China: The triglyceride-glucose (TyG) index is strongly associated with the recurrence of ischemic stroke (IS) and death in acute IS patients with T2DM (type 2 diabetes mellitus), a recent study in Cardiovascular Diabetology has revealed. Therefore, the TyG index might predict clinical outcomes for acute ischemic stroke patients with type 2 diabetes.
Calculating the TyG index level is a simple method to analyze the sum of blood sugar and lipid status before vascular atherosclerosis. In addition, vascular atherosclerotic pathological changes are closely related to cardiovascular and cerebrovascular events. In healthy and cardiovascular disease individuals, most studies focus on the level of the TyG index to evaluate the prognosis and prevalence of cardiovascular disease (CVD) and coronary artery disease. Some studies have suggested that the increased levels of TyG index are linked with a higher risk of progression of coronary atherosclerosis and all-cause mortality, confirmed by some meta-analyses in coronary heart disease studies.
TyG index is also associated with an increased risk of neurologic worsening, all-cause mortality, and stroke in patients with acute IS. However, there are few clinical studies on the TyG index in type 2 diabetes and impaired glucose tolerance, particularly in type 2 diabetes patients with ischemic stroke. And the predictive role of the TyG index on clinical events, such as all-cause mortality, IS recurrence, and poor outcome, in IS patients with T2DM has yet to be thoroughly studied.
Against the above background, Dong Liu from Capital Medical University in Beijing, China, and colleagues conducted the study to estimate the role of the TyG index for the prediction of adverse outcomes in acute ischemic stroke patients with T2DM in an analysis of the CNSR II (China National Stroke Registry II).
In the cross-sectional analysis, 3359 IS patients with T2DM were included among 19,604 patients with acute ischemic stroke admitted to the CNSRII. The TyG index calculated by In [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2, was split into four quartiles. The study's outcomes were all-cause death, recurrent IS, and poor outcomes at one year. The researchers assessed the link between the TyG index and adverse cerebrovascular outcomes by proportional hazards regression analysis.
The study led to the following findings:
· During 1-year follow-up, all-cause death, recurrent IS, and poor outcome occurred in 6.82%, 9.08%, and 47.9% cases, respectively.
· Multivariable Cox proportional hazards analyses revealed that the risk of incident primary endpoints was linked with a higher TyG quartile.
· Following adjusting for confounding factors, patients with a higher TyG index were associated with IS recurrence (adjusted hazard ratio, 1.41) and all-cause death (adjusted hazard ratio, 1.70), compared with those in the first quartile at 1-year time follow-up.
· There were interactions between TyG index and age (≥ 65), female, anticoagulant agents, hypertensive agents, antidiabetic agents, and statins in subgroup analyses, particularly patients without taking anticoagulant drugs were significantly related to the recurrence of IS, all-cause death and poor outcome.
"Our findings indicate that the TyG index may be used as a notable risk predictor for assessing the long-term outcomes in IS patients with type 2 diabetes," the authors wrote. "Increased levels of TyG index can be used as an indicator of increased risk of all-cause death and recurrent IS at the follow-up of one year."
"Monitoring the TyG index as a qualified risk stratification and predictor tool required more attention in clinical practice for IS patients with T2DM," they concluded.
Reference:
Liu, D., Yang, K., Gu, H. et al. Predictive effect of triglyceride-glucose index on clinical events in patients with acute ischemic stroke and type 2 diabetes mellitus. Cardiovasc Diabetol 21, 280 (2022). https://doi.org/10.1186/s12933-022-01704-4