Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Aug 15, 2025; 16(8): 108839
Published online Aug 15, 2025. doi: 10.4239/wjd.v16.i8.108839
Triglyceride glucose-body mass index is associated with cardiovascular outcomes and overall mortality in type-2 diabetes mellitus patients
Mao-Jun Liu, Sun-Min Xiang, Xin-Qun Hu
Mao-Jun Liu, Xin-Qun Hu, Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
Sun-Min Xiang, Department of Hospital Infection Control, Xingsha District of Hunan Provincial People's Hospital (Changsha County People's Hospital), Changsha 410100, Hunan Province, China
Co-first authors: Mao-Jun Liu and Sun-Min Xiang.
Author contributions: Liu MJ and Xiang SM contribute equally to this study as co-first authors; the study was designed by Hu XQ and Liu MJ; the manuscript was prepared by Hu XQ, Liu MJ and Xiang SM; the draft was revised by Hu XQ, Liu MJ and Xiang SM; all authors read and approved the final manuscript.
Institutional review board statement: The study was exempt from ethical review and approval, as no additional institutional review board approval was necessary for the secondary analysis.
Informed consent statement: The data for our study are derived from the Action to Control Cardiovascular Risk in Diabetes (ACCORD). All participants completed informed consent forms before participating in the study.
Conflict-of-interest statement: The authors declare that they have no competing interests.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The original data are available from the NHLBI BioLINCC. Some or all of the data sets generated and/or analyzed in the current study are not publicly available, but may be obtained from the corresponding author upon reasonable request at huxinqun@csu.edu.cn.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin-Qun Hu, MD, Chief Pharmacist, Professor, Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha 410011, Hunan Province, China. huxinqun@csu.edu.cn
Received: April 24, 2025
Revised: May 31, 2025
Accepted: July 4, 2025
Published online: August 15, 2025
Processing time: 112 Days and 15.2 Hours
Abstract
BACKGROUND

Although recent studies have reported the reliability of triglyceride-glucose index (TyG) as a biomarker for evaluation of insulin resistance, the research exploring the association of TyG-body mass index (BMI) with major cardiovascular outcomes and all-cause mortality among the type 2 diabetes mellitus (T2DM) population remains scarce.

AIM

To ascertain whether TyG-BMI correlates with cardiovascular outcomes and mortality risk in individuals diagnosed with T2DM.

METHODS

Data were drawn from the ACCORD trial and its subsequent follow-up (ACCORDION), which together included 10190 participants. To evaluate the associations of TyG-BMI with future cardiovascular outcomes and overall mortality risk among T2DM patients, Cox’s proportional-hazards model was employed. Non-linear associations and thresholds were investigated by performing restricted cubic spline regression, fitting smooth curves, and conducting piecewise regression. Additionally, we examined whether the above findings were robust through interaction and subgroup analyses. The robustness of results was further verified by a series of sensitivity assessments. Through the area under the receiver operating characteristic curve estimation, the incremental predictive power of TyG-BMI beyond conventional risk factors was also evaluated.

RESULTS

Applying multivariable Cox regression analysis, we identified a significant correlation of TyG-BMI with both cardiovascular outcomes and overall mortality. Specifically, after adjusting for multiple confounders, the cardiovascular mortality, congestive heart failure (CHF) and overall mortality risks in the highest TyG-BMI quartile were 1.74, 2.65 and 1.42 times greater, respectively, when compared to the lowest quartile. The analysis revealed that TyG-BMI was linked nonlinearly to both types of mortality, while a two-stage linear regression discerned inflection points at 252.77 for cardiovascular mortality and 245.90 for overall mortality. TyG-BMI was found to correlate positively with future CHF. Additionally, introducing TyG-BMI into conventional prediction models resulted in a substantial improvement of their predictability for cardiovascular outcomes and overall mortality when compared to incorporating TyG or BMI alone.

CONCLUSION

Among T2DM individuals, a higher TyG-BMI is linked strongly to elevated risks of cardiovascular outcomes and overall mortality, highlighting its utility as a predictive marker for these risks.

Keywords: Triglyceride glucose-body mass index; Cardiovascular outcomes; Overall mortality; Type 2 diabetes mellitus; ACCORDION

Core Tip: This study uncovers a novel association between triglyceride-glucose index (TyG)-body mass index (BMI) and both cardiovascular outcomes and overall mortality in patients with type 2 diabetes mellitus (T2DM), based on the high-risk Action to Control Cardiovascular Risk in Diabetes cohort. It also marks the first identification of TyG-BMI as a robust predictor of future congestive heart failure, providing fresh perspectives on the risk stratification for complex T2DM patients.