Shao Xinyi, Tan Zhaofu, Sun Lifu, Fu Yidian, Chen Aijun, Chen Jin, Bai Genlong, Zhang Jingbo
Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan.
Cardiovasc Diabetol. 2025 Dec 13;24(1):456. doi: 10.1186/s12933-025-03021-y.
The triglyceride-glucose (TyG) index, a measure of insulin resistance, has been confirmed to be associated with adverse clinical outcomes. A new composite indicator, the TyG-A body type index (TyG-ABSI), was developed by integrating the TyG index and the A body type index. This study aimed to thoroughly investigate the association between the TyG-ABSI and the risk of atherosclerotic cardiovascular disease (ASCVD) among individuals with normoglycemia, dysglycemia, and diabetes.
Participants from the UK Biobank were included and categorized into 3 groups: normoglycemia, dysglycemia (prediabetes), and diabetes. The primary study outcome was the incidence of all-cause ASCVD. Cox regression and restricted cubic spline (RCS) analyses were performed to evaluate the linear and nonlinear associations between the TyG-ABSI and ASCVD. Furthermore, time-dependent receiver operating characteristic (ROC) curves were constructed to evaluate the discriminative performance of the TyG-ABSI and other indices. Additional analyses, including Kaplan-Meier survival curves, subgroup analyses, and sensitivity analyses, were conducted to assess robustness. A mediation analysis was performed to identify potential biomarkers.
During an average follow-up of 14.8 years, a total of 29,680 ASCVD events were documented. The results indicated that elevated TyG-ABSI values were positively associated with the risk of ASCVD in the population with normoglycemia (nonlinear, P for nonlinear < 0.001) and diabetes (linear, P for nonlinear = 0.96) (HR = 1.07, 95% CI: 1.05-1.09; HR = 1.10, 95% CI: 1.06-1.14, respectively). No significant associations were detected in the dysglycemia group. Compared with the TyG index and other TyG-derived metrics, the TyG-ABSI demonstrated superior predictive performance (e.g., 10-year AUC = 0.634 in the normoglycemia group). Subgroup analyses and sensitivity analyses confirmed the robustness of our findings. Moreover, the results of the mediation analysis demonstrated that white blood cell (WBC) count (mediation proportions: 3.74-9.73%) and C-reactive protein (CRP) level (mediation proportions: 9.96-26.89%) significantly mediated the association between the TyG-ABSI and ASCVD.
In the normoglycemia subgroup, the association between the TyG-ABSI and ASCVD was nonlinear. Moreover, the TyG-ABSI was linearly associated with an increased risk of ASCVD in the diabetes subgroup but not in the dysglycemia subgroup. The predictive value of the TyG-ABSI across different glycemic statuses provides new evidence for medical practice. Furthermore, the TyG-ABSI may serve as a useful tool for identifying high-risk individuals within the seemingly low-risk normoglycemic population and for further risk identification among diabetic patients.
甘油三酯-葡萄糖（TyG）指数作为胰岛素抵抗的一种衡量指标，已被证实与不良临床结局相关。通过整合TyG指数和A体型指数，开发了一种新的综合指标——TyG-A体型指数（TyG-ABSI）。本研究旨在深入探究TyG-ABSI与血糖正常、血糖异常和糖尿病个体发生动脉粥样硬化性心血管疾病（ASCVD）风险之间的关联。
纳入英国生物银行的参与者，并将其分为3组：血糖正常、血糖异常（糖尿病前期）和糖尿病。主要研究结局是全因ASCVD的发病率。进行Cox回归和限制立方样条（RCS）分析，以评估TyG-ABSI与ASCVD之间的线性和非线性关联。此外，构建时间依赖性受试者工作特征（ROC）曲线，以评估TyG-ABSI和其他指标的判别性能。进行了包括Kaplan-Meier生存曲线、亚组分析和敏感性分析在内的额外分析，以评估结果的稳健性。进行中介分析以确定潜在的生物标志物。
在平均14.8年的随访期间，共记录了29680例ASCVD事件。结果表明，TyG-ABSI值升高与血糖正常人群（非线性，非线性P<0.001）和糖尿病患者（线性，非线性P = 0.96）发生ASCVD的风险呈正相关（HR分别为1.07，95%CI：1.05-1.09；HR为1.10，95%CI：1.06-1.14）。在血糖异常组中未检测到显著关联。与TyG指数和其他TyG衍生指标相比，TyG-ABSI表现出更好的预测性能（例如，在血糖正常组中10年AUC = 0.634）。亚组分析和敏感性分析证实了我们研究结果的稳健性。此外，中介分析结果表明，白细胞（WBC）计数（中介比例：3.74-9.73%）和C反应蛋白（CRP）水平（中介比例：9.96-26.89%）显著介导了TyG-ABSI与ASCVD之间的关联。
在血糖正常亚组中，TyG-ABSI与ASCVD之间的关联是非线性的。此外，TyG-ABSI与糖尿病亚组中ASCVD风险增加呈线性相关，但与血糖异常亚组无关。TyG-ABSI在不同血糖状态下的预测价值为医学实践提供了新的证据。此外，TyG-ABSI可能是一种有用的工具，可用于在看似低风险的血糖正常人群中识别高危个体，并在糖尿病患者中进行进一步的风险识别。
