Department of Nutrition and Food Hygiene, School of Public Health, Key Laboratory of Precision Nutrition and Health, Ministry of Education, Harbin Medical University, 157 Baojian Road, Heilongjiang, 150081, People's Republic of China.
MED-X Institute, Center for Immunological and Metabolic Diseases (CIMD), First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710000, China.
Cardiovasc Diabetol. 2024 Jan 6;23(1):8. doi: 10.1186/s12933-023-02115-9.
BACKGROUND: In the American population, the relationship between the triglyceride-glucose (TyG) index and TYG combined with indicators of obesity and cardiovascular disease (CVD) and its mortality has been less well studied. METHODS: This cross-sectional study included 11,937 adults from the National Health and Nutrition Examination Survey (NHANES) 2003-2018. Cox proportional hazards model, binary logistic regression analyses, restricted cubic spline (RCS), and receiver operating characteristic (ROC) were used to analyze the relationship between TyG and its combined obesity-related indicators and CVD and its mortality. Mediation analysis explored the mediating role of glycated hemoglobin and insulin in the above relationships. RESULTS: In this study, except for no significant association between TyG and CVD mortality, TyG, TyG-WC, TyG-WHtR, and TyG-BMI were significantly and positively associated with CVD and CVD mortality. TyG-WHtR is the strongest predictor of CVD mortality (HR 1.66, 95% CI 1.21-2.29). The TyG index correlated better with the risk of coronary heart disease (OR 2.52, 95% CI 1.66-3.83). TyG-WC correlated best with total CVD (OR 2.37, 95% CI 1.77-3.17), congestive heart failure (OR 2.14, 95% CI 1.31-3.51), and angina pectoris (OR 2.38, 95% CI 1.43-3.97). TyG-WHtR correlated best with myocardial infarction (OR 2.24, 95% CI 1.45-3.44). RCS analyses showed that most of the above relationships were linear (P-overall < 0.0001, P-nonlinear > 0.05). Otherwise, ROC curves showed that TyG-WHtR and TyG-WC had more robust diagnostic efficacy than TyG. In mediation analyses, glycated hemoglobin mediated in all the above relationships and insulin-mediated in partial relationships. CONCLUSIONS: TyG-WC and TyG-WtHR enhance CVD mortality prediction, diagnostic efficacy of CVD and its mortality, and correlation with some CVD over and above the current hottest TyG. TyG-WC and TyG-WtHR are expected to become more effective metrics for identifying populations at early risk of cardiovascular disease and improve risk stratification.
背景：在美国人群中，甘油三酯-葡萄糖（TyG）指数与 TyG 联合肥胖相关指标及心血管疾病（CVD）及其死亡率之间的关系研究较少。
方法：本横断面研究纳入了 2003-2018 年国家健康和营养调查（NHANES）中的 11937 名成年人。使用 Cox 比例风险模型、二项逻辑回归分析、限制性三次样条（RCS）和受试者工作特征（ROC）分析 TyG 及其与肥胖相关指标的联合与 CVD 及其死亡率之间的关系。中介分析探讨了糖化血红蛋白和胰岛素在上述关系中的中介作用。
结果：除 TyG 与 CVD 死亡率之间无显著关联外，TyG、TyG-WC、TyG-WHtR 和 TyG-BMI 与 CVD 和 CVD 死亡率呈显著正相关。TyG-WHtR 是 CVD 死亡率最强的预测因子（HR 1.66，95%CI 1.21-2.29）。TyG 指数与冠心病风险相关性更好（OR 2.52，95%CI 1.66-3.83）。TyG-WC 与总 CVD（OR 2.37，95%CI 1.77-3.17）、充血性心力衰竭（OR 2.14，95%CI 1.31-3.51）和心绞痛（OR 2.38，95%CI 1.43-3.97）相关性最好。TyG-WHtR 与心肌梗死（OR 2.24，95%CI 1.45-3.44）相关性最好。RCS 分析表明，上述大部分关系呈线性（P 总体<0.0001，P 非线性>0.05）。否则，ROC 曲线表明，TyG-WHtR 和 TyG-WC 比 TyG 具有更强的诊断效能。在中介分析中，糖化血红蛋白介导了上述所有关系，而胰岛素介导了部分关系。
结论：TyG-WC 和 TyG-WtHR 增强了 CVD 死亡率预测、CVD 及其死亡率的诊断效能，以及与某些 CVD 的相关性，超过了目前最热门的 TyG。TyG-WC 和 TyG-WtHR 有望成为识别心血管疾病早期高危人群并改善风险分层的更有效指标。
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