≥ 45 years of age) [20,21]. Currently, NHANES found that a non-linear trend between TyG index and TyG-WC indices with all-cause mortality of the MetS population in America [22]. Thus, additional research is necessary in different populations and ethnic group where the varieties of anthropometric and lipid measures especially the newly proposed indices have not been expansively analysed and studied.…”

Association of the triglyceride-glucose index and its related parameters with frailty

“…In addition, the triglyceride-glucose (TyG) index is easier to obtain than the HOMA-IR. The TyG index, which is based on fasting triglycerides and fasting glucose, has gained widespread acceptance as a reliable substitute indicator of IR in recent years for predicting CVD, DM, hypertension, stroke, and mortality [13][14][15][16]. Numerous studies have suggested that the diagnostic value of TyG for disease and IR is superior to that of the traditional indicator HOMA-IR [17][18][19].…”