![]() ![]() However, to the best of our knowledge, no study to date has explored the mediating role of prevalent diabetes, hypertension, and dyslipidemia in the associations of the TyG index and TG/HDL-C ratio with CVD risk. The pathophysiologic mechanisms known to increase CVD risk in individuals with insulin resistance include diabetes, hypertension, and dyslipidemia, suggesting that the effect of the TyG index and TG/HDL-C ratio on CVD might be partly mediated through these comorbidities. Most prospective cohort studies on the predictive value of the TyG index and TG/HDL-C ratio for CVD risk have been conducted in Asian populations, and few in European and American populations. Several cross-sectional and retrospective studies have reported significant associations of the TyG index and TG/HDL-C ratio with incident CVD. The triglyceride-glucose (TyG) index and triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio have been proposed as simple and credible surrogate indicators of insulin resistance because they show strong correlations with the euglycemic-hyperinsulinemic clamp and they are suitable for clinical practice and large epidemiological studies. The euglycemic-hyperinsulinemic clamp is served as the gold standard to identify insulin resistance, but the technique is laborious, costly, and therefore impractical in the clinical setting. Insulin resistance, a pathophysiological condition characterized by the decreased insulin sensitivity of peripheral tissues, plays a key role in the development of metabolic syndrome and atherosclerosis. This highlights the importance of identifying risk factors that could predict the risk of CVD and thereby facilitate its prevention at an early stage. In 2017, CVD caused an estimated 17.8 million deaths and was responsible for 330 million years of life lost globally. These associations were largely mediated by greater prevalence of dyslipidemia, type 2 diabetes, and hypertension.Ĭardiovascular disease (CVD), including ischemic heart disease and stroke, constitute the leading cause of premature death worldwide. ConclusionsĮlevated baseline TyG index and TG/HDL-C ratio were associated with a higher risk of CVD after adjustment for the well-established CVD risk factors. ![]() In mediation analyses, dyslipidemia, type 2 diabetes, and hypertension explained 45.8%, 27.0%, and 15.0% of TyG index’s association with CVD, respectively, and 40.0%, 11.8%, and 13.3% of TG/HDL-C ratio’s association with CVD, respectively. ![]() There were significant trends toward an increasing risk of CVD across the quartiles of TyG index and TG/HDL-C ratio. ![]() The multivariable-adjusted hazard ratios of total CVD in higher quartiles versus the lowest quartiles were 1.05, 1.05, and 1.19, respectively, for TyG index, and 1.07, 1.13, and 1.29, respectively, for TG/HDL-C ratio. Resultsĭuring a median follow-up of 8.1 years, 19,754 (4.9%) individuals developed CVD, including 16,404 (4.1%) cases of CHD and 3976 (1.0%) cases of stroke. Mediation analyses were performed to evaluate the contribution of prevalent diabetes, hypertension, and dyslipidemia to observed associations. Cox models were applied to evaluate the association between TyG index and TG/HDL-C ratio and incident CVD. MethodsĪ total of 403,335 participants from the UK Biobank with data for TyG index and TG/HDL-C ratio and free from CVD at baseline were included. However, very few studies have investigated their associations with CVD in European populations. The triglyceride-glucose (TyG) index and triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, two simple surrogate indicators of insulin resistance, have been demonstrated to predict cardiovascular disease (CVD). ![]()
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