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Meta-Analysis
. 2025 Jan 27;24(1):42.
doi: 10.1186/s12933-025-02585-z.

Does diabetes modify the triglyceride-glucose index associated with cardiovascular events and mortality? A meta-analysis of 50 cohorts involving 7,239,790 participants

Jun Zhang #  1   2 , Qiye Zhan #  3 , Zhihao Deng  4 , Ling Lin  3 , Zhaolan Feng  5 , Huabin He  5 , Deju Zhang  6 , Huilei Zhao  7 , Xiang Gu  1   2 , Xiaoping Yin  8   2 , Peng Yu  9   10 , Xiao Liu  11   12   13
Affiliations
Meta-Analysis

Does diabetes modify the triglyceride-glucose index associated with cardiovascular events and mortality? A meta-analysis of 50 cohorts involving 7,239,790 participants

Jun Zhang et al. Cardiovasc Diabetol. .

Abstract

Introduction: Previous studies highlighted the association between the triglyceride-glucose (TyG) index and cardiovascular events in patients with diabetes. However, whether diabetes affects TyG-cardiovascular diseases (CVD) is still unclear. This study aimed to evaluate the association between the TyG index and CVD risk, stratified by diabetes status, as well as the potential modifying effect of diabetic status.

Methods/design: The PubMed, Cochrane Library, and Embase databases were searched for studies on the associations between the TyG index and cardiovascular events and mortality in patients with and without diabetes from inception to December 2, 2024. The random effects model was employed to pool the effect sizes.

Results: A total of 50 cohort studies (7,239,790 participants) were included. The mean age of participants was 31.46 years (diabetes mellitus [DM]: 65.18; non-DM: 31.23), and 40.66% of participants were female (DM: 36.07%; non-DM: 40.70%). The associations between the TyG index and cardiovascular events (HR: 1.72 vs. 1.55, P = 0.55), major adverse cardiovascular and cerebrovascular events (HR: 2.02 vs. 1.91, P = 0.84), stroke (HR: 1.46 vs. 1.39, P = 0.77) and cardiovascular death (HR: 1.85 vs. 1.60, P = 0.56) were similar among DM and non-DM individuals. However, the associations between the TyG index and ischemic heart disease (IHD) (HR: 2.20 vs. 1.57, P = 0.03) as well as all-cause mortality (HR: 1.94 vs. 1.24, P = 0.01) were stronger in DM patients than in non-DM patients.

Conclusion: TyG index showed association with cardiovascular events, mortality, and all-cause mortality independent of diabetic status, with low to moderate certainty. The associations for IHD and all-cause death were stronger in diabetic patients than in individuals without diabetes. Future studies should explore the role of diabetes in the TyG index-associated CVD outcomes and mortality.

Keywords: Cardiovascular disease; Diabetes mellitus; Meta-analysis; Mortality; Triglyceride–glucose index.

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Conflict of interest statement

Declarations. Ethical approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the study selection process in the meta-analysis of TyG index and risk of cardiovascular events and mortality in patients with or without diabetes
Fig. 2
Fig. 2
Forest plot of the association between TyG index and cardiovascular events in patients with or without diabetes. A cardiovascular events, analyzed as category variables (highest vs. lowest). B, cardiovascular events, analyzed as continuous variables (per 1 unit increase). TyG, triglyceride-glucose; DM, diabetes mellitus
Fig. 3
Fig. 3
Forest plot of the association between TyG index and MACCE in patients with or without diabetes. A MACCE, analyzed as category variables (highest vs. lowest). B MACCE, analyzed as continuous variables (per 1 unit increase). TyG, triglyceride-glucose; DM, diabetes mellitus; MACCE, major adverse cardio-cerebral event
Fig. 4
Fig. 4
Forest plot of the association between TyG index and stroke, IHD and cardiovascular death in patients with or without diabetes. A stroke, analyzed as category variables (highest vs. lowest). B IHD, analyzed as category variables (highest vs. lowest). C cardiovascular death, analyzed as category variables (highest vs. lowest). D cardiovascular death, analyzed as continuous variables (per 1 unit increase). TyG, triglyceride-glucose; DM, diabetes mellitus; IHD, ischemic heart disease
Fig. 5
Fig. 5
Forest plot of the association between TyG index and all-cause mortality in patients with or without diabetes. A all-cause mortality, analyzed as category variables (highest vs. lowest). B all-cause mortality, analyzed as continuous variables (per 1 unit increase). TyG, triglyceride-glucose; DM, diabetes mellitus
See this image and copyright information in PMC

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