Liu Jiajun, Kang Jinhua, Liang Pengpeng, Song Zhangxiao, Li Guiyun, Jin Xueshan, Wu Hongyan
Shanghai University of Traditional Chinese Medicine, Shenzhen Hospital, Shenzhen, China.
Luohu District Hospital of Traditional Chinese Medicine, Shenzhen, China.
Cardiovasc Diabetol. 2025 Sep 24;24(1):367. doi: 10.1186/s12933-025-02826-1.
The triglyceride-glucose index (TyG) is an emerging marker of metabolic health, yet its association with mortality across different glucose metabolism statuses remains unclear. This study aimed to investigate the relationship between the TyG and the risk of all-cause and cardiovascular mortality among individuals with normoglycemia, dysglycemia, and diabetes mellitus.
Participants from nine cycles of the National Health and Nutrition Examination Survey (NHANES) were included and categorized into three groups: normoglycemia, dysglycemia, and diabetes. Cox regression and restricted cubic spline (RCS) analyses were performed to evaluate the linear and nonlinear associations between TyG and mortality. To assess the predictive power of TyG and the atherogenic index of plasma (AIP) for mortality, time-dependent receiver operating characteristic (ROC) curves were constructed. Subgroup analyses were conducted based on age, sex, and blood pressure status.
During a median follow-up of 9.2 years, a total of 2199 all-cause deaths and 606 cardiovascular deaths were documented. In the normoglycemic group, a single standard unit increase in TyG was associated with a 35% higher risk of all-cause mortality and a 38% higher risk of cardiovascular mortality (HR: 1.35, 95% CI 1.17-1.56; HR: 1.38, 95% CI 1.04-1.84, respectively). Among participants with diabetes, RCS analysis revealed a U-shaped association between TyG and all-cause/cardiovascular mortality, with an inflection point at 9.1. No significant associations were observed in the dysglycemia group. TyG demonstrated superior predictive performance compared to the AIP for 3-year mortality in both normoglycemic and diabetic individuals. Subgroup analyses identified significant interaction effects of age and sex on the association between TyG and mortality.
TyG was associated with an increased risk of all-cause and cardiovascular death in the normoglycemic subgroup, but not in the dysglycemic subgroup. In the diabetes subgroup, the association between the TyG and mortality was nonlinear. The predictive value of TyG across different glucose metabolism statuses provides new evidence for medical practice.
甘油三酯-葡萄糖指数（TyG）是一种新兴的代谢健康标志物，但其与不同糖代谢状态下死亡率的关联仍不明确。本研究旨在探讨TyG与血糖正常、血糖异常和糖尿病患者全因死亡及心血管死亡风险之间的关系。
纳入来自九个周期的美国国家健康与营养检查调查（NHANES）的参与者，并将其分为三组：血糖正常、血糖异常和糖尿病组。采用Cox回归和限制性立方样条（RCS）分析来评估TyG与死亡率之间的线性和非线性关联。为评估TyG和血浆致动脉粥样硬化指数（AIP）对死亡率的预测能力，构建了时间依赖性受试者工作特征（ROC）曲线。根据年龄、性别和血压状态进行亚组分析。
在中位随访9.2年期间，共记录了2199例全因死亡和606例心血管死亡。在血糖正常组中，TyG每增加一个标准差单位，全因死亡风险增加35%，心血管死亡风险增加38%（HR分别为1.35，95%CI 1.17-1.56；HR为1.38，95%CI 1.04-1.84）。在糖尿病患者中，RCS分析显示TyG与全因/心血管死亡率之间呈U形关联，拐点为9.1。在血糖异常组中未观察到显著关联。在血糖正常和糖尿病个体中，TyG在预测3年死亡率方面表现优于AIP。亚组分析确定了年龄和性别对TyG与死亡率之间关联的显著交互作用。
TyG与血糖正常亚组中全因和心血管死亡风险增加相关，但与血糖异常亚组无关。在糖尿病亚组中，TyG与死亡率之间的关联是非线性的。TyG在不同糖代谢状态下的预测价值为医学实践提供了新证据。
