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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (3): 430-435. doi: 10.19723/j.issn.1671-167X.2025.03.004

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Association of triglyceride-glucose index and cardiovascular disease in a community-based Chinese cohort

Mengxi LU1, Qiuping LIU1, Tianjing ZHOU1, Xiaofei LIU1, Yexiang SUN2, Peng SHEN2, Hongbo LIN2, Xun TANG1,3,*(), Pei GAO1,3,4,*()   

  1. 1. Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
    2. Yinzhou District Center for Disease Control and Prevention, Ningbo 315101, Zhejiang, China
    3. Key Laboratory of Epidemiology of Major Disease (Peking University), Ministry of Education, Beijing 100191, China
    4. Center for Real-World Evidence Evaluation, Peking University Clinical Research Institute, Beijing 100191, China
  • Received:2025-02-07 Online:2025-06-18 Published:2025-06-13
  • Contact: Xun TANG, Pei GAO
  • Supported by:
    the Noncommunicable Chronic Diseases-National Science and Technology Major Project(2024ZD0527406); the National Natural Sciences Foundation of China(82373662); the Beijing Natural Science Foundation(IS24047)

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Abstract:

Objective: To investigate the association between the triglyceride-glucose (TyG) index and the incidence and mortality of cardiovascular disease (CVD) in a large population-based cohort. Methods: Participants aged 40-79 years without a history of CVD at baseline were drawn from the CHinese Electronic health Records Research in Yinzhou (CHERRY) study between January 1, 2010, and May 31, 2020. The TyG index was calculated using baseline triglyceride and fasting blood glucose. Cox proportional hazards models were used to assess the association between the TyG index and the composite outcome of CVD (incidence and mortality), adjusting for age, gender, education, region, smoking status, body mass index, systolic blood pressure, and total cholesterol. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated. Nonlinear associations between the TyG index and CVD were further evaluated using restricted cubic splines, and subgroup analyses by gender and age were conducted to explore potential differences. Results: A total of 226 406 individuals were included, with a mean age of (55.0±9.7) years at baseline, 46.8% of whom were men, and a median TyG index of 8.68. Over a median follow-up of 7.99 years, 9 815 (4.34%) participants experienced CVD incidence or mortality. After adjusting for age, gender, education, region, smoking status, body mass index, systolic blood pressure and total cholesterol, the risk of CVD increased with higher TyG index levels (P < 0.001). The risk in the highest TyG quartile (TyG>9.10) was 42% higher than in the lowest quartile (TyG≤8.32) (HR=1.42, 95%CI: 1.34-1.51). Individuals under 60 years had a higher HR for CVD compared with those aged 60 years and above (HR: 1.71 vs. 1.27, P < 0.05). Restricted cubic spline analysis revealed a reverse L-shaped association between the TyG index and CVD risk in the overall population (P < 0.001 for nonlinear trend), with risk increasing after the TyG index exceeded 8.67. However, the threshold varied by gender, with a lower threshold in women (8.51) than in men (8.67). Conclusion: A significant nonlinear relationship was revealed between the TyG index and CVD risk, with a threshold effect. The risk of CVD increased once the TyG index surpassed a certain threshold, with a lower threshold in women than in men. These findings suggest that cardiovascular risk prediction and interventions based on the TyG index should be gender-stratified, and early intervention for individuals under 60 years old might have important public health implications.

Key words: Cardiovascular disease, Risk factors, Triglyceride-glucose index, Cohort study

CLC Number: 

  • R54

Table 1

Baseline characteristics of study participants"

Characteristic Total (n=226 406) Women (n=120 558) Men (n=105 848) P value*
Age/years 55.0±9.7 54.5±9.6 55.5±9.9 < 0.001
Education (senior high school or higher) 34 173 (15.1) 14 806 (12.3) 40 238 (38.0) < 0.001
Region (Urban) 154 444 (68.2) 81 099 (67.3) 73 345 (69.3) < 0.001
Current smoker 41 861 (18.5) 1 623 (1.3) 40 238 (38.0) < 0.001
Diabetes 19 701 (8.7) 10 475 (8.7) 9 226 (8.7) 0.823
Hypertension 74 319 (32.8) 39 305 (32.6) 35 014 (33.1) 0.016
Treated hypertension 69 047 (30.5) 34 237 (28.4) 348 100 (32.9) < 0.001
Family history of CVD 1 486 (0.7) 691 (0.6) 795 (0.8) < 0.001
SBP/mmHg 131.2±16.3 130.6±16.7 131.9±15.9 < 0.001
DBP/mmHg 81.6±9.6 80.8±9.6 82.5±9.5 < 0.001
BMI/(kg/m2) 23.3±2.8 23.2±2.9 23.3±2.7 < 0.001
FBG/(mg/dL) 103.6±30.8 101.8±27.2 105.7±34.3 < 0.001
TG/(mg/dL) 145.5 (111.5, 179.1) 141.6 (106.4, 172.8) 151.2 (116.4, 185.7) < 0.001
TC/(mg/dL) 190.2±37.8 194.3±37.7 185.6±37.3 0.030
HDL-C/(mg/dL) 50.3±12.9 52.0±12.4 48.5±13.1 < 0.001
LDL-C/(mg/dL) 109.7±31.0 111.5±31.3 107.2±30.6 < 0.001
TyG index 8.7 (8.3, 9.1) 8.7 (8.2, 9.0) 8.8 (8.3, 9.1) < 0.001

Figure 1

Kaplan-Meier curve of cardiovascular disease events by quartiles of triglyceride-glucose index"

Table 2

Association of triglyceride-glucose index and cardiovascular disease events"

Quartile Number of cases Case per 1 000 person-years Model 1 Model 2 Model 3 Model 4
HR (95%CI) P HR (95%CI) P HR (95%CI) P HR (95%CI) P
Quartile 1
(≤8.32)		 1 890 4.93 Reference Reference Reference Reference
Quartile 2
(>8.32-8.68)		 2 169 5.56 1.12
(1.05-1.19)		 < 0.001 1.04
(0.98-1.10)		 0.244 1.02
(0.96-1.08)		 0.611 1.02
(0.96-1.08)		 0.611
Quartile 3
(>8.68-9.10)		 2 621 6.67 1.34
(1.26-1.42)		 < 0.001 1.19
(1.12-1.26)		 < 0.001 1.15
(1.08-1.22)		 < 0.001 1.15
(1.08-1.22)		 < 0.001
Quartile 4
(>9.10)		 3 135 8.00 1.61
(1.52-1.70)		 < 0.001 1.50
(1.41-1.58)		 < 0.001 1.42
(1.34-1.51)		 < 0.001 1.42
(1.34-1.51)		 < 0.001

Figure 2

Nonlinear association of triglyceride-glucose index and cardiovascular disease events, by gender A, overall; B, men; C, women. P for all tested whether using splines improves the model compared to a simple linear term; P for nonlinear tested whether the nonlinear part of the spline model is statistically significant; Graphs show multivariate adjusted hazard ratios (HR; solid lines) and 95%CI (shaded areas). Dashed lines represent the proportion of the population with different levels of triglyceride-glucose index. Arrows indicate the triglyceride-glucose index at the point where risk crosses the reference line (HR=1)."

Figure 3

Association of triglyceride-glucose index and cardiovascular disease events, by gender and age groups"

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