The long-term prognostic value of triglyceride-glucose index in type 2 diabetics without clinical coronary artery disease.
BACKGROUND The triglyceride-glucose (TyG) index, a simple laboratory marker of insulin resistance, has been associated with cardiometabolic risk. OBJECTIVES The purpose of this study was to evaluate whether baseline TyG predicts long-term major adverse cardiovascular events (MACE) in patients with type 2 diabetes (T2DM) without clinical coronary artery disease (CAD), independent of traditional risk factors and coronary artery calcium scoring (CACS). METHODS We conducted a retrospective analysis of a prospectively recruited cohort of 735 patients with T2DM, aged 55-74 years (48% women), enrolled between 2006 and 2008. All participants had at least one additional cardiovascular risk factor, no history or symptoms of CAD, and underwent computed tomography for CACS assessment. Multivariate Cox proportional hazards models were used to investigate the association of baseline TyG with the occurrence of myocardial infarction, stroke, or all-cause death, adjusting for demographic factors, diabetes severity, and CACS. RESULTS Over a median follow-up of 16.4 years, 327 patients experienced a first MACE. Compared with patients with TyG <50th percentile (<9.26), multivariable-adjusted hazard ratios (95% CI) were 1.62 (1.30-2.03), 1.84 (1.43-2.38), and 2.09 (1.48-2.94) for TyG ≥50th (≥9.26), >75th (>9.68), and ≥90th (>10.16) percentiles, respectively. The association remained significant after additional adjustment for diabetes severity and CACS. In a combined TyG-CACS model, MACE incidence progressively increased from 1.29 (TyG <9.26; CACS=0) to 5.33 (TyG >9.68; CACS ≥100) events per 100 patient-years. CONCLUSIONS In a cohort without known CAD, baseline TyG independently predicts long-term MACE in T2DM. This simple, widely available metabolic marker may enhance cardiovascular risk stratification and MACE primary prevention strategies.