Triglyceride-glucose (TyG) index as a potent marker of subclinical atherosclerosis: insights into carotid intima-media thickness remodeling

Abstract

Insulin resistance is a key mechanism in the development of atherosclerosis. The triglyceride–glucose (TyG) index is an easily obtainable surrogate of insulin resistance; however, its relationship with structural vascular damage in high-risk clinical settings remains insufficiently defined. To investigate the association between the TyG index and carotid intima–media thickness (IMT) and to determine whether this relationship is independent of established cardiovascular risk factors. This cross-sectional study included 260 men with erectile dysfunction (mean age 59.3 ± 9.6 years) who underwent carotid ultrasound for IMT assessment. The TyG index was calculated using the formula: Ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL) / 2]. Associations between TyG and vascular parameters were evaluated using correlation analysis. Multivariable linear regression was performed with IMT as the dependent variable, adjusting for age, mean arterial pressure (MAP), and body mass index (BMI). Mean IMT was 0.88 ± 0.18 mm and mean TyG index was 8.88 ± 0.63. TyG was positively associated with IMT (Spearman ρ = 0.116, p = 0.031). In multivariable analysis, TyG remained an independent determinant of IMT (B = 0.044, standardized β = 0.153, p = 0.003; 95% CI 0.015–0.072), beyond the effects of age, blood pressure, and BMI. In men with erectile dysfunction, the TyG index is independently associated with increased carotid IMT, reflecting early structural atherosclerosis. As a simple and low-cost marker of insulin resistance, TyG provides incremental information beyond traditional risk factors and may support early cardiovascular risk stratification in this high-risk population.