Association of the triglyceride glucose index as a measure of insulin resistance with mortality and cardiovascular disease in populations from five continents (PURE study): A prospective cohort study

• Published in: The Lancet Healthy Longevity
• Main Authors: Lopez-Jaramillo, Patricio, Gomez-Arbelaez, Diego, Martinez-Bello, Daniel, Abat, Marc Evans, Alhabib, Khalid F, Avezum, Álvaro, Barbarash, Olga, Chifamba, Jephat, Diaz, Maria L, Gulec, Sadi, Ismail, Noorhassim, Iqbal, Romaina, Kelishadi, Roya, Khatib, Rasha, Lanas, Fernando, Levitt, Naomi S, Li, Yang, Mohan, Viswanathan, Mony, Prem K, Poirier, Paul, Rosengren, Annika, Soman, Biju, Wang, Chuangshi, Wang, Yang, Yeates, Karen, Yusuf, Rita, Yusufali, Afzalhussein, Zatonska, Katarzyna, Rangarajan, Sumathy, Yusuf, Salim
• Format: Text
• Language: unknown
• Published: Advocate Aurora Health Institutional Repository 2023
• Subjects: insulin; triglycerides; cardiovascular disease; population health; Advocate Aurora Research Institute; Cardiology; Population Health and Public Health; Aurora Research Institute
• Online Access: https://institutionalrepository.aah.org/allother/402; https://doi.org/10.1016/S2666-7568(22)00247-1; https://libkey.io/libraries/1712/10.1016/S2666-7568(22)00247-1

Background: The triglyceride glucose (TyG) index is an easily accessible surrogate marker of insulin resistance, an important pathway in the development of type 2 diabetes and cardiovascular diseases. However, the association of the TyG index with cardiovascular diseases and mortality has mainly been investigated in Asia, with few data available from other regions of the world. We assessed the association of insulin resistance (as determined by the TyG index) with mortality and cardiovascular diseases in individuals from five continents at different levels of economic development, living in urban or rural areas. We also examined whether the associations differed according to the country's economical development. Methods: We used the TyG index as a surrogate measure for insulin resistance. Fasting triglycerides and fasting plasma glucose were measured at the baseline visit in 141 243 individuals aged 35-70 years from 22 countries in the Prospective Urban Rural Epidemiology (PURE) study. The TyG index was calculated as Ln (fasting triglycerides [mg/dL] x fasting plasma glucose [mg/dL]/2). We calculated hazard ratios (HRs) using a multivariable Cox frailty model with random effects to test the associations between the TyG index and risk of cardiovascular diseases and mortality. The primary outcome of this analysis was the composite of mortality or major cardiovascular events (defined as death from cardiovascular causes, and non-fatal myocardial infarction, or stroke). Secondary outcomes were non-cardiovascular mortality, cardiovascular mortality, all myocardial infarctions, stroke, and incident diabetes. We also did subgroup analyses to examine the magnitude of associations between insulin resistance (ie, the TyG index) and outcome events according to the income level of the countries. Findings: During a median follow-up of 13·2 years (IQR 11·9-14·6), we recorded 6345 composite cardiovascular diseases events, 2030 cardiovascular deaths, 3038 cases of myocardial infarction, 3291 cases of stroke, and 5191 incident ...