Beyond Traditional Risk Factors: The MAINER Approach to Atherosclerotic Cardiovascular Disease

Abstract

Recent studies have increasingly shown that cardiovascular risk cannot be adequately explained by isolated biomarkers alone. Among emerging metabolic markers, the triglyceride-glucose (TyG) index and its anthropometric derivatives have demonstrated promising associations with coronary slow flow phenomenon, highlighting the importance of metabolic dysfunction in cardiovascular disease. 1 Atherosclerotic cardiovascular disease results from the interaction of insulin resistance, central adiposity, systemic inflammation, endocrine dysfunction, and nutritional status rather than from isolated metabolic abnormalities. 2,3 This complexity has stimulated the development of composite indices that integrate biomarkers from different biological domains, although most currently focus on only a limited number of pathways. Furthermore, the TyG index has recently been shown to independently predict major adverse cardiovascular and cerebrovascular events in a large prospective cohort of nondiabetic individuals, reinforcing its role as a clinically relevant metabolic risk marker. 4 Similarly, in our study of patients with decompensated heart failure admitted to the coronary intensive care unit, the C-reactive protein (CRP)-TyG index (CTI) was identified as a predictor of in-hospital mortality. 5 These findings suggest that a single biochemical or clinical index may not adequately capture the complexity of cardiovascular disease. In addition to these parameters, incorporating body shape-related characteristics may further improve patient evaluation. Composite indices that simultaneously assess inflammatory burden, metabolic status, anthropometric characteristics, and endocrine balance may