Department of Family Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.
Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul, 03277, Republic of Korea.
Eur J Med Res. 2024 Apr 2;29(1):214. doi: 10.1186/s40001-024-01820-9.
The triglyceride and glucose-waist circumference (TyG-WC) index demonstrated a strong association with insulin resistance, especially in Asian population. However, evidence on the association between TyG-WC index and the occurrence of cardiovascular disease (CVD) is limited. This study aimed to verify association between the TyG-WC index and the occurrence of CVD by considering all-cause mortality as a competing risk.
The study included 7482 participants divided into four groups based on the TyG-WC index quartiles. Kaplan-Meier curves illustrated cumulative incidence rates of CVD and all-cause mortality during the follow-up period. Log-rank tests determined group differences. The Cox proportional hazard spline curve demonstrates the dose-dependent relationship between the TyG-WC index and incident CVD. Modified Cox regression (Fine and Gray) estimated hazard ratios (HRs) with 95% CIs for incident CVD, treating death as a competing risk. Death event after incident CVD was excluded from the death count.
During the median 15.94 year of follow-up period, a total of 691 (9.24%) new-onset CVD cases and 562 (7.51%) all-cause mortality cases were confirmed. Cox proportional hazard spline curves suggested that TyG-WC index exhibited a dose-dependent positive correlation with incident CVD. The cumulative incidence rate of CVD was significantly higher in the groups with higher TyG-WC index quartiles in Kaplan-Meier curves. The adjusted HR (95% CI) for incident CVD in Q2-Q4, compared with Q1, was 1.47 (1.12-1.93), 1.91 (1.44-2.54) and 2.24 (1.63-3.07), respectively. There was no significant association between TyG-WC index and all-cause mortality. Specifically, angina and stroke were significantly associated with the TyG-WC index, in contrast to myocardial infarction and peripheral artery disease.
The TyG-WC index was positively associated with incident CVD even considering all-cause mortality as a competing risk. Therefore, TyG-WC index may be a valuable marker for predicting the occurrence of CVD.
甘油三酯和葡萄糖-腰围（TyG-WC）指数与胰岛素抵抗有很强的相关性，尤其是在亚洲人群中。然而，关于 TyG-WC 指数与心血管疾病（CVD）发生之间的关系的证据有限。本研究旨在通过考虑全因死亡率作为竞争风险来验证 TyG-WC 指数与 CVD 发生之间的关联。
该研究纳入了 7482 名参与者，根据 TyG-WC 指数四分位数分为四组。Kaplan-Meier 曲线说明了随访期间 CVD 和全因死亡率的累积发生率。对数秩检验确定了组间差异。Cox 比例风险样条曲线显示了 TyG-WC 指数与 CVD 事件发生之间的剂量依赖性关系。修正的 Cox 回归（Fine 和 Gray）估计了发生 CVD 的风险比（HRs），95%置信区间（CIs），将死亡视为竞争风险。CVD 事件后发生的死亡事件从死亡计数中排除。
在中位数为 15.94 年的随访期间，共确诊 691 例（9.24%）新发生的 CVD 病例和 562 例（7.51%）全因死亡病例。Cox 比例风险样条曲线表明 TyG-WC 指数与 CVD 事件发生呈剂量依赖性正相关。Kaplan-Meier 曲线中的 TyG-WC 指数 quartiles 越高，CVD 的累积发生率越高。与 Q1 相比，Q2-Q4 发生 CVD 的调整后 HR（95%CI）分别为 1.47（1.12-1.93）、1.91（1.44-2.54）和 2.24（1.63-3.07）。TyG-WC 指数与全因死亡率之间无显著相关性。具体而言，心绞痛和中风与 TyG-WC 指数显著相关，而心肌梗死和外周动脉疾病则无显著相关性。
即使考虑全因死亡率作为竞争风险，TyG-WC 指数与 CVD 事件的发生仍呈正相关。因此，TyG-WC 指数可能是预测 CVD 发生的一个有价值的标志物。
