Zhao Songfeng, Duan Jiayue
Peking Union Medical College Hospital, Beijing, China.
Department of Neurosurgery, Third Xiangya Hospital of Central South University, Changsha, Hunan, China.
BMJ Open. 2025 May 21;15(5):e093383. doi: 10.1136/bmjopen-2024-093383.
The study investigated the association between the triglyceride-glucose (TyG) index (a surrogate measure for insulin resistance) and all-cause and cardiovascular disease (CVD) mortality among individuals with cardiovascular-kidney-metabolic syndrome.
Population-based cohort study.
US National Health and Nutrition Examination Survey, 1999-2018.
A total of 13 585 participants who had valid data were included in this analysis.
Data from the participants were linked to death certificates to obtain follow-up mortality information from the National Death Index. Cox proportional hazards models were used to assess the associations between the TyG index and all-cause and CVD mortality. Non-linear associations and threshold effects were investigated using restricted cubic spline regression and a two-piecewise Cox proportional hazards model.
During a median follow-up of 99 months, a total of 2876 (16.24%) deaths occurred, of which 961 were attributed to CVD. Each one-unit increase in the TyG index was associated with an 8.9% relative increase in the hazard of all-cause mortality (HR 1.089, 95% CI 1.013 to 1.171) and a 19.5% relative increase in the hazard of CVD mortality (HR 1.195, 95% CI 1.027 to 1.390). Non-linear relationships were identified between the TyG index and all-cause and CVD mortality, with threshold values of 8.97 and 8.81 for all-cause and CVD mortality, respectively. A significant interaction effect was found between age and the TyG index.
There was a U-shaped relationship between the TyG index and both all-cause and CVD mortality. The thresholds of the TyG index may serve as potential tools for managing populations with cardiovascular-kidney-metabolic syndrome to reduce mortality risk.
本研究调查了甘油三酯-葡萄糖（TyG）指数（胰岛素抵抗的替代指标）与心血管-肾脏-代谢综合征患者的全因死亡率和心血管疾病（CVD）死亡率之间的关联。
基于人群的队列研究。
美国1999 - 2018年国家健康与营养检查调查。
本分析共纳入13585名有有效数据的参与者。
参与者的数据与死亡证明相关联，以从国家死亡指数获取随访死亡率信息。采用Cox比例风险模型评估TyG指数与全因死亡率和CVD死亡率之间的关联。使用受限立方样条回归和两段式Cox比例风险模型研究非线性关联和阈值效应。
在中位随访99个月期间，共发生2876例（16.24%）死亡，其中961例归因于CVD。TyG指数每增加一个单位，全因死亡率风险相对增加8.9%（风险比1.089，95%置信区间1.013至1.171），CVD死亡率风险相对增加19.5%（风险比1.195，95%置信区间1.027至1.390）。TyG指数与全因死亡率和CVD死亡率之间存在非线性关系，全因死亡率和CVD死亡率的阈值分别为8.97和8.81。年龄与TyG指数之间存在显著的交互作用。
TyG指数与全因死亡率和CVD死亡率之间呈U形关系。TyG指数的阈值可作为管理心血管-肾脏-代谢综合征人群以降低死亡风险的潜在工具。
