Triglyceride glucose index (TyG-i) is an alternative marker of insulin resistance and an independent predictor of CV events; yet its prognostic value in T2D remains poorly assessed.A cohort of 961 T2D was followed-up for 13.1±2.8 years. Vital status was retrieved on December 31, 2017 and data for CV events were available for 947 of them. TyG-i [ln (fasting triglycerides (mg/dL) x fasting glucose (mg/dL) / 2) ] was calculated at baseline and divided in tertiles (thresholds: 8.97 and 9.51) . Events were assessed by Kaplan-Meier (K-M) curves and HRs (95% CI) by unadjusted and adjusted Cox regressions (Cox-r) in TyG-i tertiles.At follow-up, 229 (23.8%) subjects died (18.25 x 1000 PYs) ; CV events occurred in 273 (28.8%; 25.68 x 1000 PYs) , coronary events (CHD) in 181 (19.1%; 16.20 x 1000 PYs) , hospitalization for heart failure (hHF) in 82 (8.7%; 6.79 x 1000 PYs) , cerebrovascular events (CVE) in 1 (10.7%) , peripheral vascular events (PVE) in 39 (4.1%) , ESRD in 71 subjects (7.5%; 5.87 x 1000 PYs) . On K-M, CVD (24.2%, 25.6% and 36.7%; p=0.001) and CHD (14.5%, 17.1% and 25.9%; p=0.001) increased with TyG-i. All other outcomes increased across tertiles in a not significant manner. On unadjusted Cox-r, cumulative incidence of CV events and CHD increased significantly across TyG-i tertiles (T3 vs. T1) for major CVD (HR 1.65, 95% CI 1.24-2.20, p=0.001) and CHD (1.91, 1.33-2.74, p<0.00for) , or marginally for PVD (1.99, 0.93-4.29, p=0.078) . After adjusting for age, diabetes duration, age at diagnosis, sex, BMI, active smoking, HbA1c, uric acid, fibrinogen, hypertension, dyslipidemia, prior CVD, CKD, retinopathy and neuropathy, HRs still increased with TyG-i for CV events (T3 vs. T1, 1.96, 95% CI 1.44-2.67, p<0.0001) , and CHD (T3 vs. T1, 2.03, 1.40-2.93, p<0.0001) .

In conclusion, TyG-i was significantly and independently associated with CVD and CHD, suggesting that it may be a simple yet valid marker for risk stratification in T2D.


M.Garofolo: Employee; Eli Lilly and Company. D.Lucchesi: None. E.Gualdani: None. P.Falcetta: Speaker's Bureau; Abbott Diabetes. M.Giambalvo: None. P.Francesconi: None. S.Del prato: Advisory Panel; Applied Therapeutics, Eli Lilly and Company, Novartis Pharmaceuticals Corporation, Novo Nordisk A/S, Sanofi, Consultant; Menarini Group, Research Support; AstraZeneca, Boehringer Ingelheim International GmbH, Speaker's Bureau; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck & Co., Inc., Sanofi, Stock/Shareholder; Novo Nordisk A/S. G.Penno: Advisory Panel; Eli Lilly and Company.

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