The triglyceride glucose index and cardiovascular disease outcomes.
The triglyceride glucose index and cardiovascular disease outcomes.
复制标题
DOI：
10.1016/s2666-7568(22)00269-0
复制
发表时间：
2023-01
影响因子：
13.1
通讯作者：
Sussman, Jeremy B
中科院分区：
文献类型：
--
作者：
Flood, David;Brant, Luisa Campos Caldeira;Sussman, Jeremy B
Jaramillo及其同事1介绍了前瞻性城乡流行病学（PURE）研究胰岛素抵抗与心血管疾病结局之间关系的结果。本研究1利用PURE数据引入了一种新的心脏代谢危险因素——甘油三酯葡萄糖（TyG）指数。TyG指数是胰岛素抵抗的替代标志物，通常被认为是糖尿病和前驱糖尿病的关键病理生理异常。它被计算为空腹甘油三酯乘以空腹血糖的自然对数，因此在具有实验室能力的初级保健机构中测量是实用的。这项PURE分析纳入了22个国家（5个低收入国家[lic]， 13个中等收入国家[MICs]和4个高收入国家[HICs]）的141 243名年龄在35-70岁之间的个体，随访时间中位数为13.2年（IQR为11.9 - 14.6）。复合主要结局为主要心血管疾病事件（非致死性心肌梗死或卒中）或心血管疾病导致的死亡。在调整后的模型中，TyG指数最高的个体与TyG指数最低的个体相比，复合结局发生率更高（HR为1.21；95% CI为1.13 - 1.30）。此外，这种关联的大小在不同的国家收入群体中存在异质性；在低收入国家和中等收入国家中观察到更大的相关性，而在高收入国家中没有观察到相关性。这些发现是有希望的，但TyG指数在因果推理、描述不公平、预测临床风险以及在临床实践中实施该标志物方面的作用还需要更多的知识。从因果关系的角度来看，一个挑战是解开胰岛素抵抗与已知的血糖升高和甘油三酯升高对心血管疾病风险的生物学作用。2,3换句话说，TyG指数的解释力有多少不是通过胰岛素抵抗途径介导的？在敏感性分析中，作者报告说，在单独的模型中，TyG指数比葡萄糖或甘油三酯的三分位数具有更大的心血管疾病发生率。作者假设，较高的风险比
Jaramillo and colleagues1 present results from the Prospective Urban Rural Epidemiology (PURE) study on the association between insulin resistance and cardiovascular disease outcomes. This study1 uses PURE data to introduce a novel cardiometabolic risk factor, the triglyceride glucose (TyG) index. The TyG index is a surrogate marker for insulin resistance, often considered the key pathophysiological abnormality in diabetes and prediabetes. It is calculated as the natural log of fasting triglycerides multiplied by fasting plasma glucose and therefore is practical to measure in primary care settings with laboratory capacity. This PURE analysis included 141 243 individuals aged 35–70 years who were followed up for a median of 13· 2 years (IQR 11· 9–14· 6) in 22 countries (5 lowincome countries [LICs], 13 middle-income countries [MICs], and 4 high-income countries [HICs]). The composite primary outcome was major cardiovascular disease events (non-fatal myocardial infarction or stroke) or death due to cardiovascular diseases. In the adjusted models, individuals in the highest TyG tertile had a greater incidence of the composite outcome compared with those in the lowest TyG tertile (HR 1· 21; 95% CI 1· 13–1· 30). Moreover, there was heterogeneity in the size of this association by country income group; a larger association was seen in LICs and MICs, while no association was observed in HICs. These findings are promising, but more knowledge is required for the role the TyG index in causal inference, describing inequity, predicting clinical risk, and implementing the marker in clinical practice.From a causal perspective, one challenge is disentangling the biological role of insulin resistance versus the known risk factors of elevated glucose and elevated triglycerides on cardiovascular disease risk. 2, 3 In other words, how much of the explanatory power of the TyG index is not mediated via a pathway of insulin resistance? In a sensitivity analysis, the authors reported that the TyG index had a greater hazard ratio for incident cardiovascular diseases than tertiles of glucose or triglycerides in separate models. The authors hypothesise that the higher hazard ratios for