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.
- 1Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi Province, China.
- 2School of Public Health, Shanxi Medical University, Taiyuan, Shanxi Province, China.
- 3Shanxi Province Clinical Research Center for Dermatologic and Immunologic Diseases (Rheumatic Diseases), Taiyuan, Shanxi Province, China.
Abstract
Cardiovascular disease (CVD) is a major cause of excess mortality among patients with rheumatoid arthritis (RA). Conventional risk assessment may not fully capture the metabolic abnormalities and physiological vulnerability associated with RA. We investigated whether the triglyceride-glucose-frailty index (TyG-FI), which combines a surrogate marker of insulin resistance with accumulated health deficits, was associated with prevalent CVD and cardiovascular mortality among adults with RA. We analyzed 1090 adults with self-reported RA from 10 cycles of the National Health and Nutrition Examination Survey conducted between 1999 and 2018. TyG-FI was calculated as the product of the triglyceride-glucose index and a 49-item deficit-accumulation frailty index. Multivariable logistic regression was used to examine the association with prevalent CVD, whereas Cox proportional hazards regression was used to examine cardiovascular mortality. Restricted cubic splines, subgroup analyses, sensitivity analyses, and discrimination analyses were conducted as secondary analyses. In the fully adjusted models, each 1-unit higher TyG-FI was associated with higher odds of prevalent CVD (odds ratio, 4.50; 95% confidence interval, 3.20-6.33) and a higher hazard of cardiovascular mortality (hazard ratio, 1.77; 95% confidence interval, 1.16-2.70). The reported areas under the receiver operating characteristic curve were 0.80 for prevalent CVD and 0.81 for cardiovascular mortality in models incorporating TyG-FI, compared with 0.73 and 0.80, respectively, in models incorporating TyG. An exploratory subgroup analysis suggested a stronger association between TyG-FI and prevalent CVD among participants aged ≤65 years (P for interaction = .044). Higher TyG-FI was associated with prevalent CVD and cardiovascular mortality among US adults with self-reported RA. TyG-FI may capture complementary metabolic and frailty-related information; however, its incremental predictive value, calibration, clinical utility, and external validity require further evaluation before clinical implementation.
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
- Prevalence of Triglyceride–Glucose Index-Defined Insulin Resistance and Its Association with Recorded Cardiovascular Disease Among Adults in the Municipality of Naples: A Cross-Sectional Primary-Care Study
- Association of the C-reactive protein–triglyceride–glucose index with adverse cardiovascular outcomes in patients with acute coronary syndrome and type 2 diabetes: findings from an observational cohort study in China
- Association between triglyceride–glucose–related indices and all-cause and cause-specific mortality among individuals with periodontitis: A population-based study
BibTeX
@article{xu2026comparison,
title = {{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.}},
author = {Yangyu Xu and Hong Zhao and Yuxiang Gao and Jiannan Han and Zewen Wu and Liyun Zhang and Junkang Zhao},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000051143},
url = {https://europepmc.org/article/MED/42888590},
note = {CC BY},
}
RIS
TY - JOUR
TI - 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.
AU - Yangyu Xu
AU - Hong Zhao
AU - Yuxiang Gao
AU - Jiannan Han
AU - Zewen Wu
AU - Liyun Zhang
AU - Junkang Zhao
PY - 2026
DA - 2026/10/01
JO - Medicine
DO - 10.1097/md.0000000000051143
UR - https://europepmc.org/article/MED/42888590
AB - Cardiovascular disease (CVD) is a major cause of excess mortality among patients with rheumatoid arthritis (RA). Conventional risk assessment may not fully capture the metabolic abnormalities and physiological vulnerability associated with RA. We investigated whether the triglyceride-glucose-frailty index (TyG-FI), which combines a surrogate marker of insulin resistance with accumulated health deficits, was associated with prevalent CVD and cardiovascular mortality among adults with RA. We analyzed 1090 adults with self-reported RA from 10 cycles of the National Health and Nutrition Examination Survey conducted between 1999 and 2018. TyG-FI was calculated as the product of the triglyceride-glucose index and a 49-item deficit-accumulation frailty index. Multivariable logistic regression was used to examine the association with prevalent CVD, whereas Cox proportional hazards regression was used to examine cardiovascular mortality. Restricted cubic splines, subgroup analyses, sensitivity analyses, and discrimination analyses were conducted as secondary analyses. In the fully adjusted models, each 1-unit higher TyG-FI was associated with higher odds of prevalent CVD (odds ratio, 4.50; 95% confidence interval, 3.20-6.33) and a higher hazard of cardiovascular mortality (hazard ratio, 1.77; 95% confidence interval, 1.16-2.70). The reported areas under the receiver operating characteristic curve were 0.80 for prevalent CVD and 0.81 for cardiovascular mortality in models incorporating TyG-FI, compared with 0.73 and 0.80, respectively, in models incorporating TyG. An exploratory subgroup analysis suggested a stronger association between TyG-FI and prevalent CVD among participants aged ≤65 years (P for interaction = .044). Higher TyG-FI was associated with prevalent CVD and cardiovascular mortality among US adults with self-reported RA. TyG-FI may capture complementary metabolic and frailty-related information; however, its incremental predictive value, calibration, clinical utility, and external validity require further evaluation before clinical implementation.
SN - 0304-5412
SN - 1536-5964
ER -