Comparison of six surrogate insulin resistance indices for predicting the accumulation of pericardial fat on noncontrast computed tomography

Abstract

Background: Insulin resistance is closely associated with pericardial fat. In this prospective study, we aimed to compare the utility of six surrogate insulin resistance indices, including the triglyceride glucose (TyG) index, TyG-waist circumference (TyG-WC), TyG-waist-to-height ratio (TyG-WHtR), lipid accumulation production (LAP), visceral adiposity index (VAI), and Chinese VAI (CVAI) in predicting pericardial fat accumulation on noncontrast computed tomography.

Methods: The six surrogate insulin resistance indices (TyG, TyG-WC, TyG-WHtR, LAP, VAI, and CVAI) were calculated using their respective formulae. The pericardial fat volume (PFV) was obtained from noncontrast computed tomography scans and categorized into PFV-low (PFV-L) and PFV-high (PFV-H) via the Youden statistic according to the risk for atherosclerotic cardiovascular disease (ASCVD). A logistic regression model, receiver operating characteristic (ROC) curves, and generalized additive model were used for statistical analyses.

Results: Overall, 2,735 adults were analyzed. The TyG, TyG-WC, TyG-WHtR, LAP, VAI, and CVAI were significantly higher in the PFV-H group than in the PFV-L group. All six insulin resistance surrogates showed significant positive correlations with PFV. The CVAI demonstrated the highest predictive value for assessing PFV, followed by TyG-WC, TyG-WHtR, LAP, TyG, and VAI. The CVAI was associated with the largest increase in PFV based on the original model [age, sex, diabetes, hypertension, hyperlipidemia, and estimated glomerular filtration rate (eGFR)] as compared to the other insulin resistance indices.

Conclusions: The TyG, TyG-WC, TyG-WHtR, LAP, VAI, and CVAI were positively associated with PFV in patients without overt cardiovascular diseases. The CVAI may effectively reflect PFV accumulation.

Keywords: Chinese visceral adiposity index (CAVI); Pericardial fat; insulin resistance.

Figure 1

Flowchart for the study population. AF, atrial fibrillation; ASCVD, atherosclerotic cardiovascular disease; HF, heart failure; MI, myocardial infraction; PFV, pericardial fat volume; PFV-H group, pericardial fat volume with high risk for atherosclerotic cardiovascular disease; PFV-L group, pericardial fat volume with low or medium risk for atherosclerotic cardiovascular disease.

Figure 2

Associations between the pericardial fat volume and insulin resistance indices. Values were adjusted for covariates, including age, sex, smoking status, hypertension, diabetes, and hyperlipemia. TyG (A), TyG-WC (B), TyG-WHtR (C), LAP (D), VAI (E), and CVAI (F). CVAI, Chinese visceral adiposity index; LAP, lipid accumulation production; TyG, triglyceride glucose; TyG-WC, triglyceride glucose-waist circumference; TyG-WHtR, triglyceride glucose-waist to height ratio; VAI, visceral adiposity index.

Figure 3

Subgroup analysis based on sex, hypertension, and diabetes. Plots in the top row evaluate the effect modification by sex (A-F; female = red, male = bule), plots in the middle row evaluate the effect modification by hypertension (G-L; hypertension = red, nonhypertension = blue), and plots in the lower row evaluate effect modification by diabetes (M-R; diabetes = red, non-diabetes = blue). CVAI, Chinese visceral adiposity index; LAP, lipid accumulation production; TyG, triglyceride glucose; TyG-WC, triglyceride glucose-waist circumference; TyG-WHtR, triglyceride glucose-waist to height ratio; VAI, visceral adiposity index.

Figure 4

Subgroup analysis of the interaction between insulin resistance indices and pericardial fat volume based on sex, hypertension, and diabetes. CI, confidence interval; CVAI, Chinese visceral adiposity index; LAP, lipid accumulation production; OR, odds ratio; TyG, triglyceride glucose; TyG-WC, triglyceride glucose-waist circumference; TyG-WHtR, triglyceride glucose-waist to height ratio; VAI, visceral adiposity index.