Triglyceride-glucose index and the incidence of peripheral artery disease: a dose-response meta-analysis of longitudinal studies
- 1Vascular Surgery Department, The Fourth People’s Hospital of Jinan
Abstract
Background: The triglyceride-glucose (TyG) index is a simple surrogate marker of insulin resistance and has been increasingly investigated as a predictor of cardiovascular diseases. However, longitudinal evidence regarding its association with incident peripheral artery disease (PAD) remains limited and inconsistent. We conducted a systematic review and dose-response meta-analysis to evaluate the association between the TyG index and the risk of incident PAD.
Methods: PubMed, Embase, and Web of Science were systematically searched from inception to June 28, 2026. Longitudinal observational studies evaluating the association between the conventional TyG index and incidents PAD in adults were eligible. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) comparing the highest versus lowest TyG categories were calculated using restricted maximum likelihood random-effects models. Linear and nonlinear dose-response meta-analyses were performed using restricted cubic spline models.
Results: Five longitudinal studies involving 417,499 participants and 7,800 incident PAD events were included. Compared with the lowest TyG category, a high TyG index was associated with a significantly increased risk of incident PAD (RR = 1.49, 95% CI 1.06 to 2.10; p = 0.02), although substantial heterogeneity was observed (I ² = 88.4%). Sensitivity analyses demonstrated robust findings. In the linear dose-response meta-analysis, each 1-unit increase in the TyG index was associated with a 22% higher risk of incident PAD (RR = 1.22, 95% CI 1.08 to 1.37; p = 0.001). Restricted cubic spline analysis demonstrated a significant overall dose-response association ( p = 0.001) with no evidence of nonlinearity ( p for nonlinearity = 0.367), indicating an approximately linear relationship between the TyG index and PAD risk.
Conclusions: A higher TyG index is associated with an increased risk of incident PAD in a dose-dependent and approximately linear manner.
Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD420261470450.
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BibTeX
@article{fu2026triglycerideglucose,
title = {{Triglyceride-glucose index and the incidence of peripheral artery disease: a dose-response meta-analysis of longitudinal studies}},
author = {Mofan Fu and Hucheng Teng and Zhen Li and Yuanshun Jiang and Baohua Sun},
journal = {Frontiers in Endocrinology},
year = {2026},
month = nov,
doi = {10.3389/fendo.2026.1959950},
url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.1959950/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Triglyceride-glucose index and the incidence of peripheral artery disease: a dose-response meta-analysis of longitudinal studies
AU - Mofan Fu
AU - Hucheng Teng
AU - Zhen Li
AU - Yuanshun Jiang
AU - Baohua Sun
PY - 2026
DA - 2026/11/03
JO - Frontiers in Endocrinology
DO - 10.3389/fendo.2026.1959950
UR - https://www.frontiersin.org/articles/10.3389/fendo.2026.1959950/full
AB - Background: The triglyceride-glucose (TyG) index is a simple surrogate marker of insulin resistance and has been increasingly investigated as a predictor of cardiovascular diseases. However, longitudinal evidence regarding its association with incident peripheral artery disease (PAD) remains limited and inconsistent. We conducted a systematic review and dose-response meta-analysis to evaluate the association between the TyG index and the risk of incident PAD. Methods: PubMed, Embase, and Web of Science were systematically searched from inception to June 28, 2026. Longitudinal observational studies evaluating the association between the conventional TyG index and incidents PAD in adults were eligible. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) comparing the highest versus lowest TyG categories were calculated using restricted maximum likelihood random-effects models. Linear and nonlinear dose-response meta-analyses were performed using restricted cubic spline models. Results: Five longitudinal studies involving 417,499 participants and 7,800 incident PAD events were included. Compared with the lowest TyG category, a high TyG index was associated with a significantly increased risk of incident PAD (RR = 1.49, 95% CI 1.06 to 2.10; p = 0.02), although substantial heterogeneity was observed (I ² = 88.4%). Sensitivity analyses demonstrated robust findings. In the linear dose-response meta-analysis, each 1-unit increase in the TyG index was associated with a 22% higher risk of incident PAD (RR = 1.22, 95% CI 1.08 to 1.37; p = 0.001). Restricted cubic spline analysis demonstrated a significant overall dose-response association ( p = 0.001) with no evidence of nonlinearity ( p for nonlinearity = 0.367), indicating an approximately linear relationship between the TyG index and PAD risk. Conclusions: A higher TyG index is associated with an increased risk of incident PAD in a dose-dependent and approximately linear manner. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD420261470450.
SN - 1664-2392
ER -