Horm Metab Res 2022; 54(03): 175-186
DOI: 10.1055/a-1766-0202
Endocrine Care

Triglyceride-Glucose Index and the Risk of Stroke: A Systematic Review and Dose-Response Meta-Analysis

Xiao Feng
1   Department of Neurology, Huazhong University of Science and Technology, Wuhan, China
,
Yao Yao
1   Department of Neurology, Huazhong University of Science and Technology, Wuhan, China
,
Lingshan Wu
1   Department of Neurology, Huazhong University of Science and Technology, Wuhan, China
,
Chang Cheng
1   Department of Neurology, Huazhong University of Science and Technology, Wuhan, China
,
Qiaoqiao Tang
1   Department of Neurology, Huazhong University of Science and Technology, Wuhan, China
,
Shabei Xu
1   Department of Neurology, Huazhong University of Science and Technology, Wuhan, China
› Author Affiliations
Funding Information: Key Research and Development Program of Hubei Province (2020BCA070 to X. Luo).

Abstract

Insulin resistance (IR) is an independent risk factor of cardiovascular disease. Recent research has proposed a new inexpensive and reliable indicator of IR: triglyceride glucose index (TyG index). We aim to evaluate the dose-response association between the TyG index and stroke through meta-analysis. Literature published from inception until October 2021 were searched in PubMed, Embase, Cochrane Library and Web of science. Cohort studies published in English and focusing on the association between the TyG index and stroke were included in our meta-analysis. I2 statistic and Chi-square were used to assess the heterogeneity. When I2≥30% or p≤0.10, the random-effect model was used to pool the effect; otherwise, we chose the fixed-effect model. Eleven cohort studies, including 5 721 077 subjects and 95 490 stroke patients, were included in our study. After pooling the effect adjusted by multiple confounders, we found that compared with the lowest baseline TyG index group, the highest one was independently associated with increased stroke risk (RR: 1.27; 95% CI, 1.24 to 1.29; I2=6%). Dose-response meta-analysis showed that the association between the two variables had a non-linear trend (p-nonlinearity<0.0001; p-heterogeneity=0.28). Subgroup analysis showed that the risk of ischemic stroke was positively correlated with TyG index (RR: 1.48; 95% CI, 1.34 to 1.62; I2=15%), while we did not observe this correlation in hemorrhagic stroke patients. In patients with type 2 diabetes and acute coronary syndrome, the TyG index was linearly correlated with incident strokes. In conclusion, elevated TyG index is the independent risk factor for incident strokes (especially ischemic stroke).

Supplementary Material



Publication History

Received: 06 November 2021

Accepted after revision: 27 January 2022

Article published online:
11 March 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Hill MA, Yang Y, Zhang L. et al. Insulin resistance, cardiovascular stiffening and cardiovascular disease. Metabolism 2021; 119: 154766
  • 2 Li Y, You A, Tomlinson B. et al. Insulin resistance surrogates predict hypertension plus hyperuricemia. J Diabetes Investig 2021; 12: 2046-2053
  • 3 Bonora E, Targher G, Alberiche M. et al. Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care 2000; 23: 57-63
  • 4 Kang B, Yang Y, Lee EY. et al. Triglycerides/glucose index is a useful surrogate marker of insulin resistance among adolescents. Int J Obes (Lond) 2017; 41: 789-792
  • 5 Du T, Yuan G, Zhang M. et al. Clinical usefulness of lipid ratios, visceral adiposity indicators, and the triglycerides and glucose index as risk markers of insulin resistance. Cardiovasc Diabetol 2014; 13: 146
  • 6 Park HM, Lee HS, Lee YJ. et al. The triglyceride-glucose index is a more powerful surrogate marker for predicting the prevalence and incidence of type 2 diabetes mellitus than the homeostatic model assessment of insulin resistance. Diabetes Res Clin Pract 2021; 180: 109042
  • 7 Li S, Guo B, Chen H. et al. The role of the triglyceride (triacylglycerol) glucose index in the development of cardiovascular events: a retrospective cohort analysis. Sci Rep 2019; 9: 7320
  • 8 Sánchez-Íñigo L, Navarro-González D, Fernández-Montero A. et al. The TyG index may predict the development of cardiovascular events. Eur J Clin Invest 2016; 46: 189-197
  • 9 Hong S, Han K, Park CY. The triglyceride glucose index is a simple and low-cost marker associated with atherosclerotic cardiovascular disease: a population-based study. BMC Med 2020; 18: 361
  • 10 Mao Q, Zhou D, Li Y. et al. The triglyceride-glucose index predicts coronary artery disease severity and cardiovascular outcomes in patients with non-ST-segment elevation acute coronary syndrome. Dis Markers 2019; 6891537
  • 11 Wang L, Cong HL, Zhang JX. et al. Triglyceride-glucose index predicts adverse cardiovascular events in patients with diabetes and acute coronary syndrome. Cardiovasc Diabetol 2020; 19: 80
  • 12 Zhao Q, Zhang TY, Cheng YJ. et al. Triglyceride-glucose index as a surrogate marker of insulin resistance for predicting cardiovascular outcomes in nondiabetic patients with non-ST-segment elevation acute coronary syndrome undergoing percutaneous coronary intervention. J Atheroscler Thromb 2020; 28: 1175-1194
  • 13 Zhang Y, Ding X, Hua B. et al. Predictive effect of triglyceride‑glucose index on clinical events in patients with type 2 diabetes mellitus and acute myocardial infarction: results from an observational cohort study in China. Cardiovasc Diabetol 2021; 20: 43
  • 14 Zhang Y, Ding X, Hua B. et al. High triglyceride-glucose index is associated with poor cardiovascular outcomes in nondiabetic patients with ACS with LDL-C below 1.8 mmol/L. J Atheroscler Thromb 2022; 29: 268-281
  • 15 Zhao Y, Sun H, Zhang W. et al. Elevated triglyceride-glucose index predicts risk of incident ischaemic stroke: The Rural Chinese cohort study. Diabetes Metab 2021; 47: 101246
  • 16 Wang A, Wang G, Liu Q. et al. Triglyceride-glucose index and the risk of stroke and its subtypes in the general population: an 11-year follow-up. Cardiovasc Diabetol 2021; 20: 46
  • 17 Wang A, Tian X, Zuo Y. et al. Change in triglyceride-glucose index predicts the risk of cardiovascular disease in the general population: a prospective cohort study. Cardiovasc Diabetol 2021; 20: 113
  • 18 Li J, Ren L, Chang C. et al. Correction: triglyceride-glucose index predicts adverse events in patients with acute coronary syndrome: a meta-analysis of cohort studies. Horm Metab Res 2021; 53: e3
  • 19 Akbar MR, Pranata R, Wibowo A. et al. The association between triglyceride-glucose index and major adverse cardiovascular events in patients with acute coronary syndrome – dose-response meta-analysis. Nutr Metab Cardiovasc Dis 2021; 31: 3024-3030
  • 20 Ding X, Wang X, Wu J. et al. Triglyceride-glucose index and the incidence of atherosclerotic cardiovascular diseases: a meta-analysis of cohort studies. Cardiovasc Diabetol 2021; 20: 76
  • 21 Wang A, Tian X, Zuo Y. et al. Association between the triglyceride-glucose index and carotid plaque stability in nondiabetic adults. Nutr Metab Cardiovasc Dis 2021; 31: 2921-2928
  • 22 Zhang N, Xiang Y, Zhao Y. et al. Association of triglyceride-glucose index and high-sensitivity C-reactive protein with asymptomatic intracranial arterial stenosis: A cross-sectional study. Nutr Metab Cardiovasc Dis 2021; 31: 3103-3110
  • 23 Gao JW, Hao QY, Gao M. et al. Triglyceride-glucose index in the development of peripheral artery disease: findings from the Atherosclerosis Risk in Communities (ARIC) Study. Cardiovasc Diabetol 2021; 20: 126
  • 24 Thai PV, Tien HA, Van Minh H. et al. Triglyceride glucose index for the detection of asymptomatic coronary artery stenosis in patients with type 2 diabetes. Cardiovasc Diabetol 2020; 19: 137
  • 25 Kahn AM, Allen JC, Seidel CL. et al. Insulin inhibits migration of vascular smooth muscle cells with inducible nitric oxide synthase. Hypertension 2000; 35: 303-306
  • 26 Lteif AA, Han K, Mather KJ. Obesity, insulin resistance, and the metabolic syndrome: determinants of endothelial dysfunction in whites and blacks. Circulation 2005; 112: 32-38
  • 27 Oh J, Riek AE, Darwech I. et al. Deletion of macrophage Vitamin D receptor promotes insulin resistance and monocyte cholesterol transport to accelerate atherosclerosis in mice. Cell Rep 2015; 10: 1872-1886
  • 28 Reardon CA, Lingaraju A, Schoenfelt KQ. et al. Obesity and insulin resistance promote atherosclerosis through an IFNγ-regulated macrophage protein network. Cell Rep 2018; 23: 3021-3030
  • 29 Moore SF, Williams CM, Brown E. et al. Loss of the insulin receptor in murine megakaryocytes/platelets causes thrombocytosis and alterations in IGF signalling. Cardiovasc Res 2015; 107: 9-19
  • 30 Santilli F, Vazzana N, Liani R. et al. Platelet activation in obesity and metabolic syndrome. Obes Rev 2012; 13: 27-42
  • 31 Randriamboavonjy V, Fleming I. Insulin, insulin resistance, and platelet signaling in diabetes. Diabetes Care 2009; 32: 528-530
  • 32 Wang Y, Yang W, Jiang X. Association between triglyceride-glucose index and hypertension: a meta-analysis. Front Cardiovasc Med 2021; 8: 644035
  • 33 Dong J, Yang H, Zhang Y. et al. Triglyceride-glucose index is a predictive index of hyperuricemia events in elderly patients with hypertension: a cross-sectional study. Clin Exp Hypertens 2021; 1-6
  • 34 Hägg S, Thorn LM, Forsblom CM. et al. Different risk factor profiles for ischemic and hemorrhagic stroke in type 1 diabetes mellitus. Stroke 2014; 45: 2558-2562
  • 35 Landsberg L. Pathophysiology of obesity-related hypertension: role of insulin and the sympathetic nervous system. J Cardiovasc Pharmacol 1994; 23: S1-S8
  • 36 Horita S, Seki G, Yamada H. et al. Insulin resistance, obesity, hypertension, and renal sodium transport. Int J Hypertens 2011; 2011: 391762
  • 37 Jin X, Chen H, Shi H. et al. Lipid levels and the risk of hemorrhagic stroke: A dose-response meta-analysis. Nutr Metab Cardiovasc Dis 2021; 31: 23-35