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Background <p>Triglyceride-glucose (TyG) is a vital marker for assessing cardiovascular risk and insulin resistance (IR) in individuals with Type 2 diabetes mellitus (T2DM) or metabolic dysfunction-associated steatotic liver disease (MASLD). Nevertheless, the prognostic significance of TyG, especially in patients manifesting both conditions, is insufficiently characterized. In this study, the association between TyG and the occurrence of major adverse cardiovascular events (MACEs) in patients concurrently diagnosed with T2DM and MASLD was examined.</p> Methods <p>In this retrospective cohort study, 1021 patients diagnosed with both T2DM and MASLD at Wenzhou Hospital from 2019 to 2022 were encompassed. To explore the non-linear association between TyG and outcomes, such as all-cause mortality (ACM) or MACEs, a cox proportional hazards model was employed. Additionally, subgroups were analyzed to assess the consistency across different demographic and clinical subgroups. Furthermore, mediation analyses were conducted to investigate the potential mediating effects of body roundness index (BRI) and estimated glomerular filtration rate (eGFR). Parallel supportive analysis was performed on a cohort of 1343 individuals from NHANES 1999–2018.</p> Results <p>Over a median follow-up of 53.4 months, 62 instances of ACM and 101 MACEs were documented. Cox proportional hazards regression analysis revealed that an elevated TyG was significantly associated with an increased risk of mortality (HR = 1.85, 95% CI: 1.25, 2.73) and MACEs (HR = 1.71, 95% CI: 1.26, 2.33). Subgroup analysis revealed that the association between TyG and the risk of MACE is more prominent among individuals below 60. Mediation analysis revealed that eGFR mediated 8.8% of the total effect of TyG on ACM and 10.6% of the effect on MACEs. BRI accounted for 6.2% of the total effect of TyG on ACM. Incorporating TyG into conventional risk models significantly enhanced the predictive accuracy.</p> Conclusion <p>This study established a strong association between TyG and both ACM and MACEs in patients with T2DM and MASLD in the Wenzhou cohort, with TyG-ACM association independently validated in the NHANES cohort.</p> Graphical abstract <p></p>

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Predictive significance of triglyceride-glucose index in forecasting adverse cardiovascular events among Type 2 diabetes mellitus patients with co-existing metabolic dysfunction-associated steatotic liver disease (MASLD): evidence from two cohort studies

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  • 发表日期：

    2026年6月18日

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  • Jing Xu,
  • Jianyong Zhao,
  • Zhijuan Dai,
  • Yue-Chun Li,
  • Chunmei Li

摘要

Background

Triglyceride-glucose (TyG) is a vital marker for assessing cardiovascular risk and insulin resistance (IR) in individuals with Type 2 diabetes mellitus (T2DM) or metabolic dysfunction-associated steatotic liver disease (MASLD). Nevertheless, the prognostic significance of TyG, especially in patients manifesting both conditions, is insufficiently characterized. In this study, the association between TyG and the occurrence of major adverse cardiovascular events (MACEs) in patients concurrently diagnosed with T2DM and MASLD was examined.

Methods

In this retrospective cohort study, 1021 patients diagnosed with both T2DM and MASLD at Wenzhou Hospital from 2019 to 2022 were encompassed. To explore the non-linear association between TyG and outcomes, such as all-cause mortality (ACM) or MACEs, a cox proportional hazards model was employed. Additionally, subgroups were analyzed to assess the consistency across different demographic and clinical subgroups. Furthermore, mediation analyses were conducted to investigate the potential mediating effects of body roundness index (BRI) and estimated glomerular filtration rate (eGFR). Parallel supportive analysis was performed on a cohort of 1343 individuals from NHANES 1999–2018.

Results

Over a median follow-up of 53.4 months, 62 instances of ACM and 101 MACEs were documented. Cox proportional hazards regression analysis revealed that an elevated TyG was significantly associated with an increased risk of mortality (HR = 1.85, 95% CI: 1.25, 2.73) and MACEs (HR = 1.71, 95% CI: 1.26, 2.33). Subgroup analysis revealed that the association between TyG and the risk of MACE is more prominent among individuals below 60. Mediation analysis revealed that eGFR mediated 8.8% of the total effect of TyG on ACM and 10.6% of the effect on MACEs. BRI accounted for 6.2% of the total effect of TyG on ACM. Incorporating TyG into conventional risk models significantly enhanced the predictive accuracy.

Conclusion

This study established a strong association between TyG and both ACM and MACEs in patients with T2DM and MASLD in the Wenzhou cohort, with TyG-ACM association independently validated in the NHANES cohort.

Graphical abstract