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Original Article
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Korean J Intern Med. 2025;40(6):961-974. Published online October 31, 2025.
DOI: https://doi.org/10.3904/kjim.2025.082
- Association of the triglyceride-glucose index with cardiovascular outcomes across cardiovascular-kidney-metabolic syndrome stages
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Byung Sik Kim1, Hyun-Jin Kim1, Shinje Moon2, Hasung Kim3, Jungkuk Lee3, Jeong-Hun Shin1
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1Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Hanyang University Guri Hospital, Guri, Korea
2Division of Endocrinology, Department of Internal Medicine, Hanyang University College of Medicine, Hanyang University Seoul Hospital, Seoul, Korea
3Data Science Team, Hanmi Pharm. Co., Ltd, Seoul, Korea
- Corresponding author: Jeong-Hun Shin ,Tel: +82-31-560-2216, Fax: +82-31-560-2219, Email: cardio.hyapex@gmail.com
- Received: March 10, 2025; Revised: May 24, 2025 Accepted: June 24, 2025.
- Abstract
- Background/Aims
Cardiovascular-kidney-metabolic (CKM) syndrome reflects the interplay between metabolic dysfunction, chronic kidney disease, and cardiovascular disease. Insulin resistance (IR) is a key driver of CKM and is associated with adverse cardiovascular outcomes. The triglyceride-glucose (TyG) index is a cost-effective surrogate marker of IR; however, its prognostic value across CKM syndrome stages remains unclear.
Methods
We conducted a retrospective cohort study using data of 1,497,913 adults enrolled in the Korean National Health Insurance Database between 2009 and 2012. The participants were stratified into four CKM stages (0/1, 2, 3, and 4) and further categorized into three TyG index tertiles: Group 1 (< 8.27), Group 2 (8.27–8.81), and Group 3 (> 8.81). The primary composite outcomes were all-cause mortality, heart failure, stroke, and myocardial infarction.
Results
Over an average follow-up period of 12.6 ± 1.50 years, individuals in the highest TyG tertile demonstrated a significantly higher risk of the composite primary outcome compared to those in the lowest tertile (hazard ratio, 1.116; 95% confidence interval, 1.101–1.131; p < 0.001). This dose-dependent relationship was consistent across CKM stages, with the strongest associations observed in the early CKM stages (0/1 and 2). An elevated TyG index is also associated with an increased risk of secondary outcomes, including all-cause death, heart failure, stroke, and myocardial infarction.
Conclusions
The TyG index independently predicted cardiovascular risk across the CKM syndrome stages. Its integration into routine clinical assessments could enhance early risk stratification and guide preventive strategies, particularly for patients in the early stages of CKM syndrome.
Keywords :Triglyceride-glucose index; Cardiovascular disease; Kidney disease; Metabolic syndrome; Insulin resistance
