Sex differences in the nonlinear association of triglyceride glucose index with all-cause and cardiovascular mortality in the general population

Yu Yu; Jing Wang; Ligang Ding; Hao Huang; Sijing Cheng; Yu Deng; Min Gu; Chi Cai; Xiaohui Ning; Xuhua Chen; Hongxia Niu; Wei Hua

doi:10.1186/s13098-023-01117-7

Sex differences in the nonlinear association of triglyceride glucose index with all-cause and cardiovascular mortality in the general population

Diabetol Metab Syndr. 2023 Jun 23;15(1):136. doi: 10.1186/s13098-023-01117-7.

Authors

Yu Yu¹, Jing Wang¹, Ligang Ding¹, Hao Huang¹, Sijing Cheng¹, Yu Deng¹, Min Gu¹, Chi Cai¹, Xiaohui Ning¹, Xuhua Chen¹, Hongxia Niu¹, Wei Hua²

Affiliations

¹ Cardiac Arrhythmia Center, Department of Cardiology, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Cardiac Arrhythmia Center, Department of Cardiology, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. drhuaweifw@sina.com.

Abstract

Background: The evidence on the association between the triglyceride glucose (TyG) index and the risk of death in the general population remains controversial. This study aims to investigate the relationship between the TyG index and all-cause and cardiovascular mortality in the general population, with a focus on sex differences.

Methods: This prospective cohort study analyzed data from the National Health and Nutrition Examination Survey (1999-2002), comprising 7,851 US adults. The study employed multivariate Cox proportional hazards regression and two-segment Cox hazard regression models to evaluate the sex-specific differences in the relationship between the TyG index and all-cause and cardiovascular mortality.

Results: After 11,623 person-years of follow-up, there were 539 deaths, with 10.56% due to all-cause mortality and 2.87% due to cardiovascular mortality. After adjusting for multiple variables, our study found a U-shaped association of the TyG index with all-cause and cardiovascular mortality, with inflection points at 9.36 and 9.52. A significant sex difference was observed in the association between the TyG index and mortality. Below the inflection point, the relationship between the TyG index and mortality was consistent in males and females. However, above the inflection point, only males exhibited a positive association between the TyG index and all-cause mortality (adjusted hazard risk [HR], 1.62, 95% confidence interval [CI], 1.24-2.12) and cardiovascular mortality (adjusted HR, 2.28, 95% CI, 1.32-3.92).

Conclusions: Our study showed a U-shaped association between the TyG index and all-cause and cardiovascular mortality in the general population. Furthermore, sex differences were observed in the association between the TyG index and mortality once it exceeded a certain threshold.

Keywords: Insulin resistance; Mortality; NHANES; Sex difference; Triglyceride glucose index.