Ding Lei, Zhang Hongda, Liu Yuandong, Jiang Zihan, Yu Fengyuan, Qi Yingjie, Zhou Bin, Shen Yujing, Tang Min
Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Union Medical College, Beijing, 100037, China.
Department of Cardiology, Fuwai Shenzhen Hospital, Chinese Academy of Medical Sciences, Shenzhen, China.
Cardiovasc Diabetol. 2025 Oct 29;24(1):414. doi: 10.1186/s12933-025-02963-7.
The triglyceride-glucose (TyG) related indices are simple biomarkers of insulin resistance and are associated with metabolic syndrome (MetS) and atrial fibrillation (AF). However, whether TyG-related indices are linked to all-cause and cardiovascular mortality in individuals with coexisting AF and MetS remains unclear.
We included 2535 participants with both AF and MetS from the UK Biobank. TyG-related indices, including TyG, TyG combined with body mass index (TyG-BMI), TyG combined with waist circumference (TyG-WC), and TyG combined with the waist-to-height ratio (TyG-WHtR), were calculated. The study endpoints were all-cause and cardiovascular mortality. Participants were followed until death or December 31, 2023, whichever occurred first. Associations between TyG-related indices and mortality outcomes were assessed using Cox proportional hazards models and restricted cubic spline (RCS) analyses.
Over a mean follow-up period of 12.7 years (IQR: 11.8‒15.2), 956 all-cause deaths and 385 cardiovascular deaths were documented. Kaplan‒Meier survival analyses revealed the highest incidence of all-cause mortality in the fourth quartile of TyG (log-rank P < 0.001). Compared with individuals in the second quartile, individuals in the highest quartile had a significantly increased risk of all-cause mortality (TyG: hazard ratio (HR) 1.36, 95% confidence interval (CI): (1.14‒1.64); TyG-BMI: 1.31, 1.10‒1.56; TyG-WC: 1.41, 1.18‒1.68; TyG-WHtR: 1.56, 1.3‒-1.86). Moreover, TyG, TyG-BMI, and TyG-WHtR were significantly associated with cardiovascular mortality (TyG: HR 1.47, 95% CI 1.10‒1.95; TyG-WC: 1.41, 1.03‒1.93; TyG‒WHtR: 1.35, 1.01‒1.80). RCS analyses revealed nonlinear association between TyG and mortality and between TyG-BMI and all-cause mortality (all P < 0.05). The results of the sensitivity and subgroup analyses were consistent with those of the primary analyses.
This study demonstrateed the prognostic value of TyG-related indices in individuals with AF and MetS. These indices may serve as practical surrogate markers for risk stratification and the prevention of adverse outcomes.
甘油三酯-葡萄糖（TyG）相关指标是胰岛素抵抗的简单生物标志物，与代谢综合征（MetS）和心房颤动（AF）相关。然而，在同时患有AF和MetS的个体中，TyG相关指标是否与全因死亡率和心血管死亡率相关仍不清楚。
我们纳入了英国生物银行中2535名同时患有AF和MetS的参与者。计算了TyG相关指标，包括TyG、TyG与体重指数结合（TyG-BMI）、TyG与腰围结合（TyG-WC）以及TyG与腰高比结合（TyG-WHtR）。研究终点为全因死亡率和心血管死亡率。对参与者进行随访，直至死亡或2023年12月31日，以先发生者为准。使用Cox比例风险模型和受限立方样条（RCS）分析评估TyG相关指标与死亡率结局之间的关联。
在平均12.7年的随访期（四分位间距：11.8 - 15.2）内，记录了956例全因死亡和385例心血管死亡。Kaplan-Meier生存分析显示，TyG第四四分位数组的全因死亡率最高（对数秩P < 0.001）。与第二四分位数组的个体相比，最高四分位数组的个体全因死亡风险显著增加（TyG：风险比（HR）1.36，95%置信区间（CI）：（1.14 - 1.64）；TyG-BMI：1.31，1.10 - 1.56；TyG-WC：1.41，1.18 - 1.68；TyG-WHtR：1.56，1.3 - 1.86）。此外，TyG、TyG-BMI和TyG-WHtR与心血管死亡率显著相关（TyG：HR 1.47，95% CI 1.10 - 1.95；TyG-WC：1.41，1.03 - 1.93；TyG-WHtR：1.35，1.01 - 1.80）。RCS分析显示TyG与死亡率之间以及TyG-BMI与全因死亡率之间存在非线性关联（所有P < 0.05）。敏感性分析和亚组分析结果与主要分析结果一致。
本研究证明了TyG相关指标在AF和MetS个体中的预后价值。这些指标可作为风险分层和预防不良结局的实用替代标志物。
