455-P: The Triglyceride–Glucose Index and Type 2 Diabetes are Mutually Independent Predictors of Major Cardiovascular Events in Patients with Established Cardiovascular Disease

The triglyceride-glucose index (TyG) is a validated biomarker of insulin resistance. Its power to predict major cardiovascular events (MACE) in patients with established cardiovascular disease is unclear and is addressed in the present study. We enrolled 1790 consecutive patients, 1481 with angiographically proven CAD and 309 with sonographically proven PAD. Prospectively, MACE were recorded over a mean follow-up period of 10.7±5.0 years. At baseline, the TyG index was significantly higher in patients with T2DM (n=586) than in nondiabetic subjects (9.2±0.7 vs. 8.7±0.5; p<0.001). During follow-up, 916 of our patients suffered MACE. The event rate was significantly higher in patients with T2DM than in nondiabetic subjects (60.2 vs. 47.7%; p<0.001). The TyG index in Cox regression models adjusting for age, sex, hypertension, smoking, body mass index, and LDL cholesterol independently predicted MACE in the total study population (standardized adjusted HR 1.21 [1.12-1.30], p<0.001); HRs in patients without T2DM and in diabetic subjects were 1.08 [0.95-1.25], p=0.272 and 1.16 [1.03-1.31], p=0.013, respectively, with no evidence of an interaction between TyG and T2DM (p=0.093). With T2DM additionally entered into the regression model, TyG in the total study population predicted cardiovascular events independently from the presence of T2DM (HR 1.12 [1.03-1.23], p=0.008), while T2DM remained independently predictive of MACE after adjustment for TyG (HR 1.42 [1.19-1.67]; p<0.001). From our data we conclude that the TyG index and T2DM are mutually independent predictors of MACE in patients with CAD.