This study aimed to evaluate the association of triglyceride-glucose (TyG) index with all-cause and cardiovascular mortality risk among patients with cardiometabolic syndrome (CMS). We performed a cohort study of 5754 individuals with CMS from the 2001–2018 National Health and Nutrition Examination Survey. The TyG index was calculated as Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Multivariate Cox proportional hazards regression models assessed the associations between TyG index and mortality . Non-linear correlations and threshold effects were explored using restricted cubic splines and a two-piecewise Cox proportional hazards model. Over a median follow-up of 107 months, 1201 all-cause deaths occurred, including 398 cardiovascular disease-related deaths. The multivariate Cox proportional hazards regression model showed a positive association between the TyG index and all-cause and cardiovascular mortality. Each one-unit increase in the TyG index was associated with a 16% risk increase in all-cause mortality (HR: 1.16, 95% CI 1.03, 1.31, P = 0.017) and a 39% risk increase in cardiovascular mortality (HR: 1.39, 95% CI 1.14, 1.71, P = 0.001) after adjusting for confounders. The restricted cubic splines revealed a U-shaped association between the TyG index and all-cause (P for nonlinear < 0.001) and cardiovascular mortality (P for nonlinear = 0.044), identifying threshold values (all-cause mortality: 9.104; cardiovascular mortality: 8.758). A TyG index below these thresholds displayed a negative association with all-cause mortality (HR: 0.58, 95% CI 0.38, 0.90, P = 0.015) but not with cardiovascular mortality (HR: 0.39, 95% CI 0.12, 1.27, P = 0.119). Conversely, a TyG index exceeding these thresholds was positively associated with all-cause and cardiovascular mortality (HR: 1.35, 95% CI 1.17, 1.55, P < 0.001; HR: 1.54, 95% CI 1.25, 1.90, P < 0.001, respectively). Notably, a higher TyG index (≥ threshold values) was significantly associated with increased mortality only among individuals aged under 55 compared to those with a lower TyG index (< threshold values). The TyG index demonstrated a U-shaped correlation with all-cause and cardiovascular mortality in individuals with CMS. The thresholds of 9.104 and 8.758 for all-cause and cardiovascular mortality, respectively, may be used as intervention targets to reduce the risk of premature death and cardiovascular disease.

中文翻译：

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甘油三酯-葡萄糖指数与心脏代谢综合征患者全因死亡率和心血管死亡率的关联：一项全国队列研究

本研究旨在评估心脏代谢综合征（CMS）患者中甘油三酯-葡萄糖（TyG）指数与全因死亡风险和心血管死亡风险的关联。我们对 2001-2018 年国家健康和营养检查调查中的 5754 名 CMS 个体进行了队列研究。TyG 指数计算为 Ln [空腹甘油三酯 (mg/dL) × 空腹血糖 (mg/dL)/2]。多变量 Cox 比例风险回归模型评估了 TyG 指数与死亡率之间的关联。使用受限三次样条和两段 Cox 比例风险模型探索非线性相关性和阈值效应。在中位随访 107 个月的时间里，发生了 1201 例全因死亡，其中 398 例与心血管疾病相关。多变量 Cox 比例风险回归模型显示 TyG 指数与全因死亡率和心血管死亡率之间呈正相关。TyG 指数每增加一个单位，全因死亡率风险增加 16%（HR：1.16，95% CI 1.03、1.31，P = 0.017），心血管死亡率风险增加 39%（HR：1.16，95% CI 1.03、1.31，P = 0.017）。 1.39, 95% CI 1.14, 1.71, P = 0.001) 调整混杂因素后。受限三次样条揭示了 TyG 指数与全因死亡率（非线性 P < 0.001）和心血管死亡率（非线性 P = 0.044）之间的 U 形关联，确定了阈值（全因死亡率：9.104；心血管死亡率： 8.758）。低于这些阈值的 TyG 指数与全因死亡率呈负相关（HR：0.58，95% CI 0.38，0.90，P = 0.015），但与心血管死亡率无关（HR：0.39，95% CI 0.12，1.27，P = 0.119）。相反，超过这些阈值的 TyG 指数与全因死亡率和心血管死亡率呈正相关（HR：分别为 1.35、95% CI 1.17、1.55、P < 0.001；HR：分别为 1.54、95% CI 1.25、1.90、P < 0.001 ）。值得注意的是，与TyG指数较低（<阈值）的人相比，仅在55岁以下的个体中，较高的TyG指数（≥阈值）与死亡率增加显着相关。TyG 指数显示与 CMS 患者的全因死亡率和心血管死亡率呈 U 形相关。全因死亡率和心血管死亡率的阈值分别为9.104和8.758，可作为干预目标，以降低过早死亡和心血管疾病的风险。