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Background <p>Stroke is a leading cause of mortality and disability in China. Insulin resistance (IR) is a crucial modifiable risk factor. While the triglyceride-glucose (TyG) index is a recognized surrogate for IR, it overlooks the protective role of high-density lipoprotein cholesterol (HDL-C) and the impact of obesity (BMI). The novel TyHGB index integrates triglycerides, fasting blood glucose, HDL-C, and BMI, offering a comprehensive metabolic profile. However, the association between its longitudinal patterns and new-onset stroke risk remains unclear.</p> Methods <p>Data from 4,823 participants free of stroke at baseline were analyzed using the China Health and Retirement Longitudinal Study (CHARLS, 2011–2020). Longitudinal patterns of the TyHGB index were identified using K-means clustering. Cox proportional hazards models evaluated the association between TyHGB metrics (patterns, baseline, and cumulative) and stroke risk. Restricted cubic splines (RCS) explored non-linear relationships, and time-dependent ROC curves compared the predictive value of TyHGB versus the TyG index.</p> Results <p>During the 5-year follow-up, 417 (8.6%) incident stroke cases were recorded. Three distinct TyHGB patterns were identified: “Low,” “Medium,” and “High.” After full adjustment for confounders, participants in the High (HR = 1.33, 95% CI: 1.01–1.78) and Medium (HR = 1.34, 95% CI: 1.07–1.67) patterns had a significantly higher stroke risk compared to the Low group. A non-linear dose-response relationship was observed between cumulative TyHGB and stroke risk (P-non-linear &lt; 0.05), with a risk saturation threshold at 25.76. Furthermore, the TyHGB index demonstrated a modest but statistically significant improvement in predictive ability compared to the traditional TyG index for 5-year stroke risk (AUC: 0.591 vs. 0.574).</p> Conclusions <p>Long-term elevated patterns and cumulative burden of the TyHGB index are independent risk factors for new-onset stroke. The identification of an RCS-derived inflection point (25.76) serves as a useful population-level reference value.TyHGB provides incremental value over the single TyG index in risk stratification, highlighting the importance of dynamic metabolic monitoring for stroke prevention.</p> Trial registration <p>Not applicable.</p>

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Association between the triglyceride-high-density lipoprotein-glucose-body index and new-onset stroke risk: a prospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月20日

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  • AoMen Lu,
  • Qian Xu

摘要

Background

Stroke is a leading cause of mortality and disability in China. Insulin resistance (IR) is a crucial modifiable risk factor. While the triglyceride-glucose (TyG) index is a recognized surrogate for IR, it overlooks the protective role of high-density lipoprotein cholesterol (HDL-C) and the impact of obesity (BMI). The novel TyHGB index integrates triglycerides, fasting blood glucose, HDL-C, and BMI, offering a comprehensive metabolic profile. However, the association between its longitudinal patterns and new-onset stroke risk remains unclear.

Methods

Data from 4,823 participants free of stroke at baseline were analyzed using the China Health and Retirement Longitudinal Study (CHARLS, 2011–2020). Longitudinal patterns of the TyHGB index were identified using K-means clustering. Cox proportional hazards models evaluated the association between TyHGB metrics (patterns, baseline, and cumulative) and stroke risk. Restricted cubic splines (RCS) explored non-linear relationships, and time-dependent ROC curves compared the predictive value of TyHGB versus the TyG index.

Results

During the 5-year follow-up, 417 (8.6%) incident stroke cases were recorded. Three distinct TyHGB patterns were identified: “Low,” “Medium,” and “High.” After full adjustment for confounders, participants in the High (HR = 1.33, 95% CI: 1.01–1.78) and Medium (HR = 1.34, 95% CI: 1.07–1.67) patterns had a significantly higher stroke risk compared to the Low group. A non-linear dose-response relationship was observed between cumulative TyHGB and stroke risk (P-non-linear < 0.05), with a risk saturation threshold at 25.76. Furthermore, the TyHGB index demonstrated a modest but statistically significant improvement in predictive ability compared to the traditional TyG index for 5-year stroke risk (AUC: 0.591 vs. 0.574).

Conclusions

Long-term elevated patterns and cumulative burden of the TyHGB index are independent risk factors for new-onset stroke. The identification of an RCS-derived inflection point (25.76) serves as a useful population-level reference value.TyHGB provides incremental value over the single TyG index in risk stratification, highlighting the importance of dynamic metabolic monitoring for stroke prevention.

Trial registration

Not applicable.