The association between triglyceride-glucose index and its combination with post-stroke depression: NHANES 2005–2018

 Why are you ignoring the elephant in the room explaining post stroke depression? It's incredibly simple; NO 100% RECOVERY PROTOCOLS!

You create EXACT 100% recovery protocols and your survivor will be motivated to do the millions of reps needed because they are looking forward to 100% recovery. GET THERE!

There would be no need for this useless research and no survivor depression.

The association between triglyceride-glucose index and its combination with post-stroke depression: NHANES 2005–2018

• Fengjiao Liang,
• Xiaoqian Shan,
• Xiang Chen &
• Banghua Yang 

BMC Psychiatry volume 25, Article number: 243 (2025) Cite this article

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Abstract

Background

Growing evidence indicates a link between insulin resistance and post-stroke depression (PSD). This study employed the triglyceride glucose (TyG) index as a measure of insulin resistance to investigate its relationship with PSD.

Methods

This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (2005–2018). PSD was assessed using data from patient health questionnaires, while the TyG index was calculated based on fasting venous blood glucose and fasting triglyceride levels. The formula used for the TyG index is ln[triglycerides (mg/dL) × fasting blood glucose (mg/dL)/2]. Participants were categorized into four groups according to the TyG index quartiles. A weighted multivariable logistic regression model was applied to examine the relationship between the TyG index and PSD.

Results

A total of 1217 patients were included in the study, of which 232 were diagnosed with PSD. The TyG index was divided into quartiles (Q1-Q4) for analysis. After adjusting for potential confounders, we found a significant positive association between the highest quartile of the TyG index (Q4: ≥9.33) and PSD (OR = 2.51, 95% CI: 1.04–6.07, p = 0.041). This suggests that in the U.S. adult stroke population, individuals with higher TyG indices are more likely to experience depressive symptoms. Subgroup analysis further confirmed a stable and independent positive association between the TyG index and PSD (all trend p > 0.05).

Conclusion

In this large cross-sectional study, our results suggest that among US adults who have experienced a stroke, those with higher TyG index levels are more likely to exhibit depressive symptoms. This provides a novel approach for the clinical prevention of PSD. Patients with higher TyG indices in the stroke population may require closer psychological health monitoring and timely intervention. Additionally, since the TyG index is calculated using only fasting blood glucose and triglyceride levels, it can help identify high-risk PSD patients, particularly in regions with limited healthcare resources.

Peer Review reports

Introduction

Post-stroke depression (PSD) is one of the most prevalent complications following a stroke, marked by high incidence, mortality, and disability rates. A meta-analysis by Hackett et al., which included 51 studies, revealed that the comorbidity rate of PSD is approximately 33% [1]. Jianglong Guo summarized several representative studies and found that the incidence of PSD ranges from 11 to 41% [2]. Overall, about one-third of stroke patients experience depression. In recent years, the number of PSD patients has been gradually increasing due to the sharp rise in the number of stroke patients [1,2,3]. The occurrence of PSD significantly impacts the daily life and rehabilitation of stroke patients, increasing the burden on their families. Researches indicate that the development of PSD is closely related to various factors, including social factors and individual characteristics [4, 5].

Insulin resistance (IR) refers to the reduced sensitivity of insulin target cells to insulin concentration. It is not only associated with the occurrence of various metabolic-related diseases but also closely linked to the development of cardiovascular and cerebrovascular diseases [6, 7]. A longitudinal analysis of the Netherlands Study of Depression and Anxiety (NESDA) cohort by researchers from Stanford University revealed that individuals with insulin resistance exhibited a two-fold increased risk of developing major depressive disorder (MDD) compared to their insulin-sensitive counterparts. Notably, even among participants without baseline depressive symptoms, those with insulin resistance demonstrated a substantially elevated MDD incidence during follow-up [8]. Fernandes BS and colleagues have proposed that insulin resistance may serve as a biomarker for acute depressive states, with their meta-analysis demonstrating significant associations between IR and depression severity scores [9]. Studies have shown that for each unit increase in the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), the risk of PSD in stroke patients increases accordingly [10, 11]. This confirms the positive correlation between insulin resistance and the risk of PSD, suggesting that insulin resistance is an independent risk factor for PSD. The HOMA-IR is useful for the early prediction and assessment of PSD. However, the calculation of HOMA-IR requires fasting serum insulin, which is not a routine biochemical indicator and is thus limited in clinical application (it is not practical in clinical practice).

The triglyceride-glucose index (TyG index) is also an effective means of assessing insulin resistance [12]. Compared to the HOMA-IR, the TyG index offers distinct advantages in clinical applicability. Its calculation does not require fasting insulin measurements, relying solely on triglycerides and fasting glucose levels, thereby simplifying implementation and reducing costs in routine practice [13]. Furthermore, the TyG index exhibits high sensitivity and specificity for identifying insulin resistance, outperforming HOMA-IR in detecting individuals with reduced insulin sensitivity across diverse populations [14]. Critically, the TyG index demonstrates superior predictive performance for metabolic abnormalities compared to HOMA-IR, with consistent efficacy observed in key subgroups such as older adults and individuals with obesity [15]. To date, no studies have directly indicated a correlation between the TyG index and the risk of PSD. Therefore, our research team used a cross-sectional design based on data from the National Health and Nutrition Examination Survey (NHANES) to evaluate whether there is an association between the TyG index and the risk of PSD. The aim of this study is to provide a potential new method for clinically identifying PSD, which could be used for the early detection of high-risk groups, thereby guiding targeted interventions to mitigate the burden of PSD and improve patient outcomes.

More at link.

When someone has a stroke, every second delayed is critical

Well in one second 31,666 neurons will die. ABSOLUTELY NOTHING COMPARED TO THE BILLIONS THAT WILL DIE THE FIRST WEEK, because your doctor and hospital have nothing for stopping the 5 causes of the neuronal cascade of death in the first week. I lost 5.4 billion neurons that first week. If I'd only lost 177 million neurons in the 90 minutes it took to get tPA I'd easily be recovered by now. They are not even focusing on the humongous elephant in the room, just swatting mites on the gnats.

When someone has a stroke, every second delayed is critical

Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? stroke Sentinel Digital DeskBy : Sentinel Digital Desk | 10 Oct 2021 12:54 AM Follow Us on Google News Dr Praveen Aggarwal & Dr Manorama Bakshi (The authors, Dr Praveen Aggarwal is co-founder and Director of Consocia Advisor, while Dr Manorama Bakshi is Public Health Expert, Head Health care and Advocacy of Consocia Advisory.) Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? To quote him: "Much of India's development agenda is mirrored in the Sustainable Development Goals (SDGs). Our national plans are ambitious and purposeful, sustainable development of one-sixth of humanity will be of great consequence to the world and our beautiful planet." Also Read - Securing land from 'land-hungry' migrants India along with many other countries is tumbling behind on global commitments to tackle premature deaths from chronic diseases, such as strokes, diabetes, lung cancer and heart disease. The NCD Countdown to 2030 report states that the pace of change is too slow to achieve SDG 3.4 in most countries. It may be noted that non-communicable diseases (NCDs) kill 41 million people each year, equivalent to 71 per cent of all deaths globally. Each year, more than 15 million people die from NCD between the ages of 30 and 69 years; 85 per cent of these "premature" deaths occur in low- and middle-income countries.

https://www.sentinelassam.com/editorial/when-someone-has-a-stroke-every-second-delayed-is-critical-558437

 

Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? stroke Sentinel Digital DeskBy : Sentinel Digital Desk | 10 Oct 2021 12:54 AM Follow Us on Google News Dr Praveen Aggarwal & Dr Manorama Bakshi (The authors, Dr Praveen Aggarwal is co-founder and Director of Consocia Advisor, while Dr Manorama Bakshi is Public Health Expert, Head Health care and Advocacy of Consocia Advisory.) Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? To quote him: "Much of India's development agenda is mirrored in the Sustainable Development Goals (SDGs). Our national plans are ambitious and purposeful, sustainable development of one-sixth of humanity will be of great consequence to the world and our beautiful planet." Also Read - Securing land from 'land-hungry' migrants India along with many other countries is tumbling behind on global commitments to tackle premature deaths from chronic diseases, such as strokes, diabetes, lung cancer and heart disease. The NCD Countdown to 2030 report states that the pace of change is too slow to achieve SDG 3.4 in most countries. It may be noted that non-communicable diseases (NCDs) kill 41 million people each year, equivalent to 71 per cent of all deaths globally. Each year, more than 15 million people die from NCD between the ages of 30 and 69 years; 85 per cent of these "premature" deaths occur in low- and middle-income countries.

https://www.sentinelassam.com/editorial/when-someone-has-a-stroke-every-second-delayed-is-critical-558437

 Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? stroke Sentinel Digital DeskBy : Sentinel Digital Desk | 10 Oct 2021 12:54 AM Follow Us on Google News Dr Praveen Aggarwal & Dr Manorama Bakshi (The authors, Dr Praveen Aggarwal is co-founder and Director of Consocia Advisor, while Dr Manorama Bakshi is Public Health Expert, Head Health care and Advocacy of Consocia Advisory.) Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? To quote him: "Much of India's development agenda is mirrored in the Sustainable Development Goals (SDGs). Our national plans are ambitious and purposeful, sustainable development of one-sixth of humanity will be of great consequence to the world and our beautiful planet."

https://www.sentinelassam.com/editorial/when-someone-has-a-stroke-every-second-delayed-is-critical-558437

Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? stroke Sentinel Digital DeskBy : Sentinel Digital Desk | 10 Oct 2021 12:54 AM Follow Us on Google News Dr Praveen Aggarwal & Dr Manorama Bakshi (The authors, Dr Praveen Aggarwal is co-founder and Director of Consocia Advisor, while Dr Manorama Bakshi is Public Health Expert, Head Health care and Advocacy of Consocia Advisory.) Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? To quote him: "Much of India's development agenda is mirrored in the Sustainable Development Goals (SDGs). Our national plans are ambitious and purposeful, sustainable development of one-sixth of humanity will be of great consequence to the world and our beautiful planet."

https://www.sentinelassam.com/editorial/when-someone-has-a-stroke-every-second-delayed-is-critical-558437

Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? stroke Sentinel Digital DeskBy : Sentinel Digital Desk | 10 Oct 2021 12:54 AM Follow Us on Google News Dr Praveen Aggarwal & Dr Manorama Bakshi (The authors, Dr Praveen Aggarwal is co-founder and Director of Consocia Advisor, while Dr Manorama Bakshi is Public Health Expert, Head Health care and Advocacy of Consocia Advisory.) Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? To quote him: "Much of India's development agenda is mirrored in the Sustainable Development Goals (SDGs). Our national plans are ambitious and purposeful, sustainable development of one-sixth of humanity will be of great consequence to the world and our beautiful planet."

https://www.sentinelassam.com/editorial/when-someone-has-a-stroke-every-second-delayed-is-critical-558437

Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? stroke Sentinel Digital DeskBy : Sentinel Digital Desk | 10 Oct 2021 12:54 AM Follow Us on Google News Dr Praveen Aggarwal & Dr Manorama Bakshi (The authors, Dr Praveen Aggarwal is co-founder and Director of Consocia Advisor, while Dr Manorama Bakshi is Public Health Expert, Head Health care and Advocacy of Consocia Advisory.) Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? To quote him: "Much of India's development agenda is mirrored in the Sustainable Development Goals (SDGs). Our national plans are ambitious and purposeful, sustainable development of one-sixth of humanity will be of great consequence to the world and our beautiful planet." Also Read - Securing land from 'land-hungry' migrants India along with many other countries is tumbling behind on global commitments to tackle premature deaths from chronic diseases, such as strokes, diabetes, lung cancer and heart disease. The NCD Countdown to 2030 report states that the pace of change is too slow to achieve SDG 3.4 in most countries. It may be noted that non-communicable diseases (NCDs) kill 41 million people each year, equivalent to 71 per cent of all deaths globally. Each year, more than 15 million people die from NCD between the ages of 30 and 69 years; 85 per cent of these "premature" deaths occur in low- and middle-income countries.

https://www.sentinelassam.com/editorial/when-someone-has-a-stroke-every-second-delayed-is-critical-558437

When someone has a stroke, every second delayed is critical

https://www.sentinelassam.com/editorial/when-someone-has-a-stroke-every-second-delayed-is-critical-558437

Longer term patient management following stroke: A systematic review

You're completely missing the elephant in the room. Long term patient 100% recovery is a disastrous 10% and nothing you even talk about here is going to change that. All because you have NO STRATEGY AND NO LEADERSHIP THAT IS TRYING FOR 100% RECOVERY.

Longer term patient management following stroke: A systematic review

Show all authors

Christian Boehme, Thomas Toell, Wilfried Lang, ...

First Published May 20, 2021 Review Article Find in PubMed 

https://doi.org/10.1177/17474930211016963

Article information

Abstract

Background

Tremendous progress in acute stroke therapy(Really? tPA has only a 12% full recovery rate.) has improved short-term outcome but part of this achievement may be lost in the long run. Concepts for a better long-term management of stroke survivors are needed to address their unmet needs and to reduce the burden of post-stroke complications, residual deficits, and recurrent vascular events.

Aims

This review summarizes current knowledge on post-hospital care and the scientific evidence supporting individual programs.

Summary of review

A systematic search of electronic databases according to PRISMA guidelines identified 10,374 articles, 77 of which met the inclusion criteria. One large randomised controlled trial on a multifaceted care program delivered by the multidisciplinary stroke team reduced recurrent vascular events and improved quality of life and functional outcome one year after the event, while a number of studies offer solutions for individual components of post-hospital disease management like patient education, counselling, and self-management or the management of post-stroke complications and residual deficits. A majority of studies, however, was small in size and limited by a short follow-up. Most initiatives with a narrow focus on risk factor control failed to lower the risk of recurrent events. The caregivers’ central role in post-stroke patient management is broadly neglected in research.

Conclusions

Over the past years, first knowledge on how to best organize post-hospital care of stroke patients has emerged. Comprehensive and pragmatic programs operated by the multidisciplinary stroke team hold promise to reduce the long-term health burden of stroke. There is a clear need for further high-quality studies with both clinical endpoints and patient-reported outcomes to establish sustainable solutions in different settings and regions to improve life after stroke, a key priority of the Stroke Action Plan for Europe 2018–2030.

Keywords Stroke, post-stroke care, disease management, complication, follow-up, review

Background

Structured follow-up programs are a well-established standard of care for myocardial infarction and cancer but so far not for stroke.^1,2 In coronary and cancer patients, there is compelling evidence that standardized disease pathways positively affect risk factor profiles, quality of life (QoL), and functional status,^1,2 whereas high-quality studies testing follow-up programs for stroke patients have not been available until recently.

Stroke is a leading cause of death and disability globally. The current lifetime risk of stroke is 25% for both men and women.³ There are 14 million new strokes each year and over 80 million stroke survivors with a strong upwards trajectory given the continuous ageing of societies, population growth, and declining stroke fatality.⁴ Exciting recent advances in acute stroke therapy translate into improved short-term outcome⁵ which, however, may be lost in the long run through unmet needs in post-stroke care, post-stroke complications, residual deficits, and recurrent vascular events. Stroke is considered preventable by guideline-compliant control of risk factors and adequate vascular prevention may also be effective in preserving cognitive abilities. However, there is a significant gap between recommended preventive measures and real-world target level achievement of risk factors, especially in secondary stroke prevention.⁶

Concepts for a better long-term management of stroke patients are urgently needed and the Stroke Action Plan for Europe 2018–2030 has declared life after stroke a key priority.⁷ We herein report a systematic review of randomised controlled trials and rigorous scientific evaluations of structured multimodal intervention programs targeting longer term care of stroke patients.

More at link.

 

This Is How Much Every Second Counts in Stroke Thrombectomy

 You are completely missing the massive elephant in the room. Saving a few million neurons here is miniscule compared to the billions your doctor is letting die because s/he is doing nothing to stop the 5 causes of the neuronal cascade of death in the first week. I lost 5.4 billion neurons in the first week because my doctor did nothing

This Is How Much Every Second Counts in Stroke Thrombectomy

Delays until reperfusion cost years of healthy life, meta-analysis suggests

by Nicole Lou, Staff Writer, MedPage Today May 3, 2021

Every delay in endovascular thrombectomy (EVT) translated into life lost after stroke, according to a patient-level meta-analysis that underscored the importance of fast reperfusion.

For stroke patients receiving EVT early (i.e., with last known well-to-puncture [LKWTP] times within 4 hours) who had substantial reperfusion, times to puncture and reperfusion were indicators of subsequent clinical outcome, reported Mohammed Almekhlafi, MD, MSc, of the University of Calgary in Alberta, Canada, and colleagues of the HERMES group.

For example, every hour of delay in LKWTP was tied to a loss of 0.81 healthy life-years, a "substantial" number that translates to "1.6 months per 10-minute delay, 4.9 days per 1-minute delay, and 2.0 hours per 1-second delay," the group wrote in JAMA Neurology.

Similarly, each second of delay in door-to-puncture (DTP) time and door-to-reperfusion (DTR) time amounted to 2.2 hours and 2.4 hours of healthy life lost, respectively. However, symptom onset-to-door times had no statistically significant time-benefit association.

"Delays, particularly after arrival to the hospital until reperfusion is achieved, may result in substantial losses in years of healthy life for patients. Efforts to optimize workflow and eliminate barriers preventing timely patient evaluation and treatment within health care systems are warranted," the authors concluded.

It has long been established that "time is brain" in stroke thrombectomy. Efforts are ongoing to shorten door-to-intervention times worldwide, with the American Heart Association and American Stroke Association recommending certain workflow targets to accelerate care delivery.

Almekhlafi and colleagues performed a meta-analysis of seven randomized trials testing EVT within 12 hours of acute ischemic stroke onset due to large vessel occlusion. They rated disability according to the utility-weighted modified Rankin Scale score, and based age-specific life expectancies on the 2017 U.S. National Vital Statistics.

The HERMES collaboration allowed investigators to gather patient-level data on participants for their study. There were 781 EVT-treated patients, of whom 52% had early thrombectomy and the rest had late thrombectomy with LKWTP times of 4-12 hours.

The early group had a median LKWTP time of 188 minutes and DTP time of 105 minutes. Of the 78.4% who had successful reperfusion in this cohort, it was achieved after a median last known well-to-reperfusion time of 234 minutes and DTR time of 145 minutes.

An explanatory analysis of the late-treated population -- a cohort more likely to have strokes with unwitnessed onset and symptoms first observed on awakening, but fewer patients with fast progression -- showed no significant relationship between times to puncture (or reperfusion) and life lost.

Heterogeneous entry criteria and imaging methods across trials were study limitations, Almekhlafi's group acknowledged. Findings also may not be generalizable to patients with pre-existing disability or those treated after 12 hours, two groups that were not included in the seven trials of the meta-analysis.

• 

  Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. Follow

Disclosures

The study was funded by a grant from Medtronic to the University of Calgary HERMES Coordinating Center.

Almekhlafi is a member of the scientific advisory board of Palmera Medical.

Primary Source

JAMA Neurology

Source Reference: Almekhlafi MA, et al "Healthy life-year costs of treatment speed from arrival to endovascular thrombectomy in patients with ischemic stroke: a meta-analysis of individual patient data from 7 randomized clinical trials" JAMA Neurol 2021; DOI: 10.1001/jamaneurol.2021.1055.

 

New guidelines back device for treating strokes

Neither one of these reports gives ANY factual objective basis that these prevent disability. They may save your life but once again the elephant in the room is not being treated. The neuronal cascade of death.
http://www.timesfreepress.com/news/national/business/story/2015/jun/29/first-new-guidelines-back-device-treating-str/312117/

http://www.alphagalileo.org/ViewItem.aspx?ItemId=154075&CultureCode=en