In a cohort of 97,331 patients with (MASLD), those in the highest quartile of triglyceride-glucose () indices had a significantly increased risk of cardiovascular disease (CVD) and mortality.
Participants with MASLD in the highest quartile of TyG had a hazard ratio of 1.19 for overall CVD compared to the lowest quartile.
The risk of coronary heart disease (CHD) increased with higher TyG indices, with a hazard ratio of 1.35 for TyG-BMI in the fourth quartile.
There was a nonlinear association of TyG with CVD outcomes, while TyG-BMI, TyG-waist circumference (WC), and TyG-waist-to-height ratio (WHtR) showed linear trends.
TyG-WC and TyG-WHtR demonstrated superior predictive performance for CVD and mortality risk in MASLD patients, as indicated by higher C-index, net reclassification index (NRI), and integrated discrimination improvement index (IDI).
The findings suggest that TyG-related indices may be effective surrogate predictors of CVD and mortality in individuals with MASLD.
Simplified
BACKGROUND: Triglyceride-glucose () related indices, which serve as simple markers for insulin resistance, have been closely linked to (MASLD), cardiovascular disease (CVD), and mortality. However, the prognostic utility of TyG-related indices in predicting the risk of CVD and mortality among patients with MASLD remains unclear.
METHODS: Data of 97,331 MASLD patients, with a median age of 58.0 years and free of CVD at baseline, were obtained from the UK Biobank. The TyG index, along with its combination with adiposity parameters (i.e. body mass index [BMI], waist circumference [WC], and waist-to-height ratio [WHtR]), were calculated. Cox proportional hazards models and restricted cubic spline (RCS) were performed to evaluate the associations between TyG-related indices and the risk of overall CVD, coronary heart disease (CHD), stroke, all-cause mortality, and cardiovascular mortality. Additionally, Harrell's C-index, net reclassification index (NRI), and integrated discrimination improvement index (IDI) were used to assess the predictive performance of these indices.
RESULTS: Over a median follow-up of 13.56 years, we identified 13,256 cases of overall CVD, 10,980 CHD, 2,926 stroke, 8,809 all-cause mortality, and 1,796 cardiovascular mortality. Compared with the lowest quartile of TyG-related indices, participants with MASLD in the high quartile of TyG-related indices had a significantly increased risk of incident overall CVD, CHD, stroke, and mortality. Specifically, the hazard ratios of occurring overall CVD in the fourth versus the first quartiles were 1.19 (95% confidence interval: 1.13-1.25) for TyG, 1.35 (1.28-1.42) for TyG-BMI, 1.33 (1.26-1.40) for TyG-WC, and 1.39 (1.32-1.46) for TyG-WHtR. RCS analyses indicated a nonlinear association of TyG with CVD outcomes (all P values for nonlinearity < 0.05), whereas there exhibited linear trends in TyG-BMI, TyG-WC, and TyG-WHtR with CVD outcomes (all P values for nonlinearity > 0.05, except for TyG-WC with stroke). Furthermore, TyG-WC and TyG-WHtR demonstrated the significantly higher C-index, NRI, and IDI in predicting risk of CVD and mortality in MASLD patients.
CONCLUSION: TyG-related indices, especially TyG-WC and TyG-WHtR, had significant predictive values for the risk of incident CVD and mortality in individuals with MASLD. TyG-related indices may serve as effective surrogate predictors of CVD and mortality in MASLD patients.
Key numbers
1.19–1.39×
Increased Risk of Overall CVD
Compared to the lowest quartile of -related indices.
13–17%
Higher Risk of All-Cause Mortality
For each 1-standard deviation increment in these indices.
23–25%
Higher Risk of Cardiovascular Mortality
For each 1-standard deviation increment in -BMI, -WC, and -WHtR.
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Declarations. Ethics approval and consent to participate: All participants gave written informed consent, and ethical approval of the UK Biobank was received from the North West Multicenter Research Ethics Committee (reference number: 21/NW/0157). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
