TyG index helps identify young CAD patients and predict their risk of developing target lesion failure

The findings, published in Cardiovascular Diabetology, suggest the TyG index to be a valuable component of future efforts for improving TLF outcome prediction and CAD risk stratification among young adults.

The increase in EOCAD has become an emerging public health concern. EOCAD patients were more likely to be treated with target lesion failure, and percutaneous coronary intervention (PCI) than their older counterparts. Therefore, EOCAD has been a focus of growing concern considering their life-long atherosclerotic burden. Early identification of young people at risk for CAD is of great importance for better management and prevention. There is a need for non-invasive predictive biomarkers.

Against the above background Yan Zheng, Human Phenome Institute, Fudan University, Shanghai, China, and colleagues aimed to evaluate the usefulness of the TyG index, a novel marker of insulin resistance, in identifying young CAD patients and predicting their risk of developing target lesion failure.

For this purpose, the researchers recruited 1513 EOCAD patients (luminal narrowing ≥ 70%) and 1513 (luminal narrowing < 30%) age-matched controls, both aged 45 years or younger, from 38 hospitals in China between 2017 and 2020. EOCAD patients who underwent successful PCI were followed for incident TLF. TyG index was defined as Ln [fasting triglyceride (mg/dL) × fasting blood glucose (mg/dL)/2].

The association of the TyG index with prevalent EOCAD and incident TLF, respectively was evaluated using logistic regression and Cox proportional hazards modeling. The discriminatory ability of the TyG index was evaluated by the area under the receiver-operating characteristic curve (AUC).

The researchers reported the following findings:

• TyG index was positively associated with the prevalence of EOCAD (adjusted odds ratio: 1.40).
• The addition of the TyG index to an empirical risk model provided an improvement in diagnostic ability for EOCAD, with a net reclassification improvement of 0.10.
• During a medium of 33-month follow-up, 3.3% of patients experienced TLF.
• The Multivariate Cox regression model revealed that the TyG index was an independent risk factor for TLF (adjusted hazard ratio [HR]: 2.410 comparing the top to bottom TyG index tertile groups; HR: 1.30, per SD increase in TyG index).
• Compared with a model of conventional risk factors alone, the addition of the TyG index modestly improved the AUC to predict TLF.

"Our findings suggest the usefulness of the TyG index in screening subjects with severe atherosclerotic CAD among young adults and in identifying EOCAD patients at high risk of future TLF so that intensive strategies can be provided," the researchers concluded.

Reference:

Shali, S., Luo, L., Yao, K. et al. Triglyceride-glucose index is associated with severe obstructive coronary artery disease and atherosclerotic target lesion failure among young adults. Cardiovasc Diabetol 22, 283 (2023). https://doi.org/10.1186/s12933-023-02004-1