Diabetes Triglyceride Glucose Index Heart Disease Cardiovascular Events
TyG Index as a predictor of Major Adverse Cardiovascular Events in Patients with Congenital Heart Disease: A Meta-Analysis
Table of Contents
Abstract
Patients with congenital heart disease (CHD) are at increased risk of major adverse cardiovascular events (MACEs), even in the absence of traditional cardiovascular risk factors. The triglyceride-glucose (TyG) index, a simple and readily available marker of insulin resistance and metabolic dysfunction, has emerged as a potential predictor of cardiovascular outcomes. This meta-analysis aimed to evaluate the association between the TyG index and MACEs in patients with CHD, both with and without diabetes. Our findings demonstrate a consistent association between higher TyG index levels and increased risk of MACEs, suggesting its potential as a valuable tool for risk stratification and personalized management in this vulnerable population.
Keywords: Congenital Heart Disease, Major Adverse Cardiovascular Events, TyG Index, Meta-Analysis, Insulin Resistance, Diabetes, Cardiovascular Risk
Introduction
Congenital heart disease (CHD) affects approximately 1% of live births and represents a notable global health burden. While advancements in surgical and interventional cardiology have improved survival rates, individuals with CHD remain at elevated risk for long-term complications, including major adverse cardiovascular events (MACEs) such as myocardial infarction, stroke, and cardiovascular death.1 This increased risk is multifactorial, stemming from underlying cardiac abnormalities, chronic inflammation, and the advancement of traditional cardiovascular risk factors.
Traditional risk scores often underestimate cardiovascular risk in CHD patients, highlighting the need for novel biomarkers to improve risk stratification. Insulin resistance, a key feature of metabolic syndrome, is increasingly recognized as a contributor to cardiovascular disease, even in the absence of overt diabetes.2 The triglyceride-glucose (TyG) index, calculated as ln(triglycerides [mg/dL] × glucose [mg/dL] / 2), offers a simple, cost-effective, and readily available assessment of insulin resistance and metabolic dysfunction.3
Several studies have suggested a link between the TyG index and adverse cardiovascular outcomes in the general population and in specific cardiovascular conditions. However, the association between the TyG index and MACEs in patients with CHD remains less well-defined. this meta-analysis aims to systematically evaluate the available evidence regarding the relationship between the TyG index and the risk of MACEs in patients with CHD, considering the influence of diabetes status.
Methods
Search Strategy and Study Selection
A extensive search of PubMed, Embase, and Web of Science databases was conducted up to October 2023, using the following keywords: “congenital heart disease,” “CHD,” “TyG index,” “triglyceride glucose index,” ”major adverse cardiovascular events,” “MACE,” “cardiovascular events,” “cardiovascular mortality,” and “insulin resistance.” No language restrictions were applied.
Studies were included if they met the following criteria: (1) observational studies (cohort, case-control, or cross-sectional) investigating the association between the TyG index and MACEs; (2) included patients with a confirmed diagnosis of CHD; (3) reported sufficient data to calculate hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs) for MACEs; and (4) clearly defined MACEs (e.g., myocardial infarction, stroke, cardiovascular death, heart failure hospitalization). Studies were excluded if they were case reports, reviews, editorials, or lacked relevant data.
Data Extraction and Quality Assessment
Two autonomous reviewers extracted data from each included study using a standardized data extraction form.Extracted data included study characteristics (author, year of publication, country, study design), patient characteristics (sample size, age, sex, diabetes status), TyG index assessment (categorical vs. continuous), MACE definition, and adjusted HRs or ORs with 95% CIs. discrepancies were resolved through discussion and consensus.
The Newcastle-Ottawa Scale (NOS) was used to assess the quality of observational studies. Studies were rated as good, fair, or poor quality based on thier methodological rigor.
Statistical Analysis
Meta-analyses were performed using Review Manager (version 5.4, The Cochrane Collaboration). A random-effects model was used to account for potential heterogeneity between studies.Pooled HRs or ORs with 95% CIs were calculated for the association between the TyG index and MACEs.
Heterogeneity was assessed using the