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      Triglyceride-glucose index trajectory and arterial stiffness: results from Hanzhong Adolescent Hypertension Cohort Study

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          Abstract

          Background

          The triglyceride-glucose index (TyG index) has emerged as a reliable surrogate marker of insulin resistance associated with arterial stiffness. However, most studies were based on a cross-sectional design, and few studies have evaluated the longitudinal impact of the TyG index on arterial stiffness. This study aimed to investigate the associations of single time point measurement and the long-term trajectory of the TyG index with arterial stiffness in a Chinese cohort.

          Methods

          Data are derived from the Hanzhong Adolescent Hypertension Cohort study. A total of 2480 individuals who participated in the 2017 survey was included in the cross-sectional analysis. A sample of 180 individuals from the sub-cohort with follow-up data in 2005, 2013, and 2017 was enrolled in the longitudinal analysis. The TyG index was calculated as ln (fasting triglyceride [mg/dL] × fasting glucose [mg/dL]/2), and arterial stiffness was determined using brachial-ankle pulse wave velocity (baPWV). The latent class growth mixture modeling method was used to identify the TyG index trajectories from 2005 to 2017.

          Results

          In the cross-sectional analysis, the median age of the study population was 42.8 (39.8, 44.9) years, and 1351 (54.5%) were males. Each one-unit increment in TyG index was associated with a 37.1 cm/s increase (95% confidence interval [CI] 23.7–50.6 cm/s; P < 0.001) in baPWV, and similar results were observed when the TyG index was in the form of quartiles. In the longitudinal analysis, we identified three distinct TyG index trajectories and found that the highest TyG index trajectory carried the greatest odds of increased arterial stiffness, with a fully adjusted odds ratio (OR) of 2.76 (95% CI 1.40, 7.54).

          Conclusions

          Elevated levels of baseline TyG index and higher long-term trajectory of TyG index were independently associated with increased arterial stiffness. Monitoring immediate levels and longitudinal trends of the TyG index may help with the prevention of arterial stiffness in the long run.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12933-022-01453-4.

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          Most cited references43

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          Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis.

          The purpose of this study was to calculate robust quantitative estimates of the predictive value of aortic pulse wave velocity (PWV) for future cardiovascular (CV) events and all-cause mortality by meta-analyses of longitudinal studies. Arterial stiffness is increasingly recognized as a surrogate end point for CV disease. We performed a meta-analysis of 17 longitudinal studies that evaluated aortic PWV and followed up 15,877 subjects for a mean of 7.7 years. The pooled relative risk (RR) of clinical events increased in a stepwise, linear-like fashion from the first to the third tertile of aortic PWV. The pooled RRs of total CV events, CV mortality, and all-cause mortality were 2.26 (95% confidence interval: 1.89 to 2.70, 14 studies), 2.02 (95% confidence interval: 1.68 to 2.42, 10 studies), and 1.90 (95% confidence interval: 1.61 to 2.24, 11 studies), respectively, for high versus low aortic PWV subjects. For total CV events and CV mortality, the RR was significantly higher in high baseline risk groups (coronary artery disease, renal disease, hypertension) compared with low-risk subjects (general population). An increase in aortic PWV by 1 m/s corresponded to an age-, sex-, and risk factor-adjusted risk increase of 14%, 15%, and 15% in total CV events, CV mortality, and all-cause mortality, respectively. An increase in aortic PWV by 1 SD was associated with respective increases of 47%, 47%, and 42%. Aortic stiffness expressed as aortic PWV is a strong predictor of future CV events and all-cause mortality. The predictive ability of arterial stiffness is higher in subjects with a higher baseline CV risk.
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            The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects.

            Because the insulin test is expensive and is not available in most laboratories in the cities of undeveloped countries, we tested whether the product of fasting triglycerides and glucose levels (TyG) is a surrogate for estimating insulin resistance compared with the homeostasis model assessment of insulin resistance (HOMA-IR) index. We performed a population-based cross-sectional study. Sampling strategy was based on a randomized two-stage cluster sampling procedure. Only apparently healthy subjects, men and nonpregnant women aged 18-65 years, with newly diagnosed impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or IFG + IGT were enrolled. Renal disease, malignancy, and diabetes were exclusion criteria. Sensitivity, specificity, predictive values, and the probability of disease given a positive test were calculated. The optimal TyG index for estimating insulin resistance was established using a receiver operating characteristic scatter plot analysis. A total of 748 apparently healthy subjects aged 41.4 +/- 11.2 years were enrolled. Insulin resistance was identified in 241 (32.2%) subjects (HOMA-IR index 4.4 +/- 1.6). New diagnoses of IFG, IGT, and IFG + IGT were established in 145 (19.4%), 54 (7.2%), and 75 (10.0%) individuals. respectively. The best TyG index for diagnosis of insulin resistance was Ln 4.65, which showed the highest sensitivity (84.0%) and specificity (45.0%) values. The positive and negative predictive values were 81.1% and 84.8%, and the probability of disease, given a positive test, was 60.5%. The TyG index could be useful as surrogate to identify insulin resistance in apparently healthy subjects.
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              Inflammation and insulin resistance.

              Over a hundred years ago, high doses of salicylates were shown to lower glucose levels in diabetic patients. This should have been an important clue to link inflammation to the pathogenesis of type 2 diabetes (T2D), but the antihyperglycemic and antiinflammatory effects of salicylates were not connected to the pathogenesis of insulin resistance until recently. Together with the discovery of an important role for tissue macrophages, these new findings are helping to reshape thinking about how obesity increases the risk for developing T2D and the metabolic syndrome. The evolving concept of insulin resistance and T2D as having immunological components and an improving picture of how inflammation modulates metabolism provide new opportunities for using antiinflammatory strategies to correct the metabolic consequences of excess adiposity.
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                Author and article information

                Contributors
                yanyu9mail@163.com
                994721928@qq.com
                sunyue0205@163.com
                984321683@qq.com
                wangkeke215@163.com
                1303340017@qq.com
                237072313@qq.com
                jhsnak@163.com
                iaacd@163.com
                zwl08201032@126.com
                hjw0101152661@stu.xjtu.edu.cn
                18706735086@163.com
                wangyangxxk@126.com
                13636810941@163.com
                mujjun@163.com
                Journal
                Cardiovasc Diabetol
                Cardiovasc Diabetol
                Cardiovascular Diabetology
                BioMed Central (London )
                1475-2840
                25 February 2022
                25 February 2022
                2022
                : 21
                : 33
                Affiliations
                [1 ]GRID grid.43169.39, ISNI 0000 0001 0599 1243, Department of Cardiology, First Affiliated Hospital of Medical School, Key Laboratory of Molecular Cardiology of Shaanxi Province, Ministry of Education, , Xi’an Jiaotong University, Key Laboratory of Environment and Genes Related to Diseases (Xi’an Jiaotong University), ; NO.277, Yanta West Road, Xi’an, 710061 Shaanxi People’s Republic of China
                [2 ]GRID grid.43169.39, ISNI 0000 0001 0599 1243, Department of Cardiovascular Surgery, First Affiliated Hospital of Medical School, , Xi’an Jiaotong University, ; Xi’an, China
                [3 ]GRID grid.412676.0, ISNI 0000 0004 1799 0784, Department of Cardiovascular Medicine, , Jiangsu Province Hospital, ; Nanjing, China
                Article
                1453
                10.1186/s12933-022-01453-4
                8876112
                35216614
                eb411152-aec3-4c28-a013-05294b9551a1
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 14 November 2021
                : 5 January 2022
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 82070437
                Award Recipient :
                Funded by: Clinical Research Award of the First Affiliated Hospital of Xi’an Jiaotong University
                Award ID: XJTU1AF-CRF-2019-004
                Award Recipient :
                Categories
                Original Investigation
                Custom metadata
                © The Author(s) 2022

                Endocrinology & Diabetes
                triglyceride-glucose index,insulin resistance,arterial stiffness,cohort study

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