General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China.
Clinical Medical College, Southwest Medical University, Luzhou, China.
Cardiovasc Diabetol. 2024 Nov 27;23(1):427. doi: 10.1186/s12933-024-02518-2.
Globally, cardiovascular disease (CVD) constitutes the primary cause of death, with insulin resistance (IR), measured by the triglyceride-glucose (TyG) index, and visceral obesity, reflected by the Chinese Visceral Adiposity Index (CVAI), as key contributors. However, the relationship between the TyG index and CVAI regarding CVD risk remains insufficiently understood. This research investigates the interactive impact of the TyG index and CVAI on the risk of cardiovascular disease.
We analyzed data from 8,358 participants from the China Health and Retirement Longitudinal Study (CHARLS) over a 9-year follow-up period. Participants were classified into four groups based on median TyG index (8.59) and CVAI values (101.26), and baseline characteristics were summarized. Missing data were addressed using multiple imputation by chained equations (MICE). Cox proportional hazards models assessed associations between TyG index, CVAI, CVD, coronary heart disease (CHD), and stroke risks, with Kaplan-Meier analysis used for cumulative hazard. Interaction effects were evaluated using both multiplicative and additive measures. Subgroup analyses by age, gender, and clinical conditions were conducted to explore interaction effects across different populations. Sensitivity analyses re-tested models, excluding the covariates BMI and diabetes, using tertiles for classification, and re-evaluating imputed data.
Over the 9-year follow-up, 1,240 participants (14.8%) developed CVD, including 896 cases of CHD and 475 strokes. Kaplan-Meier curves indicated that participants with low TyG index but high CVAI had the highest cumulative hazard of CVD. Cox regression showed that this group had the highest CVD risk (HR = 1.87, 95% CI: 1.57-2.24), followed by those with both high TyG index and high CVAI (HR = 1.75, 95% CI: 1.49-2.06). Interaction analysis revealed a negative interaction effect between high TyG and high CVAI on CVD and CHD risks, with no significant effect on stroke. Subgroup and sensitivity analyses further confirmed these findings, showing consistent results across demographic groups and under various analytical conditions.
This study suggests that the interaction between IR (TyG index) and visceral fat accumulation (CVAI) plays a complex role in CVD risk, with a potential antagonistic effect observed between high TyG and high CVAI on CVD events. These findings highlight the importance of considering both IR and visceral adiposity in CVD risk assessments to improve the identification of high-risk individuals.
在全球范围内，心血管疾病（CVD）是主要的死亡原因，胰岛素抵抗（IR）通过甘油三酯-葡萄糖（TyG）指数来衡量，内脏肥胖通过中国内脏脂肪指数（CVAI）来反映，这两者都是导致 CVD 的关键因素。然而，TyG 指数和 CVAI 与 CVD 风险之间的关系仍不够清楚。本研究旨在探讨 TyG 指数和 CVAI 之间的交互作用对心血管疾病风险的影响。
我们对来自中国健康与退休纵向研究（CHARLS）的 8358 名参与者进行了 9 年的随访，根据 TyG 指数（8.59）和 CVAI（101.26）中位数将参与者分为四组，并总结了基线特征。使用链方程多重插补（MICE）处理缺失数据。Cox 比例风险模型评估了 TyG 指数、CVAI、CVD、冠心病（CHD）和中风风险之间的关系，使用 Kaplan-Meier 分析评估累积风险。使用乘法和加法指标评估交互作用。通过年龄、性别和临床条件进行亚组分析，以探索不同人群中的交互作用。使用三分位法进行分类，并重新评估插补数据，对不包括 BMI 和糖尿病的协变量进行敏感性分析，重新测试模型。
在 9 年的随访期间，有 1240 名参与者（14.8%）发生 CVD，包括 896 例 CHD 和 475 例中风。Kaplan-Meier 曲线表明，TyG 指数低但 CVAI 高的参与者 CVD 的累积风险最高。Cox 回归显示，该组 CVD 风险最高（HR=1.87，95%CI：1.57-2.24），其次是 TyG 指数和 CVAI 均高的参与者（HR=1.75，95%CI：1.49-2.06）。交互分析显示，高 TyG 和高 CVAI 之间对 CVD 和 CHD 风险存在负交互作用，但对中风风险无显著影响。亚组和敏感性分析进一步证实了这些发现，在不同的人口统计学群体和各种分析条件下，结果一致。
本研究表明，IR（TyG 指数）和内脏脂肪堆积（CVAI）之间的相互作用在 CVD 风险中起着复杂的作用，高 TyG 和高 CVAI 之间对 CVD 事件可能存在拮抗作用。这些发现强调了在 CVD 风险评估中同时考虑 IR 和内脏脂肪的重要性，以提高对高危个体的识别能力。
