Association Between the Triglyceride–Glucose Index and Major Cardiovascular Events in Patients with Prior Ischemic Stroke: A Retrospective Cohort Study
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Abstract
Background: Patients with ischemic stroke have a high incidence of major adverse cardiovascular events (MACE), ranging from 15% to 30%, despite receiving standard secondary prevention. Individualized cardiovascular risk assessment is therefore crucial in optimizing preventive strategies. The triglyceride–glucose (TyG) index is a convenient and low-cost surrogate marker of insulin resistance; however, evidence in Thai patients with ischemic stroke remains limited.
Objectives: To investigate the association between the TyG index and the risk of MACE among patients with ischemic stroke, and to identify an optimal cut-off value for discriminating high-risk patients in the Thai context.
Materials and Methods: A retrospective cohort study was conducted among newly diagnosed ischemic stroke patients treated at Pasang Hospital, Lamphun Province, Thailand, between January 2019 and December 2024. A total of 281 eligible patients underwent fasting triglyceride and glucose testing to calculate the TyG index and were followed for the occurrence of 3-point MACE. The median follow-up duration was 2.5 years. Cox proportional hazards regression was used to evaluate the association, and ROC curve analysis was applied to determine the optimal cut-off value.
Results: Among 281 patients with ischemic stroke, the incidence of MACE was 24.2% (68 patients). Patients in the highest TyG tertile (>8.9) had a significantly higher risk of MACE compared with those in the lowest tertile (<8.4) (adjusted HR 2.08; 95% CI 1.23–3.49; p=0.006). ROC analysis showed that the TyG index had moderate predictive ability (AUC 0.65; 95% CI 0.57–0.73; p<0.001). The optimal cutoff value was TyG index ≥9.0, which provided a specificity of 80.0% and sensitivity of 45.1%. This cutoff remained associated with an increased risk of MACE after adjustment for major confounding factors (adjusted HR 1.96; 95% CI 1.13–3.41; p=0.017).
Conclusion: A higher TyG index was associated with an increased risk of MACE among Thai patients with ischemic stroke, with an optimal cutoff value of ≥9.0. However, the study population had relatively high baseline TyG index values with a narrow distribution, resulting in only moderate discriminatory ability. Therefore, the TyG index should be used as an adjunct to other clinical risk factors rather than as a standalone predictor.
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บทความที่ส่งมาลงพิมพ์ต้องไม่เคยพิมพ์หรือกำลังได้รับการพิจารณาตีพิมพ์ในวารสารอื่น เนื้อหาในบทความต้องเป็นผลงานของผู้นิพนธ์เอง ไม่ได้ลอกเลียนหรือตัดทอนจากบทความอื่น โดยไม่ได้รับอนุญาตหรือไม่ได้อ้างอิงอย่างเหมาะสม การแก้ไขหรือให้ข้อมูลเพิ่มเติมแก่กองบรรณาธิการ จะต้องเสร็จสิ้นเป็นที่เรียบร้อยก่อนจะได้รับพิจารณาตีพิมพ์ และบทความที่ตีพิมพ์แล้วเป็นสมบัติ ของลำปางเวชสาร
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