The impact of triglyceride-glucose index on ischemic stroke: a systematic review and meta-analysis

 If this is that useful then write it up as a protocol and get it distributed AND implemented in ALL stroke hospitals. Failure to do so is complete incompetence on the part of stroke leadership.

The impact of triglyceride-glucose index on ischemic stroke: a systematic review and meta-analysis

• Ying Yang,
• Xiangting Huang,
• Yuge Wang,
• Lin Leng,
• Jiapei Xu,
• Lei Feng,
• Shixie Jiang,
• Jiang Wang,
• Yanrong Yang,
• Gaofeng Pan,
• Bing Jiang,
• Yan Wang &
• Lan Chen 

Cardiovascular Diabetology volume 22, Article number: 2 (2023) Cite this article

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Abstract

Background

Strokes significantly impair quality of life and incur high economic and societal burdens. The triglyceride and glucose (TyG) index is a biochemical marker of insulin resistance (IR) and may have important value in the prediction of strokes, especially ischemic stroke (IS). Our study aims to investigate the relationship between TyG index and IS and ascertain whether TyG index is independently associated with IS adverse outcomes.

Methods

The Cochrane, Embase, Medline, Web of Science, PubMed, and other relevant English databases and related websites were systematically searched for articles on ‘‘TyG index’’ and "stroke" published from inception to April 4, 2022. We reviewed the available literature on the TyG index and its relation to predicting IS occurrence in the general population and adverse clinical outcomes. We calculated odds ratios (OR) of TyG index and its predictability of IS occurrence and adverse outcomes. Statistical analyses were performed using the Meta Package in STATA, version 12.0.

Results

A total of 18 studies and 592,635 patients were included in our analysis. The pooled effect values of all stroke types showed that higher TyG index was associated with increased the risk of IS in the general population (OR 1.37; 95% CI 1.22–1.54) in a total sample of 554,334 cases with a high level of heterogeneity (P = 0.000, I² = 74.10%). In addition, compared to IS patients with a lower TyG index, IS patients with a higher TyG index was associated with higher risk of stroke recurrence (OR: 1.50; 95% CI 1.19–1.89) and increased risk of mortality (OR 1.40 95% CI 1.14–1.71). No correlation was found in the effect value combinations of poor functional outcomes (OR 1.12; 95% CI 0.88–1.43) and neurological worsening (OR: 1.76; 95% CI 0.79–3.95) in a total sample of 38,301 cases with a high level of heterogeneity (P = 0.000; I² = 77.20%).

Conclusions

TyG index has potential value in optimizing risk stratification for IS in the general population. Furthermore, there is a significant association between high TyG index and many adverse outcomes of stroke, especially stroke recurrence and high mortality. Future studies should focus on multi-center and multi-regional designs in order to further explore the relationship between IS and TyG index.

Introduction

A stroke is an acute neurologic condition that occurs due to a disruption of cerebral perfusion, resulting in focal or global neurological impairment [1]. Strokes can be broadly classified into ischemic strokes (IS) and hemorrhagic strokes (HS). Approximately 84.4% of strokes are ischemic in origin [1]. Annually, over 13.7 million strokes occur globally and cause 5.5 million deaths per year as well, with a predilection for the elderly population, though increasing prevalence is being reported in younger adults [2, 3]. As stroke causes death, dementia, and disability worldwide, this common condition decreases quality of life and incurs high economic and societal burdens [4,5,6]. Despite the improvement of strategies and techniques towards the management of stroke patients in recent years, recurrence of strokes continue to account for nearly 30% of all strokes and this high rate likely represents unsuccessful secondary prevention [4, 7]. Researchers have recognized that identifying stroke-prone individuals and targeting them effectively remains an important part of stroke management; however, this is not an easy task [4]. Frans Kauwa demonstrated that predictors assessed with magnetic resonance imaging (MRI) including multiple ischemic changes and isolated cortical lesions may have potential, but computed tomography (CT) or ultrasound are not reasonable choices. Unfortunately, overuse of MRI to predict strokes was not found to be feasible, thus portraying the incomplete utility of neuroimaging in this endeavor [8]. There are several validated risk factors as a target for IS prevention, such as hypertension, diabetes mellitus, hyperlipidemia, hypercoagulable states, current smoking, atrial fibrillation (AF), and premature ventricular complexes (PVC). However, these risk factors fail to explain all cases of stroke and lack uniform applicability [4, 9].

The triglyceride-glucose (TyG) index, is a biochemical marker of insulin resistance (IR), and can be calculated as ln (fasting triglycerides (mg/dl)×fasting blood glucose (mg/dl)/2) [10, 11]. IR is known to be a key mediator of the pathogenesis of type 2 diabetes, and thus elevated stroke risk. Hyperinsulinemic-euglycemic clamp (HIEC) is considered the current gold standard to determine IR; however, HIEC is complicated and time-consuming with limited applicability for clinical practice on a large scale [11]. Therefore, the TyG index has been validated as a simple surrogate marker of IR and is cost-effective and reproducible [12]. After initial studies on its use in diabetes, many other publications now have been released which acknowledge its utility in other disorders. The TyG index has been associated with the severity of arterial stiffness, cardiovascular disease (CVD), and metabolic syndrome (MetS) (a cluster of metabolic abnormalities characterized by hypertension, dyslipidemia, obesity, and glucose dysregulation) [10, 12,13,14,15]. More interestingly, Jiao et al. also reported that a high TyG index was associated with a 1.64-fold risk of all-cause mortality and 1.36-fold risk of major adverse cardiac event in elderly acute coronary syndrome patients [10].

Stroke is one of the most significant causes of death and disability, with most of the burden in low-income and middle-income countries. Improving poststroke outcomes is an urgent issue worldwide. Several studies have investigated the association of TyG index with the risk of stroke, and its sub-types [16,17,18]. A prospective study of 54,098 participants demonstrated that patients with higher TyG index experienced a 1.30-fold increased risk of IS [19]. Huang et al. reported that long-term elevated TyG index in hypertensive patients was significantly associated with an increased risk of stroke, especially IS [20]. However, Zhao et al. demonstrated a high TyG index was not associated with nondiabetic patients with non-ST-elevation myocardial infarctions [21]. Additionally, the effect of TyG indices with studying prognosis among patients with IS also attracts great attention. A study of the 16,310 patients from the China National Stroke Registry II found that the TyG index was associated with 1.25-fold increased risk of all-cause mortality and 1.32-fold increased risk of stroke recurrence among patients with ischemic stroke [22]. This association was not found to be consistent in patients with stroke treated with intravenous thrombolysis [23].

Based on these seminal studies, there are strong implications and suggestions that the TyG index may be independently associated with stroke recurrence and clinical outcomes. Therefore, our present systematic review and meta-analysis aims to summarize and pool the current available data in order to analyze this relationship between the TyG index and IS.

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