Predictive Value Analysis Of The TyG Index,the TG/HDL-C Ratio,and The METS-IR Score For Coronary Artery Disease

Research Background and Purpose:Coronary atherosclerotic heart disease(CAD)is one of the major health threats to our population.As our standard of living improves,the incidence of insulin resistance(IR)increases.The gold standard for measuring IR is the High Insulin-euglycemic Clamp technique(HEC),but its experimental processes are complex and costly,and its clinical application is limited.Currently used clinical methods of assessing IR are based on clinical presentation and clinical scores to determine the presence or absence of IR.If IR is suspected,a further glucose tolerance test(OGTT)or insulin level measurement is required.The procedures for assessing IR are cumbersome and poorly complied with by patients.The technique of the insulin homeostasis model(HOMA-IR),commonly used in epidemiological investigations to evaluate IR,is based on the interaction of blood glucose and insulin in different organs(including the pancreas,liver,and peripheral tissues)and assumes that the insulin resistance status of the liver and peripheral tissues is equivalent,with limited measurement accuracy.The triglyceride glucose index(TyG),triglyceride-high-density lipoprotein-cholesterol ratio(TG/HDL-C),and insulin resistance metabolic score(METS-IR)are reliable indicators of insulin resistance and metabolic syndrome that can be derived from simple routine biochemical calculations to compensate for the shortcomings of traditional insulin resistance assessment methods.Recent studies have shown that novel insulin resistance markers are associated with several risk factors for cardiovascular disease(CVD),such as hypertension(HTN),diabetes mellitus(DM),obesity,and metabolic syndrome(METS),but the relationship between novel insulin resistance markers and CAD remains to be investigated at home.The objective of this study was to determine the predictive value of the Thy G index,the TG/HDL-C ratio,and the METS-IR score for the prediction of the severity of coronary heart disease and coronary artery disease.To determine the predictive value of the TyG index,the TG/HDL-C ratio,and the METS-IR score for the prediction of the severity of coronary heart disease and coronary artery disease.Methods:878 patients who underwent a first coronary angiogram between Sept 2020 and June 2021 in the Department of Cardiovascular Medicine were included in the study.Baselines,correlation tests,visualization of coronary angiogram results,and interpretation were collected.BMI,Thy G index,TG/HDL-C ratio,and METS-IR scores were calculated.Patients were divided into 653 patients with coronary heart disease and 225 patients without coronary heart disease(control group)according to the criteria for diagnosis of coronary heart disease.The severity of coronary artery disease was assessed using the Gensini scoring system and scores were calculated based on the baseline characteristics of three tertiles of the GS score: low-risk(221 patients)<32 points,intermediate-risk(215 patients)32 to 64 points,and high-risk(217 patients)>64 points.Data from this cohort were consistent with continuous variables and were normally distributed.Comparison of the data from multiple cohorts was performed using the LSD method,using one-factor analysis of variance,statistically significant variables were included in the multi-category logistic regression model for analysis of independent risk factors for severity of coronary disease.Statistical significance was determined using P<0.05.ROC curves were used to compare the predictive value of the TyG index,the TG/HDL-C ratio,and the METS-IR score for the severity of coronary artery disease in the intermediate-risk and high-risk groups and the low-risk control groups.Results:1.The differences between the CAD and non-CAD groups were statistically significant(P<0.05),as follows: the CAD and non-CAD groups were significantly older(65.58±10.28 vs 62.28±10.50,P<0.001),had higher body mass index(BMI)(25.48±4.32 vs 24.73±4.31,P=0.026),higher fasting glucose(FBG)(7.69±3.10 vs 6.34±1.33,P<0.001),higher triglyceride(TG)(1.73±1.05 vs 1.47±0.98,P=0.001),higher low-density lipoprotein cholesterol(LDL-C)(2.00±0.55 vs 1.79±0.65,P<0.001),higher uric acid(UA)(300.91±83.98 vs 261.15±82.65,P<0.001),higher systolic blood pressure(SBP)(134.67±20.80 vs 126.09±19.12,P<0.001),and lower high-density lipoprotein cholesterol(HDL)The differences in age,FBG,LDL-C,UA,SBP,and HDL-C were statistically significant(P<0.001).The proportion of patients with a history of diabetes was 24.35% in the group with coronary artery disease and 16.4% in the control group,and the proportion of patients with a history of hypertension was 45.64% in the group with coronary atherosclerotic heart disease and 37.33% in the control group,and the differences were significant(P<0.05).Diastolic blood pressure(DBP),total cholesterol(TC),glutamic alanine aminotransferase(ALT),glutamic grass aminotransferase(AST),height,weight,sex,history of smoking,history of hyperlipidemia,and family history of coronary artery disease were not significantly different(P>0.05).2.Comparison of the newly evaluated IR indicators in the coronary heart disease group and the non-coronary heart disease group revealed a higher TyG index in the coronary heart disease group than in the non-coronary heart disease group(10.69±1.99 vs 9.39±1.37,P<0.001),a higher ratio of TG/HDL-C(2.81±1.66 vs 1.58±1.34,P<0.001),and a higher ratio of METS-IR scores(1.55±0.45 vs 1.36±0.45,P<0.001),with significant between-group differences(P<0.001).3.In a binary logistic regression analysis that included factors that were statistically significant in the comparison between patients with and without coronary atherosclerotic heart disease,the following were found: age(OR: 1.035,95% CI: 1.014 ～1.055,P=0.001),FBG(OR: 1.231,95% CI: 1.101～ 1.376,P<0.001),,TyG index(OR: 1.457,95% CI: 1.258 ～1.689,P<0.001),TG/HDL-C ratio(OR: 1.607,95% CI:1.359～1.901,P<0.001),METS-IR score(OR: 7.187,95% CI: 4.673 ～11.053,P<0.001),age,FBG,history of diabetes,TyG index,TG/HDL-C ratio,and METS-IR score were independent risk factors for coronary heart disease.4.The ROC curve analysis of newer IR predictors of coronary heart disease revealed a value of 0.766(95% CI: 0.730 ～ 0.802,P<0.001)for the area under the TyG index curve,0.739(95% CI: 0.703 ～0.775,P<0.001)for the area under the TG/HDL-C ratio,and 0.813(95% CI: 0.779 ～0.846,P<0.001)for the area under the METS-IR score.5.Comparison of low-risk,intermediate-risk,and high-risk groups for the severity of coronary atherosclerotic heart disease showed that age,BMI,SBP,FBG,TG,UA,LDL-C,TG/HDL-C,TyG index,METS-IR were positively associated with the severity of coronary artery disease and HDL-C was negatively associated with the severity of coronary atherosclerotic heart disease,and the differences were statistically significant(P<0.05).The differences in SBP,FBG,TG,UA,LDL-C,TG/HDL-C ratio,TyG index,and METS-IR scores between groups were remarkable(P<0.001).For categorical variables,there were no significant differences between groups in terms of gender,smoking history,diabetes,hypertension,family history,or history of hyperlipidemia(P>0.05).6.Age,SBP,FBG,LDL-C,UA,TyG,TG/HDL-C ratio,and METS-IR score were positively associated with the severity of coronary atherosclerotic heart disease,and the differences were statistically significant(P<0.05),whereas the differences in SBP,TG/HDL-C,and METS-IR were statistically significant(P<0.001).In multivariate logistic regression analysis,we included statistically significant factors that were positively associated with the severity of coronary artery disease,such as age,SBP,FBG,TG,LDL-C,UA,TyG index,TG/HDL-C ratio,METS-IR score,and HDL-C,which were negatively associated with the severity of coronary artery disease(P<0.05).Between-group differences in FBG,SBP,LDL-C,TyG index,and METS-IR scores were statistically significant(P<0.001).7.The analysis of the ROC curve of the newly evaluated IR predicts the severity of coronary artery disease with a mean area under the TyG index curve(AUC)of 0.760(95% CI: 0.723～0.798,P<0.001),a mean area under the TG/HDL-C ratio(AUC)of 0.666(95% CI: 0.622～0.710,P<0.001),and a mean area under the METS-IR score of 0.794(95% CI: 0.760～0.829,P<0.001).The best predictive value of the METS-IR score for the severity of coronary atherosclerotic heart disease was 1.572,with a sensitivity of71.3% and a specificity of 73.8%.Conclusions:1.TyG index,TG/HDL-C ratio,and METS-IR score were predictive of coronary atherosclerotic heart disease,with a maximum AUC of 0.813 and a maximum AUC of 0.766 for METS-IR score and a minimum AUC of 0.739 for TG/HDL-C ratio.2.the TyG index,the TG/HDL-C ratio,and the METS-IR score were predictive of the severity of coronary artery disease,with a maximum AUC of 0.794 in the METS-IR index,the best predictive value of the METS-IR score,a maximum AUC of 0.760 in the TyG index,and a minimum AUC of 0.666 in the TG/HDL-C ratio.The predictive value of the METS-IR score was high,with an optimal cut-off value of1,572,a sensitivity of 71.3%,and a specificity of 73.8%,i.e.,a METS-IR score of 1.572 or greater,to prevent the risk of coronary exacerbation.3.The METS-IR score has the highest predictive value for the severity of coronary atherosclerotic heart disease and coronary artery disease and can be used as a predictive factor for the severity of coronary heart disease and coronary artery disease.