Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; State Key Laboratory of Cardiovascular Disease, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; State Key Laboratory of Cardiovascular Disease, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
Nutr Metab Cardiovasc Dis. 2024 Sep;34(9):2124-2133. doi: 10.1016/j.numecd.2024.04.010. Epub 2024 Apr 25.
This study aimed to investigate the association of the triglyceride-glucose (TyG) index, a simple-but-reliable indicator of insulin resistance, with risk of cardiovascular (CV) events in coronary artery disease (CAD) patients with different inflammation status.
We consecutively recruited 20,518 patients with angiograph-proven-CAD from 2017 to 2018 at Fuwai Hospital. Patients were categorized according to baseline TyG index tertiles (T) (tertile 1: ≤8.624; T2: 8.624-9.902 and T3: >9.902) and further assigned into 6 groups by high-sensitivity C-reactive protein (hsCRP) medians. The primary endpoint was CV events including CV death, nonfatal myocardial infarction and nonfatal stroke. During the 3.1-year-follow-up, 618 (3.0%) CV events were recorded. Overall, patients with high TyG index levels (T2 or T3) showed significantly increased risk of CV events (hazard ratio [HR]: 1.24; 95% confidence interval [CI]: 1.01-1.53; HR: 1.33; 95%CI: 1.05-1.68, respectively) compared with those with lowest Tyg index (T1) after adjusting for confounding factors. Upon stratification by hsCRP levels, elevated TyG index was associated with increased risk of CV events only in patients with hsCRP levels > median (per-1-unit-increase HR: 1.39; 95%CI: 1.11-1.74), rather than in those with hsCRP levels ≤ median. Furthermore, adding the TyG index to the predicting model led to a significant improvement in patients with hsCRP > median rather than in those with hsCRP ≤ median.
We firstly found that elevated TyG index levels were associated with increased risk of CV events in CAD patients, especially in those with increased inflammatory status, suggesting that it could help in risk stratification and prognosis in this population.
本研究旨在探讨甘油三酯-葡萄糖（TyG）指数这一简单可靠的胰岛素抵抗指标与不同炎症状态的冠心病（CAD）患者发生心血管（CV）事件风险之间的关联。
我们连续招募了 2017 年至 2018 年在阜外医院经血管造影证实的 20518 例 CAD 患者。根据基线 TyG 指数三分位（T）（T1：≤8.624；T2：8.624-9.902；T3：>9.902）将患者进行分类，并根据高敏 C 反应蛋白（hsCRP）中位数进一步分为 6 组。主要终点为 CV 事件，包括 CV 死亡、非致死性心肌梗死和非致死性卒中。在 3.1 年的随访期间，记录到 618 例（3.0%）CV 事件。总体而言，TyG 指数较高（T2 或 T3）的患者发生 CV 事件的风险显著增加（风险比 [HR]：1.24；95%置信区间 [CI]：1.01-1.53；HR：1.33；95%CI：1.05-1.68），与 TyG 指数最低（T1）的患者相比，在调整混杂因素后。根据 hsCRP 水平分层，TyG 指数升高仅与 hsCRP 水平升高（每增加 1 个单位 HR：1.39；95%CI：1.11-1.74）的患者发生 CV 事件的风险增加相关，而与 hsCRP 水平升高（每增加 1 个单位 HR：1.39；95%CI：1.11-1.74）的患者无关。此外，将 TyG 指数加入预测模型可显著改善 hsCRP 水平升高的患者的预后，而不是 hsCRP 水平升高的患者。
我们首次发现，TyG 指数升高与 CAD 患者 CV 事件风险增加相关，尤其是在炎症状态升高的患者中，提示其有助于该人群的风险分层和预后判断。
