Association between triglyceride-glucose related indices and all-cause and cardiovascular mortality among the population with cardiovascular-kidney-metabolic syndrome stage 0–3: a cohort study

Feb 28, 2025Cardiovascular diabetology

Links between blood fat and sugar measures and death risk from all causes and heart disease in people with early to moderate heart, kidney, and metabolism problems

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Abstract

A significant positive association exists between the -waist circumference index and all-cause mortality, with a hazard ratio of 1.50.

The TyG-waist-to-height ratio index is associated with all-cause mortality, showing a hazard ratio of 1.45.
The TyG-waist-to-height ratio index has the strongest correlation with cardiovascular mortality, with a hazard ratio of 1.85.
An L-shaped relationship is identified between TyG-related indices and all-cause mortality in individuals with syndrome.
TyG-related indices correlate more strongly with all-cause mortality in individuals with CKM syndrome stages 1 and 3.

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BACKGROUND: Cardiovascular-Kidney-Metabolic () syndrome typically commences with the interaction of insulin resistance (IR), excessive or dysfunctional obesity, and the consequent systemic inflammatory response and oxidative stress. The relationship between the triglyceride-glucose () index and TyG-related indices that may simply assess IR and obesity, as well as the mortality risk in the CKM syndrome population, remains ambiguous.

METHODS: This study included 6,383 participants from the National Health and Nutrition Examination Survey (NHANES) 2009-2018. The TyG index, TyG-waist-to-height ratio (TyG-WHtR), TyG-waist circumference (TyG-WC), and TyG-body mass index (TyG-BMI) were developed. Cox proportional hazards models, smooth curve fitting, and two-stage Cox proportional hazards models were employed to examine the association of TyG and TyG-related indices with all-cause and cardiovascular mortality in the CKM syndrome population. Subgroup analyses and interaction tests were conducted to evaluate the risk within various demographics.

RESULTS: In survey-weighted multifactorial regression analyses, a significant positive association existed between TyG, TyG-related indices, and both all-cause mortality and cardiovascular mortality, except for the TyG index, which did not demonstrate a significant link with all-cause mortality. Of these indices, the TyG-WC index exhibited the strongest correlation with all-cause mortality, with a hazard ratio (HR) of 1.50 and a 95% confidence interval (CI) of 1.18-1.92, followed by the TyG-WHtR index (HR: 1.45, 95%CI 1.13-1.85). The TyG-WHtR index demonstrated the strongest correlation with cardiovascular mortality (HR: 1.85, 95% CI 1.19-2.86), followed by the TyG-WC index(HR: 1.83, 95%CI 1.21-2.78). An L-shaped association was identified between TyG-WHtR, TyG-BMI, and all-cause mortality in CKM syndrome during the examination of nonlinear relationships (both P for log-likelihood ratio < 0.05). The TyG-WHtR, TyG-WC, and TyG-BMI indices exhibited a more pronounced correlation with all-cause mortality in those with CKM syndrome stages 1 and 3 (P value < 0.05, P for interaction < 0.05).

CONCLUSION: Our study emphasizes the association between TyG and TyG-related indices and mortality in individuals with CKM syndrome stages 0-3. Individuals with CKM syndrome stages 1 and 3 should be more vigilant to abnormal alterations in TyG-related indices.

Key numbers

1.50

Increase in All-Cause Mortality Risk

Hazard Ratio for -WC index per standard deviation increase.

1.85

Increase in Cardiovascular Mortality Risk

Hazard Ratio for -WHtR index per standard deviation increase.

2.78

Risk Elevation for -WC T3

Hazard Ratio for all-cause mortality in -WC T3 vs. T1.

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Association between triglyceride-glucose related indices and all-cause and cardiovascular mortality among the population with cardiovascular-kidney-metabolic syndrome stage 0–3: a cohort study

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