Triglyceride-glucose index and arterial stiffness: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

BAI Yanlin ¹ , LIANG Shichu ² , WANG Cui ³ , ZHANG Jing ^2,4 ,  DIAO Kaiyue ⁵ , HE Yong ²

1. West China School of Medicine, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
3. Laboratory of Endocrinology & Metabolism/Department of Endocrinology & Metabolism, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
4. West China School of Nursing, Sichuan University, Chengdu 610041, P. R. China;
5. Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

DIAO Kaiyue, Email: kaiyuediao@wchscu.cn

Keywords：

Triglyceride-glucose index; Arterial stiffness; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.202308160

Video：

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Objective To systematically review the correlation between the triglyceride-glucose index (TyG index) and pulse wave velocity (PWV) and explore the relationship between the TyG index and arterial stiffness (AS). Methods The PubMed, Embase, Web of Science, CBM, WanFang Data, and CNKI databases were searched to collect observational studies on the correlation between the TyG index and AS from inception to January 14, 2024. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was performed using RevMan 5.4 software. Results A total of 16 studies were included. The results of meta-analysis showed that when the TyG index was used as a continuous variable to evaluate its correlation with AS based on brachial-ankle pulse wave velocity (baPWV) as the outcome parameter, individuals with high TyG index had higher baPWV compared to those with low TyG index (OR=1.48, 95%CI 1.27 to 1.72, P<0.001). Similar correlations were observed when the TyG index was used as a categorical variable to evaluate its correlation with AS (OR=1.85, 95%CI 1.67 to 2.04, P<0.001). When carotid-femoral pulse wave velocity (cfPWV) was used as the outcome parameter, individuals with high TyG index had higher cfPWV compared to those with low TyG index when the TyG index was used as a continuous variable (OR=1.47, 95%CI 1.11 to 1.95, P=0.008). Similar correlations were observed when the TyG index was used as a categorical variable to evaluate its correlation with AS (OR=1.34, 95%CI 1.21 to 1.48, P<0.001). Subgroup analysis results showed that when the TyG index was used as a continuous variable, the correlation between the TyG index and baPWV was independent of gender, age, participant characteristics, and study type. When the TyG index was used as a categorical variable, the correlation between the TyG index and baPWV was independent of age and participant characteristics. Using high baPWV to define AS, when the TyG index was used as a continuous variable to evaluate its impact on AS, individuals with high TyG index had a higher likelihood of AS compared to those with low TyG index (OR=1.51, 95%CI 1.36 to 1.67, P<0.001). Similar correlations were observed when the TyG index was used as a categorical variable to evaluate its correlation with AS (OR=1.81, 95%CI 1.48 to 2.21, P<0.001). Using high cfPWV to define AS, when the TyG index was used as a continuous variable to evaluate its impact on arterial stiffness, individuals with high TyG index had a higher likelihood of AS compared to those with low TyG index (OR=1.30, 95%CI 1.10 to 1.53, P=0.02). Similar correlations were observed when the TyG index was used as a categorical variable to evaluate its correlation with AS (OR=1.60, 95%CI 1.33 to 1.92, P<0.001). Subgroup analysis results showed that when the TyG index was used as a continuous variable, the correlation between the TyG index and AS was independent of gender, participant characteristics, age, hypertension, and diabetes. When the TyG index was used as a categorical variable, the correlation between the TyG index and AS was independent of gender, participant characteristics, age, and hypertension. Conclusion There is a strong correlation between the TyG index and PWV, with higher TyG index associated with increased PWV and greater risk of AS. The TyG index can serve as a simple alternative marker for early diagnosis of AS and guide clinical intervention. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.

1.	中国心血管健康与疾病报告2022概要. 中国循环杂志, 2023, 38(6): 583-612.
2.	Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics-2023 update: a report from the American Heart Association. Circulation, 2023, 147(8): e93-e621.
3.	Zheng M, Zhang X, Chen S, et al. Arterial stiffness preceding diabetes: a longitudinal study. Circ Res, 2020, 127(12): 1491-1498.
4.	Rosenblit PD. Extreme atherosclerotic cardiovascular disease (ASCVD) risk recognition. Curr Diab Rep, 2019, 19(8): 61.
5.	Choi S. The potential role of biomarkers associated with ASCVD risk: risk-enhancing biomarkers. J Lipid Atheroscler, 2019, 8(2): 173-182.
6.	Namekata T, Shirai K, Tanabe N, et al. Estimating the extent of subclinical arteriosclerosis of persons with prediabetes and diabetes mellitus among Japanese urban workers and their families: a cross-sectional study. BMC Cardiovasc Disord, 2016, 16: 52.
7.	Fiori G, Fuiano F, Scorza A, et al. Non-Invasive methods for PWV measurement in blood vessel stiffness assessment. IEEE Rev Biomed Eng, 2022, 15: 169-183.
8.	Zhao D, Liu J, Wang M, et al. Epidemiology of cardiovascular disease in China: current features and implications. Nat Rev Cardiol, 2019, 16(4): 203-212.
9.	Hill MA, Yang Y, Zhang L, et al. Insulin resistance, cardiovascular stiffening and cardiovascular disease. Metabolism, 2021, 119: 154766.
10.	Minh HV, Tien HA, Sinh CT, et al. Assessment of preferred methods to measure insulin resistance in Asian patients with hypertension. J Clin Hypertens (Greenwich), 2021, 23(3): 529-537.
11.	Simental-Mendía LE, Rodríguez-Morán M, Guerrero-Romero F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord, 2008, 6(4): 299-304.
12.	Wang Y, Yang W, Jiang X. Association between triglyceride-glucose index and hypertension: a meta-analysis. Front Cardiovasc Med, 2021, 8: 644035.
13.	Pranata R, Huang I, Irvan None, et al. The association between triglyceride-glucose index and the incidence of type 2 diabetes mellitus-a systematic review and dose-response meta-analysis of cohort studies. Endocrine, 2021, 74(2): 254-262.
14.	Liang S, Wang C, Zhang J, et al. Triglyceride-glucose index and coronary artery disease: a systematic review and meta-analysis of risk, severity, and prognosis. Cardiovasc Diabetol, 2023, 22(1): 170.
15.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
16.	Lee SB, Ahn CW, Lee BK, et al. Association between triglyceride glucose index and arterial stiffness in Korean adults. Cardiovasc Diabetol, 2018, 17(1): 41.
17.	Zhao S, Yu S, Chi C, et al. Association between macro- and microvascular damage and the triglyceride glucose index in community-dwelling elderly individuals: the Northern Shanghai Study. Cardiovasc Diabetol, 2019, 18(1): 95.
18.	Li M, Zhan A, Huang X, et al. Positive association between triglyceride glucose index and arterial stiffness in hypertensive patients: the China H-type hypertension registry study. Cardiovasc Diabetol, 2020, 19(1): 139.
19.	Nakagomi A, Sunami Y, Kawasaki Y, et al. Sex difference in the association between surrogate markers of insulin resistance and arterial stiffness. J Diabetes Complications, 2020, 34(6): 107442.
20.	Poon AK, Meyer ML, Tanaka H, et al. Association of insulin resistance, from mid-life to late-life, with aortic stiffness in late-life: the atherosclerosis risk in communities study. Cardiovasc Diabetol, 2020, 19(1): 11.
21.	Guo W, Zhu W, Wu J, et al. Triglyceride glucose index is associated with arterial stiffness and 10-year cardiovascular disease risk in a Chinese population. Front Cardiovasc Med, 2021, 8: 585776.
22.	Pan Y, Zhong S, Zhou K, et al. Association between diabetes complications and the triglyceride-glucose index in hospitalized patients with type 2 diabetes. J Diabetes Res, 2021, 2021: 8757996.
23.	Su Y, Wang S, Sun J, et al. Triglyceride glucose index associated with arterial stiffness in Chinese community-dwelling elderly. Front Cardiovasc Med, 2021, 8: 737899.
24.	Wang S, Shi J, Peng Y, et al. Stronger association of triglyceride glucose index than the HOMA-IR with arterial stiffness in patients with type 2 diabetes: a real-world single-centre study. Cardiovasc Diabetol, 2021, 20(1): 82.
25.	Chiu TH, Tsai HJ, Chiou HC, et al. A high triglyceride-glucose index is associated with left ventricular dysfunction and atherosclerosis. Int J Med Sci, 2021, 18(4): 1051-1057.
26.	Baydar O, Kilic A, Okcuoglu J, et al. The Triglyceride-glucose index, a predictor of insulin resistance, is associated with subclinical atherosclerosis. Angiology, 2021, 72(10): 994-1000.
27.	Han Z, Kang X, Zhang J, et al. Glycated hemoglobin and risk of arterial stiffness in a Chinese han population: a longitudinal study. Front Endocrinol (Lausanne), 2022, 13: 854875.
28.	Ji W, Gao L, Sun P, et al. Association of the triglyceride-glucose index and vascular target organ damage in a Beijing community-based population. Front Cardiovasc Med, 2022, 9: 948402.
29.	Yang X, Gao Z, Huang X, et al. The correlation of atherosclerosis and triglyceride glucose index: a secondary analysis of a national cross-sectional study of Japanese. BMC Cardiovasc Disord, 2022, 22(1): 250.
30.	Muhammad IF, Bao X, Nilsson PM, et al. Triglyceride-glucose (TyG) index is a predictor of arterial stiffness, incidence of diabetes, cardiovascular disease, and all-cause and cardiovascular mortality: a longitudinal two-cohort analysis. Front Cardiovasc Med, 2023, 9: 1035105.
31.	Wang Y, Wang S, Pan X, et al. Association between triglyceride-glucose index and arterial stiffness reflected by carotid pulse-wave velocity in stage 1 hypertension and individuals with normal/elevated blood pressure. J Clin Hypertens (Greenwich), 2023, 25(2): 199-212.
32.	Tao LC, Xu JN, Wang TT, et al. Triglyceride-glucose index as a marker in cardiovascular diseases: landscape and limitations. Cardiovasc Diabetol, 2022, 21(1): 68.
33.	Ling Q, Song Q, Bai J, et al. Temporal relationship between arterial stiffness and systolic blood pressure under intensive or standard control: a post hoc analysis of the STEP trial. Hypertension, 2022, 79(12): 2755-2763.
34.	Gotschy A, Bauer E, Schrodt C, et al. Local arterial stiffening assessed by MRI precedes atherosclerotic plaque formation. Circ Cardiovasc Imaging, 2013, 6(6): 916-923.
35.	Zhong Q, Hu MJ, Cui YJ, et al. Carotid-femoral pulse wave velocity in the prediction of cardiovascular events and mortality: an updated systematic review and meta-analysis. Angiology, 2018, 69(7): 617-629.
36.	Laurent S, Cockcroft J, Van Bortel L, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J, 2006, 27(21): 2588-2605.
37.	Sugawara J, Hayashi K, Yokoi T, et al. Brachial-ankle pulse wave velocity: an index of central arterial stiffness. J Hum Hypertens, 2005, 19(5): 401-406.
38.	田芸凡, 彭澎, 孙婧煜, 等. 高血压患者动脉僵硬度与尿白蛋白升高的关系. 中国心血管杂志, 2023, 28(2): 159-164.
39.	祁卉卉, 陆燕, 刘梅, 等. 上海地区中青年非高血压人群血压水平对臂踝动脉脉搏波传导速度的横向、纵向影响. 中华高血压杂志, 2023, 31(5): 442-449.
40.	Tomiyama H, Yamashina A, Arai T, et al. Influences of age and gender on results of noninvasive brachial-ankle pulse wave velocity measurement--a survey of 12517 subjects. Atherosclerosis, 2003, 166(2): 303-309.
41.	Geer EB, Shen W. Gender differences in insulin resistance, body composition, and energy balance. Gend Med, 2009, 6(Suppl 1): 60-75.
42.	Laakkonen EK, Karppinen JE, Lehti S, et al. Associations of sex hormones and hormonal status with arterial stiffness in a female sample from reproductive years to menopause. Front Endocrinol (Lausanne), 2021, 12: 765916.

1. 中国心血管健康与疾病报告2022概要. 中国循环杂志, 2023, 38(6): 583-612.
2. Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics-2023 update: a report from the American Heart Association. Circulation, 2023, 147(8): e93-e621.
3. Zheng M, Zhang X, Chen S, et al. Arterial stiffness preceding diabetes: a longitudinal study. Circ Res, 2020, 127(12): 1491-1498.
4. Rosenblit PD. Extreme atherosclerotic cardiovascular disease (ASCVD) risk recognition. Curr Diab Rep, 2019, 19(8): 61.
5. Choi S. The potential role of biomarkers associated with ASCVD risk: risk-enhancing biomarkers. J Lipid Atheroscler, 2019, 8(2): 173-182.
6. Namekata T, Shirai K, Tanabe N, et al. Estimating the extent of subclinical arteriosclerosis of persons with prediabetes and diabetes mellitus among Japanese urban workers and their families: a cross-sectional study. BMC Cardiovasc Disord, 2016, 16: 52.
7. Fiori G, Fuiano F, Scorza A, et al. Non-Invasive methods for PWV measurement in blood vessel stiffness assessment. IEEE Rev Biomed Eng, 2022, 15: 169-183.
8. Zhao D, Liu J, Wang M, et al. Epidemiology of cardiovascular disease in China: current features and implications. Nat Rev Cardiol, 2019, 16(4): 203-212.
9. Hill MA, Yang Y, Zhang L, et al. Insulin resistance, cardiovascular stiffening and cardiovascular disease. Metabolism, 2021, 119: 154766.
10. Minh HV, Tien HA, Sinh CT, et al. Assessment of preferred methods to measure insulin resistance in Asian patients with hypertension. J Clin Hypertens (Greenwich), 2021, 23(3): 529-537.
11. Simental-Mendía LE, Rodríguez-Morán M, Guerrero-Romero F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord, 2008, 6(4): 299-304.
12. Wang Y, Yang W, Jiang X. Association between triglyceride-glucose index and hypertension: a meta-analysis. Front Cardiovasc Med, 2021, 8: 644035.
13. Pranata R, Huang I, Irvan None, et al. The association between triglyceride-glucose index and the incidence of type 2 diabetes mellitus-a systematic review and dose-response meta-analysis of cohort studies. Endocrine, 2021, 74(2): 254-262.
14. Liang S, Wang C, Zhang J, et al. Triglyceride-glucose index and coronary artery disease: a systematic review and meta-analysis of risk, severity, and prognosis. Cardiovasc Diabetol, 2023, 22(1): 170.
15. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
16. Lee SB, Ahn CW, Lee BK, et al. Association between triglyceride glucose index and arterial stiffness in Korean adults. Cardiovasc Diabetol, 2018, 17(1): 41.
17. Zhao S, Yu S, Chi C, et al. Association between macro- and microvascular damage and the triglyceride glucose index in community-dwelling elderly individuals: the Northern Shanghai Study. Cardiovasc Diabetol, 2019, 18(1): 95.
18. Li M, Zhan A, Huang X, et al. Positive association between triglyceride glucose index and arterial stiffness in hypertensive patients: the China H-type hypertension registry study. Cardiovasc Diabetol, 2020, 19(1): 139.
19. Nakagomi A, Sunami Y, Kawasaki Y, et al. Sex difference in the association between surrogate markers of insulin resistance and arterial stiffness. J Diabetes Complications, 2020, 34(6): 107442.
20. Poon AK, Meyer ML, Tanaka H, et al. Association of insulin resistance, from mid-life to late-life, with aortic stiffness in late-life: the atherosclerosis risk in communities study. Cardiovasc Diabetol, 2020, 19(1): 11.
21. Guo W, Zhu W, Wu J, et al. Triglyceride glucose index is associated with arterial stiffness and 10-year cardiovascular disease risk in a Chinese population. Front Cardiovasc Med, 2021, 8: 585776.
22. Pan Y, Zhong S, Zhou K, et al. Association between diabetes complications and the triglyceride-glucose index in hospitalized patients with type 2 diabetes. J Diabetes Res, 2021, 2021: 8757996.
23. Su Y, Wang S, Sun J, et al. Triglyceride glucose index associated with arterial stiffness in Chinese community-dwelling elderly. Front Cardiovasc Med, 2021, 8: 737899.
24. Wang S, Shi J, Peng Y, et al. Stronger association of triglyceride glucose index than the HOMA-IR with arterial stiffness in patients with type 2 diabetes: a real-world single-centre study. Cardiovasc Diabetol, 2021, 20(1): 82.
25. Chiu TH, Tsai HJ, Chiou HC, et al. A high triglyceride-glucose index is associated with left ventricular dysfunction and atherosclerosis. Int J Med Sci, 2021, 18(4): 1051-1057.
26. Baydar O, Kilic A, Okcuoglu J, et al. The Triglyceride-glucose index, a predictor of insulin resistance, is associated with subclinical atherosclerosis. Angiology, 2021, 72(10): 994-1000.
27. Han Z, Kang X, Zhang J, et al. Glycated hemoglobin and risk of arterial stiffness in a Chinese han population: a longitudinal study. Front Endocrinol (Lausanne), 2022, 13: 854875.
28. Ji W, Gao L, Sun P, et al. Association of the triglyceride-glucose index and vascular target organ damage in a Beijing community-based population. Front Cardiovasc Med, 2022, 9: 948402.
29. Yang X, Gao Z, Huang X, et al. The correlation of atherosclerosis and triglyceride glucose index: a secondary analysis of a national cross-sectional study of Japanese. BMC Cardiovasc Disord, 2022, 22(1): 250.
30. Muhammad IF, Bao X, Nilsson PM, et al. Triglyceride-glucose (TyG) index is a predictor of arterial stiffness, incidence of diabetes, cardiovascular disease, and all-cause and cardiovascular mortality: a longitudinal two-cohort analysis. Front Cardiovasc Med, 2023, 9: 1035105.
31. Wang Y, Wang S, Pan X, et al. Association between triglyceride-glucose index and arterial stiffness reflected by carotid pulse-wave velocity in stage 1 hypertension and individuals with normal/elevated blood pressure. J Clin Hypertens (Greenwich), 2023, 25(2): 199-212.
32. Tao LC, Xu JN, Wang TT, et al. Triglyceride-glucose index as a marker in cardiovascular diseases: landscape and limitations. Cardiovasc Diabetol, 2022, 21(1): 68.
33. Ling Q, Song Q, Bai J, et al. Temporal relationship between arterial stiffness and systolic blood pressure under intensive or standard control: a post hoc analysis of the STEP trial. Hypertension, 2022, 79(12): 2755-2763.
34. Gotschy A, Bauer E, Schrodt C, et al. Local arterial stiffening assessed by MRI precedes atherosclerotic plaque formation. Circ Cardiovasc Imaging, 2013, 6(6): 916-923.
35. Zhong Q, Hu MJ, Cui YJ, et al. Carotid-femoral pulse wave velocity in the prediction of cardiovascular events and mortality: an updated systematic review and meta-analysis. Angiology, 2018, 69(7): 617-629.
36. Laurent S, Cockcroft J, Van Bortel L, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J, 2006, 27(21): 2588-2605.
37. Sugawara J, Hayashi K, Yokoi T, et al. Brachial-ankle pulse wave velocity: an index of central arterial stiffness. J Hum Hypertens, 2005, 19(5): 401-406.
38. 田芸凡, 彭澎, 孙婧煜, 等. 高血压患者动脉僵硬度与尿白蛋白升高的关系. 中国心血管杂志, 2023, 28(2): 159-164.
39. 祁卉卉, 陆燕, 刘梅, 等. 上海地区中青年非高血压人群血压水平对臂踝动脉脉搏波传导速度的横向、纵向影响. 中华高血压杂志, 2023, 31(5): 442-449.
40. Tomiyama H, Yamashina A, Arai T, et al. Influences of age and gender on results of noninvasive brachial-ankle pulse wave velocity measurement--a survey of 12517 subjects. Atherosclerosis, 2003, 166(2): 303-309.
41. Geer EB, Shen W. Gender differences in insulin resistance, body composition, and energy balance. Gend Med, 2009, 6(Suppl 1): 60-75.
42. Laakkonen EK, Karppinen JE, Lehti S, et al. Associations of sex hormones and hormonal status with arterial stiffness in a female sample from reproductive years to menopause. Front Endocrinol (Lausanne), 2021, 12: 765916.

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