The association between triglyceride-glucose index and its combination with obesity indicators and cardiovascular disease: NHANES 2003-2018

Abstract

Background: In the American population, the relationship between the triglyceride-glucose (TyG) index and TYG combined with indicators of obesity and cardiovascular disease (CVD) and its mortality has been less well studied.

Methods: This cross-sectional study included 11,937 adults from the National Health and Nutrition Examination Survey (NHANES) 2003-2018. Cox proportional hazards model, binary logistic regression analyses, restricted cubic spline (RCS), and receiver operating characteristic (ROC) were used to analyze the relationship between TyG and its combined obesity-related indicators and CVD and its mortality. Mediation analysis explored the mediating role of glycated hemoglobin and insulin in the above relationships.

Results: In this study, except for no significant association between TyG and CVD mortality, TyG, TyG-WC, TyG-WHtR, and TyG-BMI were significantly and positively associated with CVD and CVD mortality. TyG-WHtR is the strongest predictor of CVD mortality (HR 1.66, 95% CI 1.21-2.29). The TyG index correlated better with the risk of coronary heart disease (OR 2.52, 95% CI 1.66-3.83). TyG-WC correlated best with total CVD (OR 2.37, 95% CI 1.77-3.17), congestive heart failure (OR 2.14, 95% CI 1.31-3.51), and angina pectoris (OR 2.38, 95% CI 1.43-3.97). TyG-WHtR correlated best with myocardial infarction (OR 2.24, 95% CI 1.45-3.44). RCS analyses showed that most of the above relationships were linear (P-overall < 0.0001, P-nonlinear > 0.05). Otherwise, ROC curves showed that TyG-WHtR and TyG-WC had more robust diagnostic efficacy than TyG. In mediation analyses, glycated hemoglobin mediated in all the above relationships and insulin-mediated in partial relationships.

Conclusions: TyG-WC and TyG-WtHR enhance CVD mortality prediction, diagnostic efficacy of CVD and its mortality, and correlation with some CVD over and above the current hottest TyG. TyG-WC and TyG-WtHR are expected to become more effective metrics for identifying populations at early risk of cardiovascular disease and improve risk stratification.

Keywords: Cardiovascular disease; Cardiovascular disease (CVD) mortality; National Health and Nutrition Examination Survey (NHANES); Triglyceride glucose (TyG); Triglyceride glucose-body mass index (TyG-BMI); Triglyceride glucose-waist circumference (TyG-WC); Triglyceride glucose-waist height ratio (TyG-WHtR).

Fig. 1

Flowchart depicting the participants’ selection

Fig. 2

Forest plot of the TyG, TyG-WC, TyG-WHtR, and TyG-BMI association with CVD mortality, total CVD, congestive heart failure, myocardial infarction, angina pectoris, and coronary heart disease calculated using binomial logistic regression models/Cox proportional hazards model. The adjustments involved the covariables selected in the full binomial logistic regression model/Cox proportional hazards model. Case/N, the number of case subjects/total. Q quartile

Fig. 3

Associations between TyG, TyG-WC, TyG-WHtR, and TyG-BMI with cardiovascular mortality, total CVD, congestive heart failure, myocardial infarction, angina pectoris, and coronary heart disease were evaluated by RCS after adjustment for the covariables. The solid black lines correspond to the central estimates, and the gray-shaded regions indicate the 95% confidence intervals