Relationship between the triglyceride-glucose index and risk of cardiovascular diseases and mortality in the general population: a systematic review and meta-analysis

Abstract

Background The triglyceride-glucose (TyG) index is a new alternative measure for insulin resistance. This meta-analysis was conducted to assess the associations of the TyG index with the risks of cardiovascular diseases and mortality in the general population. Methods The PubMed, Cochrane Library and Embase databases were searched for randomized controlled trials or observational cohort studies reporting associations of the TyG index with cardiovascular diseases and mortality from inception to April 16, 2022. Effect sizes were pooled using random-effects models. Robust error meta-regression methods were applied to fit nonlinear dose–response associations. Evidence quality levels and recommendations were assessed using the Grading of Recommendations Assessment, Development and Evaluation system (GRADE). Results Twelve cohort studies (6 prospective and 6 retrospective cohorts) involving 6,354,990 participants were included in this meta-analysis. Compared with the lowest TyG index category, the highest TyG index was related to a higher incidence of coronary artery disease (CAD) (3 studies; hazard ratio [HR] = 2.01; 95% confidence interval [CI] 1.68–2.40; I2 = 0%), myocardial infarction (MI) (2 studies; HR = 1.36; 95% CI 1.18–1.56; I2 = 35%), and composite cardiovascular disease (CVD) (5 studies; HR = 1.46; 95% CI 1.23–1.74; I2 = 82%). However, there was no association between the TyG index and mortality (cardiovascular mortality [3 studies; HR = 1.10; 95% CI 0.82–1.47; I2 = 76%] or all-cause mortality [4 studies; HR = 1.08; 95% CI 0.92–1.27; I2 = 87%]). In the dose–response analysis, there was a linear association of the TyG index with the risk of CAD (Pnonlinear = 0.3807) or CVD (Pnonlinear = 0.0612). GRADE assessment indicated very low certainty for CVD, MI, cardiovascular mortality and all-cause mortality, and moderate certainty for CAD. Conclusions Based on our current evidence, a higher TyG index may be associated with an increased incidence of CAD (moderate certainty), MI (very low certainty) and CVD (very low certainty) in the general population. There is a potential linear association of the TyG index with CAD and the composite CVD incidence. Further prospective studies (especially in non-Asians) are needed to confirm our findings.

The predictive value of the triglyceride—glucose index for cardiovascular events in patients with coronary chronic total occlusion

“…Similarly, the TyG index only appeared to be associated with cardiovascular risk in nondiabetes patients. Some previous studies have indicated that the TyG index could predict cardiovascular events effectively both in patients with and without DM [33][34][35], but a study has found similar associations in diabetic populations but not in nondiabetic populations [36]. In this study, we assumed that this was mainly because the insufficient sample size in the DM group led to decreased test efficiency.…”

High triglyceride-glucose index in young adulthood is associated with incident cardiovascular disease and mortality in later life: insight from the CARDIA study

“…Several previous studies have reported that a high TyG index is related to the increased risk of cardiovascular disease and all-cause mortality in the general population. A recent meta-analysis included 5 studies for composite cardiovascular disease with 259,757 participants and found higher TyG index may be associated with an increased incidence of CVD in a linear association among the general population [ 26 ]. The pooled HRs (95% CI) for CVD among those with the highest TyG index was 1.46 (1.23–1.74) when compared with the lowest TyG index category.…”

“…Although the influence of the TyG index on adverse health outcomes has been receiving increasing attention, studies evaluating the relationship between the TyG index and mortality have been limited. In the recent meta-analysis of the TyG index and the risk of mortality in the general population [ 26 ], their results showed no association between the TyG index and mortality or all-cause mortality. In fact, among the four studies they included, two found a statistically significant association between the TyG index and all-cause mortality [ 30 , 31 ], while the other two did not [ 28 , 32 ].…”

U-shaped association between the triglyceride-glucose index and atrial fibrillation incidence in general people without known cardiovascular disease

“…Previous studies(16-34) and our recent work (35) have reported a signi cant association between the TyG index and the incidence of atherosclerosis, myocardial infarction (MI), stroke, coronary artery disease and mortality in the general population regardless of T2DM status. Furthermore, the TyG index is associated with adverse cardiovascular events among diabetic or nondiabetic patients with established cardiovascular diseases (CVDs) (36)(37)(38)(39)(40)(41)(42).…”