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

2022· article· en· 345 citations· W4311426544 on OpenAlex· 10.1016/s2666-7568(22)00247-1

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Full frame distilled prediction

Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.

Candidate categories: none
Consensus categories: none
Domain: Candidate signal: noneConsensus signal: none
Study design: Candidate signal: ObservationalConsensus signal: Observational
Genre: Candidate signal: EmpiricalConsensus signal: Empirical
Teacher disagreement score: 0.040
Threshold uncertainty score: 0.964
Validation status: machine_predicted_unvalidated · codex-gemma-dda1882f352a

Codex and Gemma teacher scores by category

Category	Codex	Gemma
Metaresearch	0.004	0.001
Meta-epidemiology (narrow)	0.000	0.000
Meta-epidemiology (broad)	0.001	0.000
Bibliometrics	0.000	0.001
Science and technology studies	0.000	0.000
Scholarly communication	0.000	0.000
Open science	0.000	0.000
Research integrity	0.000	0.001
Insufficient payload (model declined to judge)	0.000	0.000

Machine scores (provisional)

Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.

The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.

Opus teacher head0.028

GPT teacher head0.286

Teacher spread: 0.258 · how far apart the two teachers sit on this one work
Validation status: score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it

Abstract

BackgroundThe 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.MethodsWe 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.FindingsDuring 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 cases of type 2 diabetes. After adjusting for all other variables, the risk of developing cardiovascular diseases increased across tertiles of the baseline TyG index. Compared with the lowest tertile of the TyG index, the highest tertile (tertile 3) was associated with a greater incidence of the composite outcome (HR 1·21; 95% CI 1·13–1·30), myocardial infarction (1·24; 1·12–1·38), stroke (1·16; 1·05–1·28), and incident type 2 diabetes (1·99; 1·82–2·16). No significant association of the TyG index was seen with non-cardiovascular mortality. In low-income countries (LICs) and middle-income countries (MICs), the highest tertile of the TyG index was associated with increased hazards for the composite outcome (LICs: HR 1·31; 95% CI 1·12–1·54; MICs: 1·20; 1·11–1·31; pinteraction=0·01), cardiovascular mortality (LICs: 1·44; 1·15–1·80; pinteraction=0·01), myocardial infarction (LICs: 1·29; 1·06–1·56; MICs: 1·26; 1·10–1·45; pinteraction=0·08), stroke (LICs: 1·35; 1·02–1·78; MICs: 1·17; 1·05–1·30; pinteraction=0·19), and incident diabetes (LICs: 1·64; 1·38–1·94; MICs: 2·68; 2·40–2·99; pinteraction <0·0001). In contrast, in high-income countries, higher TyG index tertiles were only associated with an increased hazard of incident diabetes (2·95; 2·25–3·87; pinteraction <0·0001), but not of cardiovascular diseases or mortality.InterpretationThe TyG index is significantly associated with future cardiovascular mortality, myocardial infarction, stroke, and type 2 diabetes, suggesting that insulin resistance plays a promoting role in the pathogenesis of cardiovascular and metabolic diseases. Potentially, the association between the TyG index and the higher risk of cardiovascular diseases and type 2 diabetes in LICs and MICs might be explained by an increased vulnerability of these populations to the presence of insulin resistance.FundingFull funding sources are listed at the end of the paper (see Acknowledgments).

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The record

Venue: The Lancet Healthy Longevity
Topic: Diabetes, Cardiovascular Risks, and Lipoproteins
Field: Medicine
Canadian institutions: McMaster UniversityQueen's UniversityHamilton Health SciencesUniversité LavalPopulation Health Research InstituteInstitut Universitaire de Cardiologie et de Pneumologie de Québec
Funders: Fuwai Hospital, Chinese Academy of Medical SciencesPhilippine Council for Health Research and DevelopmentServierKementerian Sains, Teknologi dan InovasiIndian Council of Medical ResearchSouth African Medical Research CouncilCanadian Institutes of Health ResearchUnited Nations Relief and Works Agency for Palestine RefugeesRiksförbundet HjärtLungDairy Farmers of CanadaPublic Health Agency of CanadaNovartis Pharmaceuticals CorporationMinistry of Higher Education, MalaysiaAstraZeneca CanadaSanofiBoehringer IngelheimVetenskapsrådetHeart and Stroke Foundation of CanadaOntario Ministry of Health and Long-Term CareHamilton Health SciencesMinisterstwo Edukacji i NaukiSaudi Heart AssociationGlaxoSmithKlineDepartamento Administrativo de Ciencia, Tecnología e Innovación (COLCIENCIAS)AstraZeneca
Keywords: Insulin resistanceTriglycerideMedicineProspective cohort studyInternal medicineDiseaseCohort studyIndex (typography)CohortInsulinDemographyCholesterol
Has abstract in OpenAlex: yes
API: /api/v1/works/W4311426544