China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of Cardiology, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang District, 100029, Beijing, China.
Cardiovasc Diabetol. 2024 Aug 22;23(1):307. doi: 10.1186/s12933-024-02396-8.
BACKGROUND: The triglyceride-glucose (TyG) index and estimated glucose disposal rate (eGDR), which are calculated using different parameters, are widely used as markers of insulin resistance and are associated with cardiovascular diseases and prognosis. However, whether they have an additive effect on the risk of mortality remains unclear. This study aimed to explore whether the combined assessment of the TyG index and eGDR improved the prediction of long-term mortality in individuals with and without diabetes. METHODS: In this cross-sectional and cohort study, data were derived from the National Health and Nutrition Examination Survey (NHANES) 2001-2018, and death record information was obtained from the National Death Index. The associations of the TyG index and eGDR with all-cause and cardiovascular mortality were determined by multivariate Cox regression analysis and restricted cubic splines. RESULTS: Among the 17,787 individuals included in the analysis, there were 1946 (10.9%) all-cause deaths and 649 (3.6%) cardiovascular deaths during a median follow-up of 8.92 years. In individuals with diabetes, the restricted cubic spline curves for the associations of the TyG index and eGDR with mortality followed a J-shape and an L-shape, respectively. The risk of mortality significantly increased after the TyG index was > 9.04 (all-cause mortality) or > 9.30 (cardiovascular mortality), and after eGDR was < 4 mg/kg/min (both all-cause and cardiovascular mortality). In individuals without diabetes, the association between eGDR and mortality followed a negative linear relationship. However, there was no association between the TyG index and mortality. Compared with individuals in the low TyG and high eGDR group, those in the high TyG and low eGDR group (TyG > 9.04 and eGDR < 4) showed the highest risk for all-cause mortality (hazard ratio [HR] = 1.592, 95% confidence interval [CI] 1.284-1.975) and cardiovascular mortality (HR = 1.683, 95% CI 1.179-2.400) in the overall population. Similar results were observed in individuals with and without diabetes. CONCLUSIONS: There was a potential additive effect of the TyG index and eGDR on the risk of long-term mortality in individuals with and without diabetes, which provided additional information for prognostic prediction and contributed to improving risk stratification.
背景：甘油三酯-葡萄糖（TyG）指数和估计葡萄糖处置率（eGDR）是使用不同参数计算得出的，它们被广泛用作胰岛素抵抗的标志物，与心血管疾病和预后相关。然而，它们对死亡率的风险是否具有附加效应尚不清楚。本研究旨在探讨 TyG 指数和 eGDR 的联合评估是否能改善有或无糖尿病个体的长期死亡率预测。
方法：本研究采用横断面和队列研究，数据来源于 2001-2018 年国家健康与营养调查（NHANES），并从国家死亡指数获取死亡记录信息。采用多变量 Cox 回归分析和限制立方样条评估 TyG 指数和 eGDR 与全因和心血管死亡率的关系。
结果：在纳入分析的 17787 人中，中位随访 8.92 年后有 1946 人（10.9%）发生全因死亡，649 人（3.6%）发生心血管死亡。在有糖尿病的个体中，TyG 指数和 eGDR 与死亡率的关联限制立方样条曲线呈 J 形和 L 形。当 TyG 指数>9.04（全因死亡率）或>9.30（心血管死亡率），或 eGDR<4mg/kg/min（全因和心血管死亡率均）时，死亡率的风险显著增加。在无糖尿病的个体中，eGDR 与死亡率呈负线性关系。然而，TyG 指数与死亡率之间无关联。与低 TyG 和高 eGDR 组的个体相比，高 TyG 和低 eGDR 组（TyG>9.04 和 eGDR<4）的个体在总体人群中全因死亡率（危险比 [HR]1.592，95%置信区间 [CI]1.284-1.975）和心血管死亡率（HR 1.683，95%CI 1.179-2.400）的风险最高。在有和无糖尿病的个体中均观察到类似的结果。
结论：在有或无糖尿病的个体中，TyG 指数和 eGDR 对长期死亡率的风险可能具有潜在的附加效应，这为预后预测提供了额外的信息，并有助于改善风险分层。
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