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

Abstract

Objective The triglyceride–glucose (TyG) index has been shown to be a new alternative measure for insulin resistance. However, no study has attempted to investigate the association of the TyG index with incident atrial fibrillation (AF) in the general population without known cardiovascular diseases. Methods Individuals without known cardiovascular diseases (heart failure, coronary heart disease, or stroke) from the Atherosclerosis Risk in Communities (ARIC) cohort were recruited. The baseline TyG index was calculated as the Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. The association between the baseline TyG index and incident AF was examined using Cox regression. Results Of 11,851 participants, the mean age was 54.0 years; 6586 (55.6%) were female. During a median follow-up of 24.26 years, 1925 incidents of AF cases (0.78/per 100 person-years) occurred. An increased AF incidence with a graded TyG index was found by Kaplan‒Meier curves (P < 0.001). In multivariable-adjusted analysis, both < 8.80 (adjusted hazard ratio [aHR] = 1.15, 95% confidence interval [CI] 1.02, 1.29) and > 9.20 levels (aHR 1.18, 95% CI 1.03, 1.37) of the TyG index were associated with an increased risk of AF compared with the middle TyG index category (8.80–9.20). The exposure-effect analysis confirmed the U-shaped association between the TyG index and AF incidence (P = 0.041). Further sex-specific analysis showed that a U-shaped association between the TyG index and incident AF still existed in females but not in males. Conclusions A U-shaped association between the TyG index and AF incidence is observed in Americans without known cardiovascular diseases. Female sex may be a modifier in the association between the TyG index and AF incidence. Graphical Abstract

Association of triglyceride glucose index and triglyceride glucose-body mass index with sudden cardiac arrest in the general population

“…Sex is a crucial determinant in CVD development and progression, with growing attention on cardiovascular risk in women. Sex-specific analyses revealed a more pronounced association between IR and SCA in women, aligning with observations from previous studies indicating a stronger link between IR and adverse cardiovascular events in women [ 20 , 37 , 38 ]. Notably, consistent findings were observed across RCS and AFT models.…”

Assessing the association between triglyceride-glucose index and atrial fibrillation: a systematic review and meta-analysis

“…At the end of the screening, nine studies fully met the inclusion criteria and were included in the analysis [ 28 – 36 ]. Studies were conducted mostly in China [ 28 , 29 , 32 – 36 ], followed by the United States [ 30 ] and Sweden [ 31 ]. The design of the included studies were prospective cohort [ 30 , 31 , 33 , 34 ], retrospective cohort [ 28 , 29 ], case–control [ 35 , 36 ], and cross-sectional [ 32 ].…”

“…Studies were conducted mostly in China [ 28 , 29 , 32 – 36 ], followed by the United States [ 30 ] and Sweden [ 31 ]. The design of the included studies were prospective cohort [ 30 , 31 , 33 , 34 ], retrospective cohort [ 28 , 29 ], case–control [ 35 , 36 ], and cross-sectional [ 32 ]. In these studies, 886 patients with AF were compared against 5285 without AF, with a mean age of 63.46 ± 10.47 years and 56.81 ± 10.54 years, respectively.…”

“…However, the TyG index was not associated with AF in the diabetic subjects No AF (control) 179 51.4 67 ± 2.22 – 8.36 ± 0.17 Shi et al [ 32 ] AF Diabetic patients AF: of ≥ 30 s showing heart rhythm with no discernible repeating P-waves and irregular RR intervals was diagnosed of AF/the subject’s self-report of AF history China Cross-sectional 213 72.3 55.97 ± 13.25 – 9.51 ± 0.74 There was a linear correlation between the TyG index and the prevalent AF in a diabetic population. In the fully adjusted model, each SD elevation of TyG casts a 40.6% additional risk for prevalent AF No AF (control) 3031 53.65 56.21 ± 10.67 – 9.17 ± 0.67 Zhang et al [ 35 ] Recurrent AF Patients who underwent valvular surgery with concurrent Cox-maze ablation Long-standing persistent AF: persistent AF (lasting more than 7 days) episodes lasting > 12 months China Case control 117 71.8 61.7 ± 12.7 50.1 ± 14.8 9.21 ± 0.38 A higher TyG index is associated with an increased risk of AF recurrence after simultaneous radiofrequency ablation maze IV procedures for heart valve surgery (HR: 2.021, 95% CI 1.374–3.245, P < 0.001) Non-recurrent AF 307 70.4 56.8 ± 13.7 53.4 ± 17.6 8.34 ± 0.72 Liu et al [ 30 ] TyG < 8.8 General population without known cardiovasc...…”

“…Different studies have evaluated the association between TyG and AF risk in the general population. Liu et al [ 30 ], using data from the Atherosclerosis Risk in Communities (ARIC) study, a U-shaped association was found between the TyG index and the incident AF in the cardiovascular disease-free general population in a 24.2-year follow-up period. In their study, the authors analyzed a population of 11,851 nondiabetic participants who were assigned to groups based on the TyG value tertiles at the baseline (T1: TyG < 8.80; T2: 8.80 ≤ TyG ≤ 9.20; and T3: TyG > 9.20), the analysis revealed that T1 and T3 presented with an incidence rate of 0.69 and 1.13 (per 100 person-years), respectively, and showed an increased risk of AF compared to T2, with an incidence rate of 0.83 ( P = 0.02).…”