Triglyceride glucose index, metabolic comorbidity, and cardiovascular disease: a national cohort study.
- 1China-Japan Union Hospital of Jilin University, Jilin University, Jilin, 130000, China.
- 2China-Japan Union Hospital of Jilin University, Jilin University, Jilin, 130000, China. [email protected].
- 3China-Japan Union Hospital of Jilin University, Jilin University, Jilin, 130000, China. [email protected].
Abstract
Background
The triglyceride-glucose (TyG) index, a widely accepted surrogate biomarker of insulin resistance, strongly predicts cardiovascular disease (CVD) risk. However, the mediating role of metabolic comorbidities in explaining the relationship between the TyG index and cardiovascular disease remains underexplored. Leveraging the longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS), this longitudinal study investigates how metabolic comorbidities mediate the association between the TyG index and cardiovascular risk.Methods
This analysis included 9,400 participants aged ≥ 45 years from CHARLS without baseline CVD. The TyG index was computed as Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Incident cardiovascular events, which were defined as physician-confirmed heart disease or stroke, were monitored until 2020. Adjusted Cox proportional hazards models estimated hazard ratios (HR). The mediation analysis quantified the percentage of excess risk (PERM) attributable to metabolic comorbidities.Results
The mean age of the participants was 59.0 ± 9.5 years, and 4 862 (51.7%) were females. Among eligible participants, 2,152 developed cardiovascular diseases over a 9-year follow-up, with 1,627 heart disease cases and 765 strokes. Compared with people with a lower TyG index (< 8.59 [median level]) and no comorbidity, those concurrently with a higher TyG and comorbidity had the highest risk of CVD (adjusted HR, 1.66; 95% CI, 1.47-1.88), coronary heart disease (aHR, 1.44; 95% CI, 1.25-1.66) and stroke (aHR, 2.94; 95% CI, 2.31-3.75). Metabolic comorbidities mediated 48.3% of the TyG-associated CVD risk, predominantly through hypertension, renal impairment, inflammation, and obesity.Conclusion
These findings underscore the partial mediating role of metabolic comorbidities in the TyG index-CVD association. Future research should explore residual pathways to fully elucidate this association.
Related
- Triglyceride-glucose index combined with DAS28-ESR predicts cardiovascular disease risk in patients with rheumatoid arthritis: a national multicenter cohort study
- Association of the triglyceride-glucose index with dynamic bidirectional transitions of cardiovascular-kidney-metabolic syndrome: a multistate Markov model study based on CHARLS
- Associations of baseline levels, cumulative exposure, and two-wave patterns of the combined triglyceride-glucose index and frailty index with progression from cardiovascular-kidney-metabolic syndrome stages 0-2 to stages 3-4 and stage 4: a prospective cohort study from CHARLS.
- The triglyceride-glucose index as a predictor of cardiovascular disease: an umbrella review of meta-analyses
- Comparison analysis of the triglyceride-glucose index, triglyceride-glucose and frailty index in cardiovascular disease and mortality association among patients with rheumatoid arthritis: A population-based cohort study.
BibTeX
@article{chen2026triglyceride,
title = {{Triglyceride glucose index, metabolic comorbidity, and cardiovascular disease: a national cohort study.}},
author = {Yuanmei Chen and Fenghe Shi and Zixin Zhang and Cancan Cui and Ning Han and Zhongwen Lv and Lin Liu},
journal = {BMC cardiovascular disorders},
year = {2026},
month = sep,
doi = {10.1186/s12872-026-06618-7},
url = {https://europepmc.org/article/MED/42907973},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Triglyceride glucose index, metabolic comorbidity, and cardiovascular disease: a national cohort study.
AU - Yuanmei Chen
AU - Fenghe Shi
AU - Zixin Zhang
AU - Cancan Cui
AU - Ning Han
AU - Zhongwen Lv
AU - Lin Liu
PY - 2026
DA - 2026/09/01
JO - BMC cardiovascular disorders
DO - 10.1186/s12872-026-06618-7
UR - https://europepmc.org/article/MED/42907973
AB - Background The triglyceride-glucose (TyG) index, a widely accepted surrogate biomarker of insulin resistance, strongly predicts cardiovascular disease (CVD) risk. However, the mediating role of metabolic comorbidities in explaining the relationship between the TyG index and cardiovascular disease remains underexplored. Leveraging the longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS), this longitudinal study investigates how metabolic comorbidities mediate the association between the TyG index and cardiovascular risk.Methods This analysis included 9,400 participants aged ≥ 45 years from CHARLS without baseline CVD. The TyG index was computed as Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Incident cardiovascular events, which were defined as physician-confirmed heart disease or stroke, were monitored until 2020. Adjusted Cox proportional hazards models estimated hazard ratios (HR). The mediation analysis quantified the percentage of excess risk (PERM) attributable to metabolic comorbidities.Results The mean age of the participants was 59.0 ± 9.5 years, and 4 862 (51.7%) were females. Among eligible participants, 2,152 developed cardiovascular diseases over a 9-year follow-up, with 1,627 heart disease cases and 765 strokes. Compared with people with a lower TyG index (< 8.59 [median level]) and no comorbidity, those concurrently with a higher TyG and comorbidity had the highest risk of CVD (adjusted HR, 1.66; 95% CI, 1.47-1.88), coronary heart disease (aHR, 1.44; 95% CI, 1.25-1.66) and stroke (aHR, 2.94; 95% CI, 2.31-3.75). Metabolic comorbidities mediated 48.3% of the TyG-associated CVD risk, predominantly through hypertension, renal impairment, inflammation, and obesity.Conclusion These findings underscore the partial mediating role of metabolic comorbidities in the TyG index-CVD association. Future research should explore residual pathways to fully elucidate this association.
SN - 1471-2261
ER -