The synergistic effect of the triglyceride-glucose index and a body shape index on cardiovascular mortality: the construction of a novel cardiovascular risk marker
Abstract Background Insulin resistance, represented by increased triglyceride-glucose (TyG) index levels, shows interplay with visceral obesity and together promotes cardiovascular diseases and mortality. However, significant controversies exist regarding whether modified TyG indices, such as TyG-BM...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-02-01
|
| Series: | Cardiovascular Diabetology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12933-025-02604-z |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1823863265061502976 |
|---|---|
| author | Hao-ming He Ying-ying Xie Qiang Chen Yi-ke Li Xue-xi Li Sun-jing Fu Na Li Yan-ru Han Yan-xiang Gao Jin-gang Zheng |
| author_facet | Hao-ming He Ying-ying Xie Qiang Chen Yi-ke Li Xue-xi Li Sun-jing Fu Na Li Yan-ru Han Yan-xiang Gao Jin-gang Zheng |
| author_sort | Hao-ming He |
| collection | DOAJ |
| description | Abstract Background Insulin resistance, represented by increased triglyceride-glucose (TyG) index levels, shows interplay with visceral obesity and together promotes cardiovascular diseases and mortality. However, significant controversies exist regarding whether modified TyG indices, such as TyG-BMI, TyG-WC, and TyG-WHtR, outperform the TyG index in predicting cardiovascular outcomes. We aimed to explore whether there was a synergistic effect of a body shape index (ABSI), a better parameter reflecting visceral obesity, and the TyG index on cardiovascular mortality. Methods We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2001–2018 of 17,329 individuals. The associations of the TyG index and ABSI with cardiovascular mortality were investigated via Cox regression analysis and restricted cubic splines. Receiver operating characteristic (ROC) curve analysis was performed to compare the predictive value. Mediation analysis was used to explore the potential mediator. Results A total of 673 (3.9%) cardiovascular deaths occurred during a median follow-up of 8.92 years. Individuals with high TyG and high ABSI (TyG > 9.04 and ABSI > 0.085) were at the highest cardiovascular mortality risk both in individuals with (HR = 1.714, 95% CI 1.123–2.616) and without diabetes (HR = 1.402, 95% CI 1.003–1.960), suggesting a synergistic effect. Next, we multiplied these two indicators and established TyG-ABSI. It showed a J-shaped relationship and a positive linear relationship with cardiovascular mortality in individuals with and without diabetes, respectively. Arterial stiffness, represented by estimated pulse wave velocity, partially mediated the effect of TyG-ABSI on cardiovascular mortality, with a mediation proportion of 42.7%. The predictive value of TyG-ABSI was greater than that of the TyG index, TyG-BMI, TyG-WC, and TyG-WHtR (Harrell’s C-index: 0.710 vs 0.623 vs 0.539 vs 0.612 vs 0.622, all p < 0.001). Conclusions The simultaneous assessment of the TyG index and ABSI revealed a synergistic effect on cardiovascular mortality. We recommended the use of TyG-ABSI instead of the TyG index and other modified TyG indices in cardiovascular risk assessment. |
| format | Article |
| id | doaj-art-46a21cababe94fd3b2aac9783b43593c |
| institution | Kabale University |
| issn | 1475-2840 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj-art-46a21cababe94fd3b2aac9783b43593c2025-02-09T12:10:53ZengBMCCardiovascular Diabetology1475-28402025-02-0124111410.1186/s12933-025-02604-zThe synergistic effect of the triglyceride-glucose index and a body shape index on cardiovascular mortality: the construction of a novel cardiovascular risk markerHao-ming He0Ying-ying Xie1Qiang Chen2Yi-ke Li3Xue-xi Li4Sun-jing Fu5Na Li6Yan-ru Han7Yan-xiang Gao8Jin-gang Zheng9China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical CollegeChina-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical CollegeChina-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical CollegeChina-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical CollegeChina-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical CollegeDepartment of Cardiology, Peking University China-Japan Friendship School of Clinical MedicineDepartment of Cardiology, China-Japan Friendship HospitalDepartment of Cardiology, China-Japan Friendship HospitalDepartment of Cardiology, China-Japan Friendship HospitalChina-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical CollegeAbstract Background Insulin resistance, represented by increased triglyceride-glucose (TyG) index levels, shows interplay with visceral obesity and together promotes cardiovascular diseases and mortality. However, significant controversies exist regarding whether modified TyG indices, such as TyG-BMI, TyG-WC, and TyG-WHtR, outperform the TyG index in predicting cardiovascular outcomes. We aimed to explore whether there was a synergistic effect of a body shape index (ABSI), a better parameter reflecting visceral obesity, and the TyG index on cardiovascular mortality. Methods We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2001–2018 of 17,329 individuals. The associations of the TyG index and ABSI with cardiovascular mortality were investigated via Cox regression analysis and restricted cubic splines. Receiver operating characteristic (ROC) curve analysis was performed to compare the predictive value. Mediation analysis was used to explore the potential mediator. Results A total of 673 (3.9%) cardiovascular deaths occurred during a median follow-up of 8.92 years. Individuals with high TyG and high ABSI (TyG > 9.04 and ABSI > 0.085) were at the highest cardiovascular mortality risk both in individuals with (HR = 1.714, 95% CI 1.123–2.616) and without diabetes (HR = 1.402, 95% CI 1.003–1.960), suggesting a synergistic effect. Next, we multiplied these two indicators and established TyG-ABSI. It showed a J-shaped relationship and a positive linear relationship with cardiovascular mortality in individuals with and without diabetes, respectively. Arterial stiffness, represented by estimated pulse wave velocity, partially mediated the effect of TyG-ABSI on cardiovascular mortality, with a mediation proportion of 42.7%. The predictive value of TyG-ABSI was greater than that of the TyG index, TyG-BMI, TyG-WC, and TyG-WHtR (Harrell’s C-index: 0.710 vs 0.623 vs 0.539 vs 0.612 vs 0.622, all p < 0.001). Conclusions The simultaneous assessment of the TyG index and ABSI revealed a synergistic effect on cardiovascular mortality. We recommended the use of TyG-ABSI instead of the TyG index and other modified TyG indices in cardiovascular risk assessment.https://doi.org/10.1186/s12933-025-02604-zTriglyceride-glucose indexA body shape indexArterial stiffnessNHANESCardiovascular mortality |
| spellingShingle | Hao-ming He Ying-ying Xie Qiang Chen Yi-ke Li Xue-xi Li Sun-jing Fu Na Li Yan-ru Han Yan-xiang Gao Jin-gang Zheng The synergistic effect of the triglyceride-glucose index and a body shape index on cardiovascular mortality: the construction of a novel cardiovascular risk marker Cardiovascular Diabetology Triglyceride-glucose index A body shape index Arterial stiffness NHANES Cardiovascular mortality |
| title | The synergistic effect of the triglyceride-glucose index and a body shape index on cardiovascular mortality: the construction of a novel cardiovascular risk marker |
| title_full | The synergistic effect of the triglyceride-glucose index and a body shape index on cardiovascular mortality: the construction of a novel cardiovascular risk marker |
| title_fullStr | The synergistic effect of the triglyceride-glucose index and a body shape index on cardiovascular mortality: the construction of a novel cardiovascular risk marker |
| title_full_unstemmed | The synergistic effect of the triglyceride-glucose index and a body shape index on cardiovascular mortality: the construction of a novel cardiovascular risk marker |
| title_short | The synergistic effect of the triglyceride-glucose index and a body shape index on cardiovascular mortality: the construction of a novel cardiovascular risk marker |
| title_sort | synergistic effect of the triglyceride glucose index and a body shape index on cardiovascular mortality the construction of a novel cardiovascular risk marker |
| topic | Triglyceride-glucose index A body shape index Arterial stiffness NHANES Cardiovascular mortality |
| url | https://doi.org/10.1186/s12933-025-02604-z |
| work_keys_str_mv | AT haominghe thesynergisticeffectofthetriglycerideglucoseindexandabodyshapeindexoncardiovascularmortalitytheconstructionofanovelcardiovascularriskmarker AT yingyingxie thesynergisticeffectofthetriglycerideglucoseindexandabodyshapeindexoncardiovascularmortalitytheconstructionofanovelcardiovascularriskmarker AT qiangchen thesynergisticeffectofthetriglycerideglucoseindexandabodyshapeindexoncardiovascularmortalitytheconstructionofanovelcardiovascularriskmarker AT yikeli thesynergisticeffectofthetriglycerideglucoseindexandabodyshapeindexoncardiovascularmortalitytheconstructionofanovelcardiovascularriskmarker AT xuexili thesynergisticeffectofthetriglycerideglucoseindexandabodyshapeindexoncardiovascularmortalitytheconstructionofanovelcardiovascularriskmarker AT sunjingfu thesynergisticeffectofthetriglycerideglucoseindexandabodyshapeindexoncardiovascularmortalitytheconstructionofanovelcardiovascularriskmarker AT nali thesynergisticeffectofthetriglycerideglucoseindexandabodyshapeindexoncardiovascularmortalitytheconstructionofanovelcardiovascularriskmarker AT yanruhan thesynergisticeffectofthetriglycerideglucoseindexandabodyshapeindexoncardiovascularmortalitytheconstructionofanovelcardiovascularriskmarker AT yanxianggao thesynergisticeffectofthetriglycerideglucoseindexandabodyshapeindexoncardiovascularmortalitytheconstructionofanovelcardiovascularriskmarker AT jingangzheng thesynergisticeffectofthetriglycerideglucoseindexandabodyshapeindexoncardiovascularmortalitytheconstructionofanovelcardiovascularriskmarker AT haominghe synergisticeffectofthetriglycerideglucoseindexandabodyshapeindexoncardiovascularmortalitytheconstructionofanovelcardiovascularriskmarker AT yingyingxie synergisticeffectofthetriglycerideglucoseindexandabodyshapeindexoncardiovascularmortalitytheconstructionofanovelcardiovascularriskmarker AT qiangchen synergisticeffectofthetriglycerideglucoseindexandabodyshapeindexoncardiovascularmortalitytheconstructionofanovelcardiovascularriskmarker AT yikeli synergisticeffectofthetriglycerideglucoseindexandabodyshapeindexoncardiovascularmortalitytheconstructionofanovelcardiovascularriskmarker AT xuexili synergisticeffectofthetriglycerideglucoseindexandabodyshapeindexoncardiovascularmortalitytheconstructionofanovelcardiovascularriskmarker AT sunjingfu synergisticeffectofthetriglycerideglucoseindexandabodyshapeindexoncardiovascularmortalitytheconstructionofanovelcardiovascularriskmarker AT nali synergisticeffectofthetriglycerideglucoseindexandabodyshapeindexoncardiovascularmortalitytheconstructionofanovelcardiovascularriskmarker AT yanruhan synergisticeffectofthetriglycerideglucoseindexandabodyshapeindexoncardiovascularmortalitytheconstructionofanovelcardiovascularriskmarker AT yanxianggao synergisticeffectofthetriglycerideglucoseindexandabodyshapeindexoncardiovascularmortalitytheconstructionofanovelcardiovascularriskmarker AT jingangzheng synergisticeffectofthetriglycerideglucoseindexandabodyshapeindexoncardiovascularmortalitytheconstructionofanovelcardiovascularriskmarker |