Trajectories of triglyceride-glucose index changes and their association with all-cause and cardiovascular mortality: a competing risk analysis

• Published in: Cardiovascular diabetology Vol. 23; no. 1; pp. 364 - 11
• Main Authors: Lee, Jun-Hyuk, Jeon, Soyoung, Lee, Hye Sun, Lee, Ji-Won
• Format: Journal Article
• Language: English
• Published: England BioMed Central 15.10.2024; BMC
• Subjects: Adult; Aged; Biomarkers - blood; Blood Glucose - metabolism; Cardiovascular disease; Cardiovascular Diseases - blood; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - mortality; Cause of Death; Databases, Factual; Female; Heart Disease Risk Factors; Humans; Insulin Resistance; Male; Middle Aged; Mortality; Prognosis; Republic of Korea - epidemiology; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Trajectory; Triglycerides - blood; TyG index; Young Adult; Republic of Korea; Cardiovascular disease; Insulin resistance; Trajectory; Mortality; TyG index
• ISSN: 1475-2840; 1475-2840
• DOI: 10.1186/s12933-024-02457-y

The association between changes in insulin resistance, reflected by the triglyceride-glucose (TyG) index, and mortality remains unclear. This study investigated whether longitudinal trajectories of TyG index changes are associated with all-cause and cardiovascular disease (CVD) mortality. This retrospective cohort study analyzed data from 233,546 adults aged ≥ 19 years from the Korea National Health Insurance Service-National Sample Cohort. Participants were categorized as having increasing, stable, or decreasing TyG index changes during a 4-year exposure period (2009-2014). Mortality outcomes were assessed during an 8.13-year follow-up period (2015-2021). Cox proportional hazards regression and competing risk analysis were used to evaluate all-cause and CVD mortality. A total of 7918 mortality events, including 651 CVD deaths, were recorded. Compared with the stable group, adjusted hazard ratios for all-cause mortality were 1.09 (95% CI 1.03-1.15) in the increasing group and 1.23 (95% CI 1.01-1.50) for CVD mortality. An increased TyG index was significantly associated with all-cause mortality in individuals aged < 50 years; men; and individuals with obesity, hypertension, diabetes, and/or dyslipidemia. For CVD mortality, significant associations were found in individuals aged 50-69 years, with obesity, with diabetes, or without dyslipidemia. An increasing TyG index from baseline during follow-up was independently associated with higher risks of all-cause and CVD mortality. Serial monitoring of TyG index changes could enhance risk stratification and inform targeted interventions to reduce insulin resistance, and ultimately lower mortality risk.