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Published on: January 28, 2020
TyG-adiposity composites predict long-term MACCE after CABG: Evidence for partial mediation by CRP
Yingying Xie1, Hao Chen2, Yanxiang Gao3
1Department of Cardiology, China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China.
Insights
New triglyceride-glucose (TyG) adiposity indices, especially TyG‑BRI, predict major adverse cardiovascular and cerebrovascular events (MACCE) after coronary artery bypass grafting (CABG). These markers improve risk assessment beyond traditional measures, with inflammation playing a mediating role.
Area of Science:
- Cardiology
- Metabolic Syndrome
- Medical Informatics
Background:
- Coronary artery bypass grafting (CABG) carries a significant long-term risk of major adverse cardiovascular and cerebrovascular events (MACCE).
- The triglyceride-glucose (TyG) index is a marker for insulin resistance with predictive value for cardiovascular outcomes.
- Current risk stratification methods do not fully capture the heterogeneity of obesity phenotypes, necessitating novel approaches.
Purpose of the Study:
- To systematically evaluate and compare four novel TyG-adiposity indices (TyG‑CVAI, TyG‑BRI, TyG‑LAP, TyG‑ABSI) for predicting long-term MACCE after CABG.
- To explore the potential mediating role of systemic inflammation in the association between these indices and MACCE.
- To determine if these composite indices offer improved risk stratification compared to the TyG index alone or simple anthropometric measures.
Main Methods:
- A retrospective cohort study of 2547 patients undergoing CABG.
- Calculation of four TyG-adiposity indices from baseline data.
- Assessment of MACCE incidence using multivariable Cox regression, restricted cubic splines, and mediation analysis.
- Evaluation of model performance via Uno's C-index, time-dependent ROC curves, and decision curve analysis.
Main Results:
- Over a median follow-up of 4.25 years, 667 MACCE events occurred.
- All four TyG-adiposity indices were significantly higher in patients experiencing MACCE and independently predicted increased risk.
- TyG‑BRI demonstrated the highest discriminatory ability (Uno's C-index 0.709), outperforming other indices and the TyG index alone.
- C-reactive protein mediated 12.26%-24.20% of the association between the indices and MACCE risk.
Conclusions:
- TyG-adiposity composite indices, particularly TyG‑BRI, are independently associated with long-term MACCE risk post-CABG.
- These novel indices provide incremental predictive value beyond the TyG index or basic anthropometric measures.
- Systemic inflammation partially mediates the relationship, suggesting these indices can refine risk stratification and identify high-risk patients for intensified management.
Background:
Coronary artery bypass grafting (CABG) is associated with a significant long-term risk of major adverse cardiovascular and cerebrovascular events (MACCE). The triglyceride-glucose (TyG) index, a surrogate marker of insulin resistance, has demonstrated predictive value for cardiovascular outcomes but does not account for the heterogeneity of obesity phenotypes. Integrating the TyG index with measures of visceral adiposity may improve risk stratification in patients after CABG.
Objectives:
This study aimed to systematically evaluate and compare the ability of four novel TyG‑adiposity indices (TyG‑CVAI, TyG‑BRI, TyG‑LAP, and TyG‑ABSI) to predict long‑term MACCE following CABG, and to explore the potential mediating role of systemic inflammation in this association.
Methods:
In a retrospective cohort of 2547 consecutive patients undergoing CABG, the four TyG‑adiposity indices were calculated from baseline clinical and laboratory data. The primary endpoint was the incidence of MACCE. Associations were assessed using multivariable Cox regression, restricted cubic splines for dose‑response relationships, and mediation analysis. Model performance was evaluated using Uno's C‑index, time‑dependent ROC curves, and decision curve analysis.
Results:
Over a median follow‑up of 4.25 years, 667 MACCE events occurred. All TyG‑adiposity indices were significantly higher in patients who experienced MACCE. After full adjustment, each index independently predicted increased MACCE risk, with strong dose‑response relationships (all P for trend <0.001). TyG‑BRI demonstrated the highest discriminatory ability (Uno's C‑index 0.709, 95 % CI 0.681-0.737), outperforming TyG‑CVAI (0.685), TyG‑LAP (0.651), TyG‑ABSI (0.587), and the TyG index alone (0.576). C‑reactive protein mediated 12.26 %-24.20 % of the association between the indices and MACCE risk.
Conclusion:
TyG‑adiposity composites, particularly TyG‑BRI, are independently associated with long‑term MACCE risk after CABG and provide incremental predictive value over the TyG index or simple anthropometric measures. The association is partly mediated by systemic inflammation. These indices may help refine risk stratification across metabolic phenotypes and identify high‑risk patients for intensified management.
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