Association of the triglyceride-glucose index with all-cause and cardiovascular mortality in patients with cardiometabolic syndrome: a national cohort study

Abstract

Objective: This study aimed to evaluate the association of triglyceride-glucose (TyG) index with all-cause and cardiovascular mortality risk among patients with cardiometabolic syndrome (CMS).

Methods: We performed a cohort study of 5754 individuals with CMS from the 2001-2018 National Health and Nutrition Examination Survey. The TyG index was calculated as Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Multivariate Cox proportional hazards regression models assessed the associations between TyG index and mortality . Non-linear correlations and threshold effects were explored using restricted cubic splines and a two-piecewise Cox proportional hazards model.

Results: Over a median follow-up of 107 months, 1201 all-cause deaths occurred, including 398 cardiovascular disease-related deaths. The multivariate Cox proportional hazards regression model showed a positive association between the TyG index and all-cause and cardiovascular mortality. Each one-unit increase in the TyG index was associated with a 16% risk increase in all-cause mortality (HR: 1.16, 95% CI 1.03, 1.31, P = 0.017) and a 39% risk increase in cardiovascular mortality (HR: 1.39, 95% CI 1.14, 1.71, P = 0.001) after adjusting for confounders. The restricted cubic splines revealed a U-shaped association between the TyG index and all-cause (P for nonlinear < 0.001) and cardiovascular mortality (P for nonlinear = 0.044), identifying threshold values (all-cause mortality: 9.104; cardiovascular mortality: 8.758). A TyG index below these thresholds displayed a negative association with all-cause mortality (HR: 0.58, 95% CI 0.38, 0.90, P = 0.015) but not with cardiovascular mortality (HR: 0.39, 95% CI 0.12, 1.27, P = 0.119). Conversely, a TyG index exceeding these thresholds was positively associated with all-cause and cardiovascular mortality (HR: 1.35, 95% CI 1.17, 1.55, P < 0.001; HR: 1.54, 95% CI 1.25, 1.90, P < 0.001, respectively). Notably, a higher TyG index (≥ threshold values) was significantly associated with increased mortality only among individuals aged under 55 compared to those with a lower TyG index (< threshold values).

Conclusions: The TyG index demonstrated a U-shaped correlation with all-cause and cardiovascular mortality in individuals with CMS. The thresholds of 9.104 and 8.758 for all-cause and cardiovascular mortality, respectively, may be used as intervention targets to reduce the risk of premature death and cardiovascular disease.

Keywords: Cardiometabolic syndrome; Insulin resistance; Mortality; NHANES; Triglyceride-glucose index.

Fig. 1

Screening flow of respondents

Fig. 2

Multivariable adjusted spline curves for associations of the TyG index with all-cause (a) and cardiovascular mortality (b) in respondents with cardiometabolic syndrome. Hazard ratios adjusted for age (as a continuous variable), gender and race, poverty ratio (as a continuous variable), education levels, marital status, body mass index (as a continuous variable), nicotine exposure, alcohol use, and physical inactivity. The solid line and red area represent the estimated values and their corresponding 95% CI. HR hazard ratio, CI confidence interval, TyG index triglyceride-glucose index

Fig. 3

Stratified analyses of the associations between the TyG index and all-cause (a) and cardiovascular mortality (b) among respondents with cardiometabolic syndrome. Hazard ratios were estimated using a two-piecewise Cox proportional risk model on both sides of the inflection point (all-cause mortality: 9.104; cardiovascular mortality: 8.758) and adjusted for confounders. Alcohol use was defined as more than 10 drinks per month. HR hazard ratio, CI confidence interval, TyG index triglyceride-glucose index, NH non-Hispanic