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Background and aims <p>The triglyceride-glucose (TyG) index has been recognized as a surrogate marker for insulin resistance (IR) and an independent risk factor for cardiovascular disease (CVD). However, the combined effect of the TyG index and visceral obesity on CVD incidence remains unclear. We aimed to investigate the interaction, joint association, and potential mediators between the TyG index and comprehensive anthropometric indices with CVD risk in middle-aged and older adults.</p> Methods <p>We analyzed 7046 participants aged ≥ 45&#xa0;years without baseline CVD from the China Health and Retirement Longitudinal Study (CHARLS) over a 9-year follow-up period. Retrospective collection included sociodemographic details, health status, physical examination results, and blood biomarkers. Adjusted Cox proportional hazards models were used to examine the interaction between TyG levels and anthropometric indices and their joint associations with CVD incidence. Subgroup analyses were conducted to evaluate the associations across different populations, and mediation analysis was performed to identify potential mediating pathways. The predictive value was determined using the area under the curve (AUC) of receiver operating characteristic curves. In addition, we validated the findings in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort.</p> Results <p>In the CHARLS study, 1768 (25.1%) participants developed CVD. All TyG–anthropometric indices exhibited significant positive associations with the incidence of CVD. TyG–waist-to-height ratio (WHtR) showed the strongest association, with each 1-SD increase correlating with a 25% increase in CVD risk. Elevated systolic and diastolic blood pressure (BP) levels partially mediated these associations. TyG–weight-adjusted waist index (WWI) indicated the highest predictive performance in CHARLS, while TyG–conicity index (ConI) was the most predictive in the MESA cohort. Across both cohorts, TyG–WHtR provided the most substantial incremental improvement to the baseline model. Models combining TyG–anthropometric indices showed higher prediction accuracy and goodness of fit than the basic model combining TyG or anthropometric indices alone. Decision curve analysis showed that TyG–WC and TyG–ConI yielded the superior net clinical benefits for CVD prediction. Subgroup analyses demonstrated consistent associations between TyG–anthropometric indices and CVD incidence across different clinical characteristics and sociodemographic groups.</p> Conclusions <p>The integration of TyG with anthropometric indices strengthened its association with CVD incidence. While TyG–WWI and TyG–ConI exhibited the highest predictive ability in the CHARLS and MESA cohorts, respectively, TyG–WHtR consistently yielded the greatest improvement to traditional risk models. Elevated BP levels partially mediated this association. Early intervention targeting visceral adiposity and impaired insulin sensitivity is crucial for mitigating CVD incidence in middle-aged and older adults.</p> Graphical Abstract <p></p>

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The combination of visceral adiposity and triglyceride-glucose indices as predictors of cardiovascular disease incidence in middle-aged and older adults

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月28日

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  • Yan Yin,
  • Jiawei Zhang,
  • Xu Liu,
  • Lili Wang,
  • Xue Li,
  • Yanguang Li,
  • Qiaoyuan Li,
  • Zhipeng Hu,
  • Zhuo Liang,
  • Ran Xiong,
  • Shangqiu Ning,
  • Yunlong Wang

摘要

Background and aims

The triglyceride-glucose (TyG) index has been recognized as a surrogate marker for insulin resistance (IR) and an independent risk factor for cardiovascular disease (CVD). However, the combined effect of the TyG index and visceral obesity on CVD incidence remains unclear. We aimed to investigate the interaction, joint association, and potential mediators between the TyG index and comprehensive anthropometric indices with CVD risk in middle-aged and older adults.

Methods

We analyzed 7046 participants aged ≥ 45 years without baseline CVD from the China Health and Retirement Longitudinal Study (CHARLS) over a 9-year follow-up period. Retrospective collection included sociodemographic details, health status, physical examination results, and blood biomarkers. Adjusted Cox proportional hazards models were used to examine the interaction between TyG levels and anthropometric indices and their joint associations with CVD incidence. Subgroup analyses were conducted to evaluate the associations across different populations, and mediation analysis was performed to identify potential mediating pathways. The predictive value was determined using the area under the curve (AUC) of receiver operating characteristic curves. In addition, we validated the findings in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort.

Results

In the CHARLS study, 1768 (25.1%) participants developed CVD. All TyG–anthropometric indices exhibited significant positive associations with the incidence of CVD. TyG–waist-to-height ratio (WHtR) showed the strongest association, with each 1-SD increase correlating with a 25% increase in CVD risk. Elevated systolic and diastolic blood pressure (BP) levels partially mediated these associations. TyG–weight-adjusted waist index (WWI) indicated the highest predictive performance in CHARLS, while TyG–conicity index (ConI) was the most predictive in the MESA cohort. Across both cohorts, TyG–WHtR provided the most substantial incremental improvement to the baseline model. Models combining TyG–anthropometric indices showed higher prediction accuracy and goodness of fit than the basic model combining TyG or anthropometric indices alone. Decision curve analysis showed that TyG–WC and TyG–ConI yielded the superior net clinical benefits for CVD prediction. Subgroup analyses demonstrated consistent associations between TyG–anthropometric indices and CVD incidence across different clinical characteristics and sociodemographic groups.

Conclusions

The integration of TyG with anthropometric indices strengthened its association with CVD incidence. While TyG–WWI and TyG–ConI exhibited the highest predictive ability in the CHARLS and MESA cohorts, respectively, TyG–WHtR consistently yielded the greatest improvement to traditional risk models. Elevated BP levels partially mediated this association. Early intervention targeting visceral adiposity and impaired insulin sensitivity is crucial for mitigating CVD incidence in middle-aged and older adults.

Graphical Abstract