a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease , Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing , China.
Ann Med. 2018 Nov;50(7):576-586. doi: 10.1080/07853890.2018.1523549. Epub 2018 Oct 25.
Previous studies have shown that both triglyceride glucose (TyG) and haemoglobin glycation indexes (HGI) are predictors of cardiovascular risk. However, the prognostic value of TyG index and HGI in patients with type 2 diabetes mellitus (T2DM) and stable coronary artery disease (CAD) is not determined.
We conducted a nested case-control study among 1282 T2DM patients with stable CAD. Patients were followed up for 3846 person-years. A total of 160 patients with events (12.5%) were identified and matched individually on age, gender, previous use of lipid lowering agents and duration of follow-up with 640 controls.
In Kaplan-Meier analysis, the upper tertiles of TyG index and HGI had a significant lower event-free survival (p = .002; p = .036, respectively). Of the note, both TyG index and HGI were associated with increased risk of MACCEs after adjusting for confounding risk factors [adjusted HR (95% CI): 1.693 (1.238-2.316); 1.215 (1.046-1.411), respectively]. Moreover, adding TyG index to the Cox model increased the C-statistic to 0.638 (95%CI: 0.595-0.683, p = .002) while the C-statistic was not statistically improved when HGI was included (p = .240).
Both TyG index and HGI could predict cardiovascular outcomes in T2DM patients with new-onset, stable CAD while TyG index might be better. Key messages Both TyG and HGI are predictors of cardiovascular risk. The prognostic value of TyG index and HGI in T2DM patients with stable coronary artery disease is not determined. Our study firstly indicates that TyG index might have better prognostic value than HGI in T2DM patients with new-onset, stable CAD.
先前的研究表明，甘油三酯-葡萄糖（TyG）和血红蛋白糖化指数（HGI）均是心血管风险的预测指标。然而，在 2 型糖尿病（T2DM）合并稳定型冠状动脉疾病（CAD）患者中，TyG 指数和 HGI 的预后价值尚未确定。
我们在 1282 例 T2DM 合并稳定 CAD 患者中开展了一项巢式病例对照研究。患者的随访时间为 3846 人年。共确定了 160 例（12.5%）事件患者，并按年龄、性别、降脂药物的既往使用情况和随访时间与 640 例对照进行个体匹配。
在 Kaplan-Meier 分析中，TyG 指数和 HGI 的上 3 分位数组具有显著较低的无事件生存率（p=0.002；p=0.036）。值得注意的是，在校正混杂危险因素后，TyG 指数和 HGI 均与 MACCEs 风险增加相关[校正后的 HR（95%CI）：1.693（1.238-2.316）；1.215（1.046-1.411）]。此外，将 TyG 指数添加到 Cox 模型中可使 C 统计量提高至 0.638（95%CI：0.595-0.683，p=0.002），而纳入 HGI 后 C 统计量无统计学改善（p=0.240）。
TyG 指数和 HGI 均可预测新发稳定 CAD 的 T2DM 患者的心血管结局，而 TyG 指数的预测价值可能更好。主要结论 TyG 和 HGI 均是心血管风险的预测指标。TyG 指数和 HGI 在 T2DM 合并稳定型冠状动脉疾病患者中的预后价值尚不确定。本研究首次表明，在新发稳定 CAD 的 T2DM 患者中，TyG 指数的预后价值可能优于 HGI。
