Zhou Xingyu, Liu Yisi, Peng Jiafei, Zhou Xianliang, Wei Hongtao
National Clinical Research Center of 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, China.
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Cardiovasc Med. 2025 Jun 23;12:1612121. doi: 10.3389/fcvm.2025.1612121. eCollection 2025.
Cardiovascular-kidney-metabolic (CKM) syndrome is highly prevalent among adults and contributes substantially to cardiovascular morbidity and mortality. However, strategies for its early identification and prevention remain inadequately defined. The triglyceride-glucose (TyG) index, a surrogate marker of insulin resistance, may be associated with CKM progression, but its role across diverse populations and CKM progression patterns warrants further investigation.
A total of 6,311 participants from the China Health and Retirement Longitudinal Study (CHARLS) were included. Associations between the TyG index and CKM progression were assessed using Cox proportional hazards and restricted cubic spline models. Subgroup analyses were conducted by age (<65 vs. ≥65 years), sex, and baseline CKM stage. CKM progression was further categorized to explore associations with specific metabolic outcomes.
Among 6,311 participants (mean age 57.8 years, 46.3% male), 31.3% experienced CKM progression over a median follow-up of 48 months. The TyG index was significantly associated with CKM progression in individuals aged ≥65 years, with a notable interaction between age and TyG ( for interaction <0.001). In participants with baseline CKM stage 0 or 1, higher TyG levels predicted greater CKM progression risk. A U-shaped relationship was observed in stage 0 ( = 0.018, for non-linearity = 0.09), whereas a linear positive association was noted in stage 1 ( = 0.002, for non-linearity = 0.008). Elevated TyG was primarily linked to subsequent hypertriglyceridemia in stage 0 (Q4 vs. Q1: HR 3.13, 95% CI 1.65-5.91, < 0.001) and to future diabetes (Q4 vs. Q1: HR 2.85, 95% CI 1.56-5.22, < 0.01), metabolic syndrome (Q4 vs. Q1: HR 1.62, 95% CI 1.10-2.37, < 0.05), and hypertriglyceridemia (Q3 vs. Q1: HR 1.63, 95% CI 1.13-2.34, < 0.01; Q4 vs. Q1: HR 2.21, 95% CI 1.58-3.08, < 0.01) in stage 1.
Elevated TyG index is a significant predictor of CKM progression, particularly via the development of metabolic abnormalities. Its predictive value varies across age groups and CKM stages. Early screening and intervention targeting TyG levels, especially in older adults and those with early-stage CKM, may be critical for halting CKM progression and reducing future cardiovascular risk.
心血管-肾脏-代谢（CKM）综合征在成年人中高度流行，对心血管疾病的发病率和死亡率有重大影响。然而，其早期识别和预防策略仍未得到充分明确。甘油三酯-葡萄糖（TyG）指数作为胰岛素抵抗的替代指标，可能与CKM进展相关，但其在不同人群和CKM进展模式中的作用值得进一步研究。
纳入了来自中国健康与养老追踪调查（CHARLS）的6311名参与者。使用Cox比例风险模型和限制性立方样条模型评估TyG指数与CKM进展之间的关联。按年龄（<65岁与≥65岁）、性别和基线CKM分期进行亚组分析。对CKM进展进行进一步分类，以探索与特定代谢结局的关联。
在6311名参与者（平均年龄57.8岁，男性占46.3%）中，在中位随访48个月期间，31.3%经历了CKM进展。TyG指数与≥65岁个体的CKM进展显著相关，年龄与TyG之间存在显著交互作用（交互作用P<0.001）。在基线CKM分期为0或1的参与者中，较高的TyG水平预示着更高的CKM进展风险。在0期观察到U型关系（P=0.018，非线性P=0.09），而在1期观察到线性正相关（P=0.002，非线性P=0.008）。TyG升高在0期主要与随后的高甘油三酯血症相关（四分位数4 vs. 四分位数1：HR 3.13，95%CI 1.65-5.91，P<0.001），在1期与未来糖尿病（四分位数4 vs. 四分位数1：HR 2.85，95%CI
