Prognostic Value of Triglyceride-Glucose Index for the Prediction of Cardiovascular Events: Results from the Multi-Ethnic Study of Atherosclerosis (MESA)

Myocardial infarction (MI) and coronary heart disease (CHD) remain the leading cause of cardiovascular disease (CVD) associated morbidity and mortality. Early risk stratification and identification of residual risk factors is crucial to prevent subsequent adverse outcomes. Insulin resistance (IR) is a pivotal risk factor for cardio-metabolic disease. The triglyceride-glucose (TyG)-index is an inexpensive clinical surrogate marker for IR. We evaluated the relationship between TyG-index and major adverse cardiovascular events(MACE). MESA prospectively enrolled 6,814 participants free of CVD, aged 45-84 years. We divided the participants into TyG index tertiles of <8.5, 8.5-10, and >10. MACE was determined as a composite of MI, stroke, resuscitated cardiac-arrest (CA), percutaneous coronary intervention, coronary-artery-bypass-surgery and all-cause mortality. Hard-CHD (MI, CA, or CHD death) and hard-CVD (hard-CHD, stroke, and stroke death) were assessed. All outcomes were analyzed by Cox proportional hazards regression analysis while controlling for baseline covariates. During a mean 13.7-years of follow-up, MACE was observed in 2,033(30%) participants. Compared to participants with TyG-index of <8.5, participants in the 8.5-10 cohort had similar MACE(HR 1.003, 95% CI 0.907-1.11, p=0.95), hard-CHD(HR 1.013, 95% CI 0.838-1.225 p=0.89) and hard-CVD(HR 1.02, 95% CI 0.87-1.2, p=0.73). Compared to participants with TyG of <8.5, participants with TyG >10 had higher MACE (HR 1.73, 95% CI 1.29-2.3, p<0.001), hard-CHD(HR 1.8, 95% CI 1.1-2.97, p=0.018) and hard-CVD(HR 2.0, 95% CI 1.37-3.04, p<0.001). Patients with a TyG-index of >10 have worse CHD and CVD outcomes. Our results support the use of TyG-index as a risk-stratifier for primary preventive therapies.