Triglyceride-Glucose Index Scores Predict Recurrent Stroke, Mortality in T2DM

Levels of TyG index can be used as a risk indicator for recurrent ischemic stroke and all-cause death at 1-year follow-up in patients with T2DM after hospital discharge.

Triglyceride-glucose (TyG) index scores strongly correlated with the incidence of recurrent ischemic stroke and all-cause death in patients with acute ischemic stroke and type 2 diabetes mellitus (T2DM), according to study findings published in Cardiovascular Diabetology.

Researchers in China conducted a cross-sectional analysis of 3359 patients enrolled in the China National Stroke Registry II (CNSRII) diagnosed with both acute ischemic stroke and a history of T2DM between June 2012 and January 2013 across 219 hospitals nationwide to investigate the relationship between the TyG index and clinical prognosis following acute ischemic stroke in patients with T2DM.

Clinicians obtained fasting blood glucose and triglyceride levels from peripheral venous blood samples for each patient following admission to the hospital for the initial acute ischemic stroke. The researchers used this information documented in the medical records to calculate the baseline TyG index scores for each patient. These patients were divided into 4 quartile groups, depending on the TyG index scores, with the highest quartile group indicating the worst TyG index scores.

The researchers followed up with the patients 1 year after discharge from the hospital after treatment for acute ischemic stroke to assess long-term effects, including all-cause death, recurrent ischemic stroke, and poor functional outcomes following the initial acute ischemic stroke. Scores between 3 and 6 on the modified Rankin Scale (mRS) indicated poor functional outcomes.

Monitoring the TyG index as a qualified predictor and risk stratification tool deserves more attention in clinical practice for IS patients with T2DM.

The researchers then analyzed the relationship between baseline TyG index scores and outcomes in this patient population to determine whether or not TyG index scores could predict poor outcomes after acute ischemic stroke in patients with T2DM.

During the 1-year follow-up period, all-cause death occurred in 229 (6.82%) of the 3359 patients, while 305 (9.08%) experienced recurrent ischemic strokes and 754 (22.45%) reported poor functional outcomes, according to the mRS.

The researchers did not observe any significant difference as far as incidence of recurrent ischemic stroke (log-rank P =.716) or mortality rates (log-rank P =.175) between the 4 quartile groups.

Poor functional outcomes occurred in 201 (25.57%) patients in the lowest quartile, 193 (24.22%) in the second quartile, 205 (25.92%) in the third quartile, and 155 (19.80%) in the highest quartile. Patients with prediabetes demonstrated significant associations between TyG index scores and poor functional outcomes after adjusting for all confounding factors (HR, 0.66; 95% CI, 0.369-1.11; P =.016).

After adjusting for possible confounding factors, higher TyG index scores at baseline independently predicted higher risk for recurrent ischemic stroke (adjusted hazard ratio [aHR], 1.41; 95% CI, 0.97-2.03; P =.0048) and all-cause death (aHR, 1.70; 95% CI, 1.062-2.74; P =.0028) after 1 year following the initial acute ischemic stroke compared with the lowest quartile.

The researchers’ findings suggest that TyG index may be a feasible tool as a risk predictor that assesses the long-term outcomes in patients with acute ischemic stroke and T2DM.

“Monitoring the TyG index as a qualified predictor and risk stratification tool deserves more attention in clinical practice for acute IS [ischemic stroke] patients with T2DM,” the researchers concluded.

Study limitations included lack of generalizability of results outside of the Chinese population, availability of only baseline TyG index data that did not reflect changes over time, lack of balance between group characteristics, and remote follow-up assessment via telephone, leading to the inability to medically validate the endpoint in all individuals.

References:

Liu D, Yang K, Gu H, Li Z, Wang Y, Wang Y. Predictive effect of triglyceride-glucose index on clinical events in patients with acute ischemic stroke and type 2 diabetes mellitus. Cardiovascular Diabetology. Published online December 12, 2022. doi:10.1186/s12933-022-01704-4