Interacting and joint effects of triglyceride-glucose index and blood pressure on cardiovascular diseases risk: a prospective cohort study

Abstract

Aims: The triglyceride-glucose (TyG) index and hypertension (HTN) are established risk factors of CVD. However, there is a dearth of studies investigating the synergistic influence of the elevated TyG index and HTN on CVD risk, as well as any potential interaction between these factors.

Method: For this investigation, we enlisted 88,384 individuals from the Kailuan Study who did not have a history of stroke, myocardial infarction, or cancer at baseline. Incidences of CVD between 2006 and 2021 were confirmed through a thorough review of medical records. Participants were categorized into 6 groups according to BP status(normal/elevated BP, stage 1 and stage 2) or the TyG index(low and elevated group), respectively. The Cox proportional hazard regression models were used to assess the association of BP status and TyG index with incident CVD. The multiplicative and additive interactions were also determined.

Results: Following a mean follow-up period of 13.66 ± 3.24 years, incidents of CVD, MI, and stroke were observed in 8,205, 1,728, and 6,705 individuals, respectively. The BP category and TyG index additively increased the risk of CVD, MI and stroke. There were significant interacting and joint effects of TyG index and BP status on CVD risk. Additionally, stratification analysis further confirmed that the relative contribution of hypertension to the CVD development decreased with deteriorating TyG index and that of TyG index was attenuated with increasing BP status.

Conclusion: Our study demonstrated that a significant interaction between TyG index and BP status on the risk of CVD.

Fig. 1

Combination of TyG index and BP status in developing CVD. Study participants were categorized into 6 groups according to a combination of TyG index (Normal TyG index, ≤ 8.57; Elevated TyG index, > 8.57) and blood pressure classification (normal, stage 1 hypertension, stage 2 hypertension). We conducted multivariable Cox regression analyses to identify the association of each combination of TyG index and BP status with incident cardiovascular disease: (A) cardiovascular disease, (B) myocardial infarction, (C) stroke. We adjusted the hazard ratio of each combination for Multivariable model adjusted for age, sex, income, physical exercise, educational level, drinking, smoking, diabetes, anti-hypertensive medication, anti-diabetic medication, anti-hyperlipidemic medication, BMI, RHR, LDL-C, UA, Hs-CRP