甘油三酯-葡萄糖指数与全因死亡率及特定病因死亡率的关联：一项基于中国350万成年人的队列研究。
Association of the triglyceride-glucose index with all-cause and cause-specific mortality: a population-based cohort study of 3.5 million adults in China.
作者信息
He Guangda, Zhang Zenglei, Wang Chunqi, Wang Wei, Bai Xueke, He Linkang, Chen Shi, Li Guangyu, Yang Yang, Zhang Xiaoyan, Cui Jianlan, Xu Wei, Song Lijuan, Yang Hao, He Wenyan, Zhang Yan, Li Xi, Chen Liang
机构信息
National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
4+4 Medical Doctor Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
出版信息
Lancet Reg Health West Pac. 2024 Jul 6;49:101135. doi: 10.1016/j.lanwpc.2024.101135. eCollection 2024 Aug.
BACKGROUND
The triglyceride-glucose (TyG) index has been recognized as a crucial risk factor for cardiovascular diseases. However, the association between the TyG index and mortality in the general population remains elusive.
METHODS
Participants were enrolled from the China Health Evaluation And risk Reduction through nationwide Teamwork (ChinaHEART), a nationwide prospective cohort study. The outcomes of interest were all-cause, cardiovascular, and cancer mortality. Restricted cubic splines and Cox regression models were used to assess the associations between the TyG index and outcomes.
FINDINGS
In total, 3,524,459 participants with a median follow-up of 4.6 (IQR, 3.1-5.8) years were included. The associations of the TyG index with all-cause and cardiovascular mortality were reverse L-shaped, with cut-off values of 9.75 for all-cause mortality and 9.85 for cardiovascular mortality. For each 1-unit increase in the TyG index, when below the cut-off values, the TyG index was not significantly associated with all-cause mortality (HR = 1.02, 95% CI: 1.00-1.03) and was only modestly associated with cardiovascular mortality (HR = 1.09, 95% CI: 1.06-1.11). Conversely, when the cut-off values were exceeded, the HRs (95% CI) were 2.10 (1.94-2.29) for all-cause mortality and 1.99 (1.72-2.30) for cardiovascular mortality. However, the association between the TyG index and cancer mortality was linearly negative (HR = 0.97, 95% CI: 0.94-0.99).
INTERPRETATION
The associations of the TyG index with all-cause and cardiovascular mortality displayed reverse L-shaped patterns, while an elevated TyG index showed a slight negative association with cancer mortality. We suggest that <9.75 could be the optimal TyG index cut-off value among the Chinese general population. Individuals at high risk of mortality might benefit from proper management of a high TyG index.
FUNDING
The National High Level Hospital Clinical Research Funding (2023-GSP-ZD-2, 2023-GSP-RC-01), the Ministry of Finance of China and National Health Commission of China.
背景
甘油三酯-葡萄糖（TyG）指数已被公认为心血管疾病的关键危险因素。然而，TyG指数与普通人群死亡率之间的关联仍不明确。
方法
参与者来自中国通过全国协作进行健康评估与风险降低（ChinaHEART）项目，这是一项全国性的前瞻性队列研究。关注的结局为全因死亡率、心血管疾病死亡率和癌症死亡率。使用受限立方样条和Cox回归模型评估TyG指数与结局之间的关联。
结果
总共纳入了3524459名参与者，中位随访时间为4.6年（四分位间距，3.1 - 5.8年）。TyG指数与全因死亡率和心血管疾病死亡率的关联呈倒L形，全因死亡率的临界值为9.75，心血管疾病死亡率的临界值为9.85。在临界值以下时，TyG指数每增加1个单位，与全因死亡率无显著关联（风险比[HR]=1.02，95%置信区间[CI]：1.00 - 1.03），与心血管疾病死亡率仅呈适度关联（HR = 1.09，95% CI：1.06 - 1.11）。相反，当超过临界值时，全因死亡率的HR（95% CI）为2.10（1.94 - 2.29），心血管疾病死亡率的HR为1.99（1.72 - 2.30）。然而，TyG指数与癌症死亡率的关联呈线性负相关（HR = 0.97，95% CI：0.94 - 0.99）。
解读
TyG指数与全因死亡率和心血管疾病死亡率的关联呈倒L形模式，而TyG指数升高与癌症死亡率呈轻微负相关。我们建议<9.75可能是中国普通人群中最佳的TyG指数临界值。死亡风险高的个体可能会从对高TyG指数的适当管理中获益。
资助
国家高水平医院临床研究资助（2023 - GSP - ZD - 2，2023 - GSP - RC - 01），中国财政部和中国国家卫生健康委员会。
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