The triglyceride-glucose index is associated with atherosclerosis in patients with symptomatic coronary artery disease, regardless of diabetes mellitus and hyperlipidaemia

Abstract

Background: Diabetes and hyperlipidaemia are both risk factors for coronary artery disease, and both are associated with a high triglyceride-glucose index (TyG index). The TyG index has been presented as a marker of insulin resistance (IR). Its utility in predicting and detecting cardiovascular disease has been reported. However, few studies have found it to be a helpful marker of atherosclerosis in patients with symptomatic coronary artery disease (CAD). The purpose of this study was to demonstrate that the TyG index can serve as a valuable marker for predicting coronary and carotid atherosclerosis in symptomatic CAD patients, regardless of diabetes mellitus and hyperlipidaemia.

Methods: This study included 1516 patients with symptomatic CAD who underwent both coronary artery angiography and carotid Doppler ultrasound in the Department of Cardiology at Tianjin Union Medical Center from January 2016 to December 2022. The TyG index was determined using the Ln formula. The population was further grouped and analysed according to the presence or absence of diabetes and hyperlipidaemia. The Gensini score and carotid intima-media thickness were calculated or measured, and the patients were divided into four groups according to TyG index quartile to examine the relationship between the TyG index and coronary or carotid artery lesions in symptomatic CAD patients.

Results: In symptomatic CAD patients, the TyG index showed a significant positive correlation with both coronary lesions and carotid plaques. After adjusting for sex, age, smoking, BMI, hypertension, diabetes, and the use of antilipemic and antidiabetic agents, the risk of developing coronary lesions and carotid plaques increased across the baseline TyG index. Compared with the lowest quartile of the TyG index, the highest quartile (quartile 4) was associated with a greater incidence of coronary heart disease [OR = 2.55 (95% CI 1.61, 4.03)] and carotid atherosclerotic plaque [OR = 2.31 (95% CI 1.27, 4.20)] (P < 0.05). Furthermore, when compared to the fasting blood glucose (FBG) or triglyceride (TG) level, the TyG index had a greater area under the ROC curve for predicting coronary lesions and carotid plaques. The subgroup analysis demonstrated the TyG index to be an equally effective predictor of coronary and carotid artery disease, regardless of diabetes and hyperlipidaemia.

Conclusion: The TyG index is a useful marker for predicting coronary and carotid atherosclerosis in patients with symptomatic CAD, regardless of diabetes mellitus and hyperlipidaemia. The TyG index is of higher value for the identification of both coronary and carotid atherosclerotic plaques than the FBG or TG level alone.

Keywords: Carotid atherosclerosis; Coronary atherosclerosis; Diabetes mellitus; Hyperlipidaemia; Risk factors; Triglyceride-glucose index.

Fig. 1

Correction of the TyG index with risk factors for CHD. P < 0.05 were considered statistically significant. CHD coronary heart disease, BMI body mass index, DM diabetes mellitus, SBP systolic blood pressure, DBP diastolic blood pressure, PLT platelet count, HbA1c glycosylated hemoglobin A1c, FBG fasting blood glucose, TG triglyceride, TC total cholesterol, LDL-C low-density lipoprotein, VLDL-C very low-density lipoprotein cholesterol, HDL-C high-density lipoprotein

Fig. 2

Relationship between Gensini score and the TyG index in CHD patients. A The Gensini score by TyG index quartile; B the TyG index by Gensini score tertile. *P < 0.05. T1 the first TyG index quartile, T4 the fourth TyG index quartile

Fig. 3

Connection between carotid lesions and the TyG index in symptomatic CAD patients. A, B The TyG index by carotid lesions groups; C proportion of carotid ultrasound findings by TyG index quartile; D plaque thickness by TyG index quartile. *P < 0.05. T1 the first TyG index quartile, T4 the fourth TyG index quartile

Fig. 4

ROC analyses of the TyG index. CHD coronary heart disease, FBG fasting blood glucose, TG triglyceride, ROC receiver operating characteristic curve

Fig. 5

Relationship between the TyG index and coronary lesions in patients with or without diabetes. *P < 0.05. T1 the first TyG index quartile, T4 the fourth TyG index quartile, CHD coronary heart disease

Fig. 6

Connection between carotid lesions and the TyG index in patients with or without diabetes. *P < 0.05. T1 the first TyG index quartile, T4 the fourth TyG index quartile

Fig. 7

Relationship of the TyG index and coronary lesions in patients with or without hyperlipidaemia. *P < 0.05. T1 the first TyG index quartile, T4 the fourth TyG index quartile, CHD coronary heart disease

Fig. 8

Connection between carotid lesions and the TyG index in patients with or without hyperlipidaemia. *P < 0.05. T1 the first TyG index quartile, T4 the fourth TyG index quartile