Sex-Specific Comparison Between Triglyceride Glucose Index and Modified Triglyceride Glucose Indices to Predict New-Onset Hypertension in Middle-Aged and Older Adults

Associations of metabolic disorders with hypertension and cardiovascular disease: recent findings and therapeutic perspectives

We theoretically know that metabolic disorders, including overweight/obesity, insulin resistance, diabetes, dyslipidemia, and relevant tissue/organ damage, play a critical role in elevating blood pressure and developing hypertension. However, staying abreast of the ever-evolving and current research on the various metabolic disorder topics is difficult. At the same time, as hypertension in childhood and adolescence is attracting significant attention globally, it is becoming increasingly evident that metabolic disorders exert an important role in its pathogenesis. In order to effectively prevent hypertension, it is essential to appropriately approach metabolic disorders, and importantly, this approach must be practiced continuously throughout all generations. Thus, focusing on metabolic disorders is the first and essential step in effectively managing and preventing hypertension. In this Mini-Review, we introduce cutting-edge research findings on "Metabolism," published in 2023 by Hypertension Research, and discuss relevant topics and therapeutic and future perspectives.

Comparison of triglyceride glucose index and modified triglyceride glucose indices in prediction of cardiovascular diseases in middle aged and older Chinese adults

BACKGROUND

Triglyceride and glucose (TyG) index, a surrogate marker of insulin resistance, has been validated as a predictor of cardiovascular disease. However, effects of TyG-related indices combined with obesity markers on cardiovascular diseases remained unknown. We aimed to investigate the associations between TyG index and modified TyG indices with new-onset cardiovascular disease and the time-dependent predictive capacity using a national representative cohort.

METHODS

This study is a retrospective observational cohort study using data from China Health and Retirement Longitudinal Study (CHARLS) of 7 115 participants. The TyG index was calculated as Ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. The modified TyG indices were developed combining TyG with body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR). We used adjusted Cox proportional hazards regression to analyze the association and predictive capacity based on hazard ratio (HR) and Harrell's C-index.

RESULTS

Over a 7-year follow-up period, 2136 participants developed cardiovascular disease, including 1633 cases of coronary heart disease and 719 cases of stroke. Compared with the lowest tertile group, the adjusted HR (95% CI) for new-onset cardiovascular disease in the highest tertile for TyG, TyG-BMI, TyG-WC, and TyG-WHtR were 1.215 (1.088-1.356), 1.073 (0.967-1.191), 1.078 (0.970-1.198), and 1.112 (1.002-1.235), respectively. The C-indices of TyG index for cardiovascular disease onset were higher than other modified TyG indices. Similar results were observed for coronary heart disease and stroke.

CONCLUSION

TyG and TyG-WhtR were significantly associated with new-onset cardiovascular diseases, and TyG outperformed the modified TyG indices to identify individuals at risk of incident cardiovascular event.

Systolic blood pressure status modifies the associations between the triglyceride-glucose index and incident cardiovascular disease: a national cohort study in China

BACKGROUND

The triglyceride-glucose (TyG) index and blood pressure (BP) are correlated and serve as risk factors for cardiovascular disease (CVD). The potential impact of BP status on the association between the TyG index and CVD risk remains uncertain. This study aims to investigate the relationships between the TyG index and incident CVD in Chinese middle-aged and elderly adults, considering variations in BP status among participants.

METHODS

6558 participants (mean age: 58.3 (± 8.7) years; 46.0% were men) without prevalent CVD were recruited from the China Health and Retirement Longitudinal Study. Participants were divided into three groups according to their systolic blood pressure (SBP) levels (< 120mmHg, 120 ∼ 129mmHg, ≥ 130mmHg). The TyG index was computed as ln[triglyceride (mg/dl) * fasting blood glucose (mg/dl)/2]. The primary outcome was CVD (heart disease and stroke), and the secondary outcomes were individual CVD components. Cox regression models and restricted cubic splines were performed to investigate the associations between continuous and categorical TyG with CVD.

RESULTS

1599 cases of CVD were captured during 58,333 person-years of follow-up. Per 1-SD higher TyG index was associated with a 19% (HR: 1.19; 95% CI: 1.12, 1.27) higher risk for incident CVD, and the participants with the highest quartile of TyG index had a 54% (HR: 1.54; 95% CI: 1.29, 1.84) higher risk of CVD compared to those in the lowest quartile. SBP significantly modifies the association between the TyG index and CVD, with higher HRs for CVD observed in those with optimal and normal SBP. SBP partially mediated the associations between the TyG index with CVD. The results were generally consistent among participants with varying pulse pressure statuses rather than diastolic BP statuses.

CONCLUSIONS

The associations between the TyG index and CVD were modified by BP status, with greater HRs for CVD observed among those who had SBP < 130mmHg. SBP can partially mediate the association between the TyG index with CVD, highlighting the importance of early screening for the TyG index to identify at risk of hypertension and CVD.

Association of hypertension with the triglyceride-glucose index and its associated indices in the Chinese population: A 6-year prospective cohort study

The authors aim to assess the correlation between hypertension and the triglyceride-glucose (TyG) index and its associated indices, and to compare their abilities to identify hypertension. Four thousand eight hundred and sixty-six non-hypertensive participants were enrolled from the China National Health Survey in 2009. The data on new-onset hypertension were gathered in both 2011 and 2015. The TyG index and its associated indices were derived from the fasting triglyceride, blood glucose levels, and anthropometric parameters. Multivariate logistic regression analyses and receiver operating characteristic curve analysis were used. The adjusted odds ratio (OR) and 95% confidence interval (CI) for the new-onset hypertension for the TyG-waist-to-height ratio (TyG-WHtR), TyG-waist circumference (TyG-WC), TyG-waist-to-hip ratio (TyG-WHR), TyG-body mass index (TyG-BMI), and TyG index were 1.379 (1.230-1.546), 1.002 (1.001-1.003), 1.156 (1.069-1.251), 1.007 (1.005-1.009), and 1.187 (1.051-1.341), respectively. In addition, comparing the lowest quartile (Q1) group with the highest quartile (Q4), the adjusted OR and 95% CI for the new-onset hypertension were found to be 1.86 (1.48-2.35), 1.93 (1.53-2.43), 1.71 (1.36-2.16), 2.00 (1.60-2.50), and 1.49 (1.19-1.88) for TyG-WHtR, TyG-WC, TyG-WHR, TyG-BMI, and TyG index, respectively, among all participants. The TyG-WHtR had the largest area under the curve (AUC) for hypertension (AUC, 0.628; 95% CI, 0.614-0.641) in all participants. Stratified analysis also indicated that the TyG-WHtR exhibited the greatest AUC in both males (AUC, 0.608; 95% CI, 0.587-0.629) and females (AUC, 0.648; 95% CI, 0.629-0.666). In conclusions, the TyG index and its associated indices were positively associated with hypertension. Among these indices, TyG-WHtR was the most valuable indicator for predicting hypertension.