Insights into the complex relationship between triglyceride glucose-waist height ratio index, mean arterial pressure, and cardiovascular disease: a nationwide prospective cohort study
An erratum to this article was published (Cardiovasc Diabetol, 15 May 2025 ↗)
Main finding · CVD riskResult — go to the resultHazard ratio 1.961 95% CI 1.660–2.317Authors' conclusion
The combination of a higher TyG-WHtR index and a higher MAP was associated with the highest risk of CVD. The combined model of the TyG-WHtR index and MAP showed improved predictive ability, as indicated by IDI and NRI, although its overall predictive performance was still moderate. The MAP could partially mediate the association between TyG-WHtR index and CVD, as well as TyG-WHtR index could also partially mediate the association between MAP and CVD. These findings suggested that the combination of TyG-WHtR index and MAP helps identify populations at early risk of CVD and improve risk stratifcation.
Study context
- Population
- Participants of the China Health and Retirement Longitudinal Study (CHARLS) free of cardiovascular disease (CVD) at baseline; mean age 58.68 ± 9.60 years, 53.45% female
- Participants
- 7,976 participants
- Exposure
- Triglyceride glucose-waist height ratio (TyG-WHtR) ≥ median and mean arterial pressure (MAP) ≥ median vs TyG-WHtR < median and MAP < median
- Outcome
- CVD (self-reported heart disease and stroke)
- Follow-up
- Maximum 7.0 years
Methodological detailsnationwide, Cox proportional hazards model, restricted cubic spline, time-dependent ROC analysis, four-way decomposition mediation analysis
- Nationwide
- Cox proportional hazards model
- Restricted cubic spline
- Time-dependent ROC analysis
- Four-way decomposition mediation analysis
Main finding
CVD risk
Hazard ratio
1.961
95% CI 1.660–2.317
As reported in the abstract
- Incident CVD (all participants)
- 1326 (16.62%)
Observational data: associations, not effects.
Further findings
Prediction of CVD
- Combination of TyG-WHtR and MAP showed incremental predictive utility over either alone (improved integrated discrimination improvement (IDI) and net reclassification improvement (NRI)); absolute predictive performance moderate
Mediation
- Proportion of TyG-WHtR–CVD association mediated by increased MAP
- 52.43%
- Proportion of MAP–CVD association mediated by increased TyG-WHtR index
- 83.40%
Original publication
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