Glycemic control and cardiovascular outcomes in patients with diabetes and coronary artery disease according to triglyceride-glucose index: a large-scale cohort study

Abstract

Background The role of triglyceride-glucose (TyG) index, an insulin resistance indicator, in glycemic management for diabetic patients with coronary artery disease (CAD) was still unknown. Therefore, we aimed to explore the association between glycemic control and cardiovascular (CV) outcomes in patients with diabetes and CAD according to different TyG index levels. Methods A total of 9996 diabetic patients with angiograph-proven CAD were consecutively recruited from 2017 to 2018 at Fuwai Hospital. Patients were assigned into 3 groups according to TyG index tertiles (T) (T1: <8.895; T2: 8.895-9.400; T3: ≥9.400). According to American Diabetes Association guidelines, controlled glycemia was defined as targeting glycosylated hemoglobin Alc (HbA1c) < 7%. The primary endpoint was CV events including CV death, nonfatal myocardial infarction, and nonfatal stroke. Results During a median 3-year follow-up, 381 (3.8%) CV events occurred. Overall, high TyG index (T3) was associated with increased risk of CV events (hazard ratio [HR]: 1.40; 95% confidence interval [CI]: 1.02–1.94) compared with the lowest TyG index (T1) after multivariable adjustment. Upon stratification by the TyG index, in fully adjusted models, controlled glycemia was associated with reduced risk of CV events in the high TyG index (T3) subgroup (HR: 0.64; 95%CI: 0.42–0.96) but not in the low (T1; HR: 0.79; 95%CI: 0.53–1.16) and moderate (T2; HR: 0.84; 95%CI: 0.56–1.25) TyG index subgroups. Conclusions Controlled glycemia was associated with improved CV outcomes in patients with diabetes and established CAD, especially in those with high TyG index levels. Our study, for the first time, provided valuable information that TyG index could help making risk stratification on the glycemic management in diabetic patients with CAD.

Adipose Dysfunction Indices as a Key to Cardiometabolic Risk Assessment—A Population-Based Study of Post-Myocardial Infarction Patients

“…Helfand et al, demonstrated that patients with elevated glucose levels upon hospital admission had the highest in-hospital mortality rates (9.9%), surpassing the rates observed in individuals diagnosed with diabetes (6.5%) and those without diagnosed diabetes (7.5%) [ 44 ]. Similarly, Lin et al, in their study enrolling 9996 patients with diabetes and confirmed CAD revealed that glycaemic control, defined as HbA1c < 7%, was linked to a decreased risk of cardiovascular events, particularly in patients with a high triglyceride-glucose (TyG) index [ 45 ]. Another study, analysing data from six prospective, population-based cohort studies involving a total of 36,180 Europeans, found that HbA1c levels were independently associated with cardiovascular mortality, overall mortality, and cardiovascular morbidity.…”

Navigating Cardiovascular Risk in Type 1 Diabetes: A Comprehensive Review of Strategies for Prevention and Management

“…Nonetheless, the impact of intensive glycemic control on cardiovascular outcomes remains uncertain, with specific studies suggesting a potential null or even adverse effect on these outcomes [ 4 ]. A large-scale cohort study revealed that maintaining controlled glycemia correlated with enhanced cardiovascular outcomes among diabetes patients with established CAD, particularly among those exhibiting elevated levels of the triglyceride-glucose (TyG) index, which is an indicator of insulin resistance [ 5 ]. The study noted that heightened TyG index levels associated heightened cardiovascular event risks.…”

“…The study noted that heightened TyG index levels associated heightened cardiovascular event risks. In contrast, controlled glycemia was linked to reduced cardiovascular event risks within the high TyG index subgroup, albeit not within the low and moderate TyG index subgroups [ 5 ]. Moreover, an additional study postulated that chronic hyperglycemia potentially contributes to coronary heart disease (CHD) in both diabetic and nondiabetic individuals, advocating for investigations into glucose-lowering strategies to mitigate heart disease risk [ 6 ].…”