Liu Jiajun, Fu Yihui, Liang Pengpeng, Song Zhangxiao, Li Yue, Wu Hongyan
Shanghai University of Traditional Chinese Medicine, Shenzhen Hospital, Shenzhen, China.
Luohu District Hospital of Traditional Chinese Medicine, Shenzhen, China.
Cardiovasc Diabetol. 2025 Feb 28;24(1):96. doi: 10.1186/s12933-025-02587-x.
Triglyceride glucose index (TyG) serves as an effective parameter for assessing metabolic status. However, it remains uncertain whether TyG and other metabolic parameters can predict clinical outcomes in people with metabolic syndrome (MetS). We investigated the association of TyG, triglyceride glucose-waist to height ratio (TyG-WHtR), and metabolic score for insulin resistance (METS-IR) with all-cause and cardiovascular mortality in the MetS cohort and determined whether this association changes with age.
Participants enrolled in the National Health and Nutrition Examination Survey (NHANES) between 2001 and 2018 were selected and categorized into two groups: younger individuals (age < 65 years) and older individuals (age ≥ 65 years). Three new metabolic indices of TyG, TyG-WHtR, and METS-IR were constructed. The weighted Cox proportional hazards model and restricted cubic spline (RCS) models were employed to evaluate the relation between three indices and mortality outcomes. The time-dependent receiver operating characteristic (ROC) curve assessed the ability of different indices to predict mortality. Sensitivity analysis was conducted to evaluate the robustness and reliability of the findings.
The study comprised a total of 8271 participants, including 5456 younger participants and 2815 older participants, and 1407 deaths were observed over a median follow-up period of 8.3 years. Compared with the first quartile (Q1), the fourth quartile's (Q4) TyG, TyG-WHtR, and METS-IR were linked to an increased risk of all-cause mortality (HR 1.63, 95% CI 1.12-2.39; HR 2.78, 95% CI 1.68-4.61; HR 1.36, 95% CI 1.12-2.02, respectively) and cardiovascular mortality (HR 2.04, 95% CI 1.15-4.90; HR 4.99, 95% CI 1.76-14.11; HR 2.69, 95% CI 1.89-8.15, respectively) in the younger group but not in the older group. The RCS results showed no significant non-linear associations between TyG, TyG-WHtR, METS-IR, and all-cause (P = 0.082; P = 0.712; P = 0.062, respectively) or cardiovascular mortality (P = 0.176; P = 0.793; P = 0.482, respectively) in the older age group. TyG-WHtR demonstrated the highest area under the curve for predicting 3-year mortality in the younger age group, with values of 0.653 for all-cause mortality and 0.688 for cardiovascular mortality.
Our results highlight the predictive value of TyG, TyG-WHtR, and METS-IR in the MetS population, providing new evidence for medical practice and public health.
甘油三酯葡萄糖指数（TyG）是评估代谢状态的有效参数。然而，TyG和其他代谢参数能否预测代谢综合征（MetS）患者的临床结局仍不确定。我们研究了TyG、甘油三酯葡萄糖-腰高比（TyG-WHtR）和胰岛素抵抗代谢评分（METS-IR）与MetS队列中全因死亡率和心血管死亡率的关联，并确定这种关联是否随年龄变化。
选取2001年至2018年参加美国国家健康与营养检查调查（NHANES）的参与者，分为两组：年轻个体（年龄<65岁）和老年个体（年龄≥65岁）。构建了TyG、TyG-WHtR和METS-IR这三个新的代谢指标。采用加权Cox比例风险模型和限制立方样条（RCS）模型评估这三个指标与死亡率结局之间的关系。时间依赖性受试者工作特征（ROC）曲线评估不同指标预测死亡率的能力。进行敏感性分析以评估研究结果的稳健性和可靠性。
该研究共纳入8271名参与者，其中5456名年轻参与者和2815名老年参与者，在中位随访期8.3年期间观察到1407例死亡。与第一四分位数（Q1）相比，第四四分位数（Q4）的TyG、TyG-WHtR和METS-IR与年轻组全因死亡率（HR分别为1.63，95%CI 1.12-2.39；HR 2.78，95%CI 1.68-4.61；HR 1.36，95%CI 1.12-2.02）和心血管死亡率（HR分别为2.04，95%CI 1.15-4.90；HR 4.99，95%CI 1.76-14.11；HR 2.69，95%CI 1.89-8.15）风险增加相关，但在老年组中无此关联。RCS结果显示，老年组中TyG、TyG-WHtR、METS-IR与全因死亡率（P分别为0.082；P为0.712；P为0.062）或心血管死亡率（P分别为0.176；P为0.793；P为0.482）之间无显著非线性关联。TyG-WHtR在年轻组预测3年死亡率的曲线下面积最高，全因死亡率为定值0.653，心血管死亡率为定值0.688。
我们的研究结果突出了TyG、TyG-WHtR和METS-IR在MetS人群中的预测价值，为医学实践和公共卫生提供了新证据。
