Objective: To explore the association between the triglyceride-glucose index (TyG) and TyG-obesity composite indices, including TyG-waist circumference (TyG-WC), TyG-body mass index (TyG-BMI), and TyG-waist-to-height ratio (TyG-WHtR), and the risk of ischemic heart disease (IHD), and to provide reference for the prevention of IHD.
Methods: The sample of this study was derived from the West China Elderly Preventive and Treatment Merging Cohort, from which 9628 elderly individuals from the retrospective cohort were selected. Cox regression models were used to analyze the association between TyG-related indices and the risk of IHD. Receiver operating characteristic (ROC) curves were plotted to assess and compare the performance of TyG-related indices in predicting the occurrence of IHD.
Results: The participants were followed up for a median of 2.82 years, with 7.2% (694/9628) of the participants experiencing IHD events. Multivariate Cox regression showed that after controlling for the covariates, including sex, age, educational attainment, smoking, drinking, exercise, dietary habits, medication history, and whether the participant had hypertension, every time TyG, TyG-WC, TyG-BMI and TyG-WHtR increased by one standard deviation (SD), the risk of IHD increased by 12% (hazard ratio [HR]=1.12, 95% confidence interval [CI]: 1.04-1.20), 21% (HR=1.21, 95% CI: 1.12-1.31), 20% (HR=1.20, 95% CI: 1.12-1.29), and 19% (HR=1.19, 95% CI: 1.10-1.28), respectively. Both the TyG index and TyG-obesity composite indices were positively correlated with IHD risk, showing a linear relationship (P<0.05). TyG-WC (area under the curve[AUC]=0.680, 95% CI: 0.660-0.700, P<0.001), TyG-BMI (AUC=0.674, 95% CI: 0.654-0.695, P<0.001), and TyG-WHtR (AUC=0.678, 95% CI: 0.658-0.698, P<0.001) demonstrated better predictive performance than TyG did (AUC=0.669, 95% CI: 0.648-0.689, P<0.001).
Conclusion: Elevated levels of TyG and TyG-obesity composite indices were associated with a higher risk for IHD, and combining TyG with BMI, WC, and WHtR may lead to better performance in risk assessment for IHD than using TyG alone.
目的: 本研究旨在探讨甘油三酯葡萄糖指数（triglyceride glucose index, TyG）及TyG-肥胖联合指数〔包括TyG-腰围（TyG-waist circumference, TyG-WC）、TyG-体质量指数（TyG-body mass index, TyG-BMI）、TyG-腰臀比（TyG-waist-to-hip ratio, TyG-WHtR）〕与缺血性心脏病（ischemic heart disease, IHD）发生风险的关联，为预防IHD提供参考依据。
方法: 本研究的样本来源于华西老年人群医防融合队列，选取其中回顾性队列样本中9628名老年人群。运用Cox回归模型分析TyG相关指数与IHD发生风险的关联；通过绘制受试者操作特征（receiver operating characteristic, ROC）曲线对比不同的TyG相关指数预测是否发生IHD的能力。
结果: 本研究的中位随访时间为2.82年，共有7.2%（694/9628）的参与者发生了IHD事件。多因素Cox回归发现在控制性别、年龄、文化程度、吸烟、饮酒、运动、饮食习惯、药物史、是否患高血压等协变量后，TyG、TyG-WC、TyG-BMI和TyG-WHtR指数每升高1个标准差（standard deviation, SD），IHD的发生风险分别增加12%〔风险比（hazard ratio, HR）=1.12，95%置信区间（confidence interval, CI）：1.04～1.20〕、21%（HR=1.21，95%CI：1.12～1.31）、20%（HR=1.20，95%CI：1.12～1.29）和19%（HR=1.19，95%CI：1.10～1.28）。TyG指数及TyG-肥胖联合指数均与IHD发生风险之间为正相关且呈线性关系（P<0.05）。TyG-WC指数〔曲线下面积（area under the curve, AUC）=0.680，95%CI：0.660～0.700，P<0.001〕、TyG-BMI指数（AUC=0.674，95%CI：0.654～0.695，P<0.001）和TyG-WHtR指数（AUC=0.678，95%CI：0.658～0.698，P<0.001）对是否发生IHD的预测效果好于TyG指数（AUC=0.669，95%CI：0.648～0.689，P<0.001）。
结论: TyG指数和TyG-肥胖联合指数升高均与IHD发生风险增加相关，TyG指数与BMI、WC和WHtR相结合可能比单独的TyG指数具有更强的IHD风险评估能力。
Keywords: Blood glucose; Insulin resistance; Myocardial ischemia; Obesity.
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