Background: Insulin resistance (IR) represents a critical regulator in the development and progress of coronary artery disease (CAD). Triglyceride-glucose (TyG) index, a novel surrogate biomarker of IR, has been implicated in several cardiovascular diseases. Accordingly, we conduct a meta-analysis to elucidate the relationship between TyG index and adverse cardiovascular events in patients with CAD.

Methods: To identify the studies examining the predictive capacity of the TyG index for adverse cardiovascular events in the setting of CAD, we performed a comprehensive literature retrieval of Scopus, PubMed, EMBASE, and Web of Science, from the inception of databases to October 5, 2021. We pooled the adjusted hazard ratio (HR) along with 95% CI using a random-effects model. The primary outcome was a composite of major adverse cardiovascular events (MACEs), including all-cause death, cardiovascular death (CV death), myocardial infarction (MI), stroke, hospitalization for unstable angina or heart failure, and revascularization. The secondary outcomes were all-cause death, CV death, MI, stroke, and revascularization. Additionally, we conducted subgroup analyses stratified by diabetes status, age, body mass index (BMI), low-density lipoprotein cholesterol (LDL-C), category of TyG index, sample size, follow-up duration, and study design.

Results: About 12 studies involving 28,795 patients with CAD were finally taken into the quantitative analysis. Our findings showed that there was a 2.14-fold higher risk of MACEs among CAD populations in the highest TyG group compared with those in the lowest TyG group (HR: 2.14, 95% CI: 1.69–2.71, P < 0.001). A greater risk of MACEs was observed in participants with higher BMI than those with lower BMI (P = 0.03 for interaction). In the analysis of secondary outcomes, we also observed a markedly increased risk of MI, stroke, and revascularization in the highest TyG group compared with the lowest TyG group. No evidence of a significant association between TyG index and CV mortality or all-cause mortality in patients with CAD was identified.

Conclusions: The elevated TyG index is a promising predictive factor of adverse cardiovascular events in patients with CAD.

Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42021228521.

背景：胰岛素抵抗 (IR) 是冠状动脉疾病 (CAD) 发展和进展的关键调节因素。甘油三酯-葡萄糖 (TyG) 指数是一种新型的 IR 替代生物标志物，与多种心血管疾病有关。因此，我们进行了一项荟萃分析，以阐明 TyG 指数与 CAD 患者不良心血管事件之间的关系。

方法：为了确定检查 TyG 指数对 CAD 环境中不良心血管事件的预测能力的研究，我们对 Scopus、PubMed、EMBASE 和 Web of Science 进行了全面的文献检索，从数据库开始到 2021 年 10 月 5 日. 我们使用随机效应模型将调整后的风险比 (HR) 与 95% CI 合并。主要结局是主要不良心血管事件 (MACE) 的复合结果，包括全因死亡、心血管死亡 (CV 死亡)、心肌梗死 (MI)、中风、因不稳定心绞痛或心力衰竭住院，以及血运重建。次要结局是全因死亡、心血管死亡、心肌梗死、卒中和血运重建。此外，我们还进行了按糖尿病状态、年龄、体重指数 (BMI)、

结果：大约 12 项涉及 28,795 名 CAD 患者的研究最终被纳入定量分析。我们的研究结果表明，与最低 TyG 组相比，最高 TyG 组的 CAD 人群发生 MACE 的风险高 2.14 倍（HR：2.14，95% CI：1.69-2.71，磷< 0.001)。与 BMI 较低的参与者相比，BMI 较高的参与者发生 MACE 的风险更高。磷= 0.03 用于交互）。在次要结局分析中，我们还观察到，与最低 TyG 组相比，最高 TyG 组的 MI、卒中和血运重建风险显着增加。没有证据表明 TyG 指数与 CAD 患者的心血管死亡率或全因死亡率之间存在显着关联。

结论： 升高的 TyG 指数是 CAD 患者心血管不良事件的一个有希望的预测因素。

系统审核注册：https://www.crd.york.ac.uk/PROSPERO，标识符：CRD42021228521。