Xu Shicong, Zhang Zhihui, Li Jing, Ding Yiyan, Chen Yuanguo, Zhou Yunxia, Hu Shenglin
Department of Cardiovascular Medicine, Ya'an People's Hospital, Ya'an, China.
Department of Nursing, Ya'an People's Hospital, Ya'an, China.
Cardiovasc Diabetol. 2025 Aug 4;24(1):317. doi: 10.1186/s12933-025-02890-7.
The triglyceride-glucose (TyG) index, a surrogate marker for insulin resistance, has been shown to be closely associated with cardiovascular risk. However, it remains unclear whether diabetes status affects the association between the TyG index and the risk of major adverse cardiovascular events (MACEs) in patients with coronary heart disease (CHD). The aim of this study is to systematically evaluate the relationship between the TyG index and MACEs among CHD patients with different diabetes statuses.
We systematically searched PubMed, the Cochrane Library, Web of Science, and Embase from inception to March 13, 2025, for cohort studies examining the association between TyG and MACEs in patients with CHD with different diabetes statuses. The outcomes included all-cause mortality, nonfatal myocardial infarction, nonfatal stroke, and revascularization. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were extracted for the TyG index as both categorical and continuous variables. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). All the statistical analyses were performed using Stata (version 17.0) and R (version 4.4.1). Depending on heterogeneity, either a fixed-effect or random-effects model was used to pool the data. Subgroup analysis and meta-regression are used to explore the sources of heterogeneity. This study was registered in PROSPERO (CRD: 420251018545).
A total of 36 longitudinal cohort studies comprising 173,851 participants (119,232 with diabetes and 54,619 without diabetes) were included, with 9159 MACEs reported during the follow-up period. In diabetic patients, a higher TyG index significantly increased the risk of MACEs (categorical HR = 1.98, 95% CI 1.61-2.43; continuous HR = 1.57, 95% CI 1.38-1.78), all-cause mortality (HR = 1.74, 95% CI 1.45-2.08), nonfatal myocardial infarction (HR = 2.05, 95% CI 1.52-2.77), nonfatal stroke (HR = 1.73, 95% CI 1.12-2.66), and revascularization (HR = 2.52, 95% CI 1.26-5.04). In nondiabetic patients, a higher TyG index also significantly increased the risk of MACEs (categorical HR = 1.65, 95% CI 1.33-2.05; continuous HR = 1.74, 95% CI 1.46-2.06), all-cause mortality (HR = 1.50, 95% CI 1.18-1.90), nonfatal myocardial infarction (HR = 2.46, 95% CI 1.11-5.47), and revascularization (HR = 2.09, 95% CI 1.57-2.76). However, no association was observed between the TyG index and nonfatal stroke (HR = 1.66, 95% CI 0.88-3.12) in nondiabetic patients.
Higher TyG index values appear to be associated with an increased risk of adverse cardiovascular events, all-cause mortality, nonfatal myocardial infarction, and revascularization in both diabetic and nondiabetic patients with CHD. However, no significant association was found between the TyG index and the risk of nonfatal stroke in nondiabetic patients. These findings suggest that the TyG index may offer potential prognostic value in CHD, but further high-quality prospective studies are warranted to confirm these associations and clarify their clinical implications.
甘油三酯-葡萄糖（TyG）指数作为胰岛素抵抗的替代指标，已被证明与心血管风险密切相关。然而，糖尿病状态是否会影响冠心病（CHD）患者中TyG指数与主要不良心血管事件（MACE）风险之间的关联仍不清楚。本研究的目的是系统评估不同糖尿病状态的CHD患者中TyG指数与MACE之间的关系。
我们系统检索了从创刊至2025年3月13日的PubMed、Cochrane图书馆、科学网和Embase，以查找检验不同糖尿病状态的CHD患者中TyG与MACE之间关联的队列研究。结局包括全因死亡率、非致命性心肌梗死、非致命性中风和血运重建。提取TyG指数作为分类变量和连续变量时的风险比（HR）及95%置信区间（95%CI）。使用纽卡斯尔-渥太华量表（NOS）评估研究质量。所有统计分析均使用Stata（17.0版）和R（4.4.1版）进行。根据异质性，采用固定效应或随机效应模型汇总数据。亚组分析和meta回归用于探索异质性来源。本研究已在PROSPERO注册（注册号：CRD: 420251018545）。
共纳入36项纵向队列研究，包括173,851名参与者（119,232名糖尿病患者和54,619名非糖尿病患者），随访期间报告了9159例MACE。在糖尿病患者中，较高的TyG指数显著增加了MACE风险（分类HR = 1.98，95%CI 1.61 - 2.43；连续HR = 1.57，95%CI 1.38 - 1.78）、全因死亡率（HR = 1.74，95%CI 1.45 - 2.08）、非致命性心肌梗死（HR = 2.05，95%CI 1.52 - 2.77）、非致命性中风（HR = 1.73，95%CI 1.12 - 2.66）和血运重建（HR = 2.52，95%CI 1.26 - 5.04）。在非糖尿病患者中，较高的TyG指数也显著增加了MACE风险（分类HR = 1.65，95%CI 1.33 - 2.05；连续HR = 1.74，95%CI 1.46 - 2.06）、全因死亡率（HR = 1.50，95%CI 1.18 - 1.90）、非致命性心肌梗死（HR = 2.46，95%CI 1.11 - 5.47）和血运重建（HR = 2.09，95%CI 1.57 - 2.76）。然而，在非糖尿病患者中未观察到TyG指数与非致命性中风之间的关联（HR = 1.66，95%CI 0.88 - 3.12）。
较高的TyG指数值似乎与糖尿病和非糖尿病CHD患者发生不良心血管事件、全因死亡率、非致命性心肌梗死和血运重建的风险增加相关。然而，在非糖尿病患者中未发现TyG指数与非致命性中风风险之间存在显著关联。这些发现表明TyG指数可能在CHD中具有潜在的预后价值，但需要进一步高质量的前瞻性研究来证实这些关联并阐明其临床意义。
