累积三酰甘油-葡萄糖指数与 2 型糖尿病患者主要不良心血管事件的相关性。
Association of the cumulative triglyceride-glucose index with major adverse cardiovascular events in patients with type 2 diabetes.
机构信息
Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China.
Department of Blood Transfusion, The Second Xiangya Hospital of Central South University, No. 139, Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China.
出版信息
Cardiovasc Diabetol. 2022 Aug 23;21(1):161. doi: 10.1186/s12933-022-01599-1.
BACKGROUND
The triglyceride-glucose (TyG) index is a reliable surrogate marker of insulin resistance and is associated with major adverse cardiovascular events (MACEs) in patients with type 2 diabetes mellitus (T2DM). However, the long-term effect of the TyG index on the incidence of MACEs remains unclear. We aimed to investigate the association between the cumulative TyG index and the risk of MACEs in patients with T2DM.
METHODS
This post-hoc analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial assessed patients' (T2DM > 3 months) cumulative TyG index and MACE data from the study database. Five fasting blood glucose and triglyceride measurements, at baseline and the first four visits, were taken from 5695 participants who had not experienced MACEs. Cumulative exposure to the TyG index was calculated as the weighted sum of the mean TyG index value for each time interval (value × time). Multivariable-adjusted Cox proportional hazard models and restricted cubic spline analysis were used to determine the association between the cumulative TyG index and MACEs. The incremental predictive value of the cumulative TyG index was further assessed.
RESULTS
Over a median follow-up of 5.09 years, 673 (11.82%) MACEs occurred, including 256 (4.50%) cardiovascular disease (CVD) deaths, 288 (5.06%) non-fatal myocardial infarctions (MIs), and 197 (3.46%) strokes. The risk of developing MACEs increased with the cumulative TyG index quartile. After adjusting for multiple potential confounders, the hazard ratios for the very high cumulative TyG index group versus the low group were 1.59 (95% confidence interval [CI], 1.17-2.16), 1.97 (95% CI 1.19-3.26), and 1.66 (95% CI 1.02-2.70) for overall MACEs, CVD death, and non-fatal MI, respectively. Restricted cubic spline analysis also showed a cumulative increase in the risk of MACEs with an increase in the magnitude of the cumulative TyG index. The addition of the cumulative TyG index to a conventional risk model for MACEs improved the C-statistics, net reclassification improvement value, and integrated discrimination improvement value.
CONCLUSIONS
In patients with T2DM, the cumulative TyG index independently predicts the incidence of MACEs, and monitoring the long-term TyG index may assist with optimized-for-risk stratification and outcome prediction for MACEs. Trial registration URL: http://www.
CLINICALTRIALS
gov . Unique identifier: NCT00000620.
背景
三酰甘油-葡萄糖（TyG）指数是胰岛素抵抗的可靠替代标志物，与 2 型糖尿病（T2DM）患者的主要不良心血管事件（MACE）相关。然而，TyG 指数对 MACE 发生率的长期影响尚不清楚。我们旨在研究 T2DM 患者的 TyG 指数累积与 MACE 风险之间的关系。
方法
该 ACTION TO CONTROL CARDIOVASCULAR RISK IN DIABETES（ACCORD）试验的事后分析评估了研究数据库中患者（T2DM>3 个月）的累积 TyG 指数和 MACE 数据。对未发生 MACE 的 5695 名参与者进行了 5 次空腹血糖和甘油三酯测量，分别在基线和前 4 次就诊时进行。累积 TyG 指数暴露量计算为每个时间间隔的平均 TyG 指数值的加权和（值×时间）。使用多变量调整的 Cox 比例风险模型和限制立方样条分析来确定 TyG 指数累积与 MACE 之间的关系。进一步评估了 TyG 指数累积的增量预测价值。
结果
中位随访 5.09 年后，发生了 673 例（11.82%）MACE，包括 256 例（4.50%）心血管疾病（CVD）死亡、288 例（5.06%）非致死性心肌梗死（MI）和 197 例（3.46%）中风。随着 TyG 指数四分位的增加，发生 MACE 的风险增加。在调整了多个潜在混杂因素后，非常高的 TyG 指数累积组与低组的危险比分别为 1.59（95%置信区间 [CI]，1.17-2.16）、1.97（95%CI 1.19-3.26）和 1.66（95%CI 1.02-2.70），分别为总体 MACE、CVD 死亡和非致死性 MI。限制立方样条分析还显示，随着 TyG 指数累积幅度的增加，MACE 风险呈累积性增加。将 TyG 指数累积值加入到 MACE 常规风险模型中，可提高 C 统计量、净重新分类改善值和综合判别改善值。
结论
在 T2DM 患者中，TyG 指数累积独立预测 MACE 发生率，监测长期 TyG 指数可能有助于优化风险分层和 MACE 结局预测。试验注册网址：http://www.clinicaltrials.gov。独特标识符：NCT00000620。
Zotero 插件