Triglyceride Glucose Body Mass Index May Predict Coronary Heart Disease

A recent retrospective analysis indicated a significant association between the triglyceride glucose-body mass index (TyG-BMI) and 1-year mortality in patients critically ill with coronary heart disease (CHD).

CHD is the cause of the highest global morbidity and mortality rates, responsible for 32% of all deaths and sitting at the top of the list of worldwide disease burden. Previous studies have drawn a correlation between the TyG index and incidence of CHD, among other cardiovascular diseases. These studies have indicated that maintaining a certain level of triglyceride (TG) and fasting blood glucose (FBG) levels affords better protection against various cardiovascular diseases.1,2

“The triglyceride glucose body mass index (TyG-BMI), which combines obesity measurements with the TyG index, has high sensitivity and specificity for recognizing IR, and both metrics have been validated in [insulin resistance] IR,” wrote Jing Tian, department of critical care medicine, the Affiliated Wuxi People’s Hospital of Nanjing Medical University, and colleagues. “However, the interaction between these two indices is largely underexplored in critically ill patients with CHD.”1

The team collected data from the Medical Information Marketplace for Critical Care IV (MIMIC-IV), retrieving information on 12,859 adult patients with severe CHD. Patients with hepatic malignancy, severe hepatitis, and hepatic insufficiency were excluded, along with patients missing TG, height, or weight data. A final total of 899 patients were organized into three quartiles based on TyG-BMI index:

• Quartile 1 (n = 296, low TyG-BMI index: <235.33)
• Quartile 2 (n = 297, medium TyG-BMI index: 235.33-294.40)
• Quartile 3 (n = 296, high TyG-BMI index: >294.40)1

The primary outcome was established as a given patient’s 365-day prognosis. Secondary outcomes included the patients’ hospital survival, ICU survival, and prognosis at 28, 90, and 180 days. TyG-BMI was calculated as ln(fasting glucose [mg/dl] x fasting TG [mg/dl]/2). BMI was calculated as body weight (kg)/height2 (m).1

The investigators utilized four multivariate Cox proportional risk regression models to explore the connection between the index and 1-year mortality. Four models were created with low TyG-BMI index as the reference. Model 1 was unadjusted for variables; model 2 was adjusted for sex and age; model 3 was adjusted for age, sex, hypertension, type 1 and type 2 diabetes mellitus, chronic kidney disease, acute myocardial infarction, stroke, white and red blood cell counts, total cholesterol, HDL-C, LDL-C, Bilirubin, Creatine, troponin T, heart rate, and systolic and diastolic blood pressure. Model 4 was adjusted for all of these plus Sofa, Apsiii, Sirs, Sapsii, and Oasis.1

Investigators noted that Quartile 2 had the highest hospital (245 [82.49%] vs 232 [78.38%], 223 [75.34%), P = .102) and ICU (261 [87.88%] vs 254 [85.81%], 237 [80.07%], P = .024) survival rates compared to the other quartiles. Similarly, the second quartile had the best prognoses at 28, 90, and 180 days.1

The second quartile also had the highest 365-day survival rate (201 [67.68%] vs 166 [56.08%], 188 [63.51%], P = .013). After fully adjusted modeling analysis, the team established the hazard ratio (HR) for the survival rate to be 0.71 (95% CI, .54-.93, P = .012). RCS curves were also implemented to explore the relationship between 365-day mortality and the TyG-BMI index. They illustrated an L-shaped relationship with a linear decrease in patient mortality as the index increases (P-nonlinear = .082, P = .016).1

Given that standard BMI measurement usually exhibits a U-shape, where CVD mortality only rises in extreme cases of obesity, investigators noted that these data could highlight another occurrence of the obesity paradox. This phenomenon is created by the seeming fact that patients with established heart failure, overweight and mild to moderate obesity has some degree of association with improved survival.1,3

“The TyG-BMI index may serve as an effective tool for classifying and preventing the risk of developing CHD,” Tian and colleagues wrote. “In addition, given the obesity paradox, BMI should be of equal concern in patients with a definite diagnosis of CHD.”1

References

1. Tian J, Dong Y, Xu Z, Ke J, Xu H. Association between triglyceride glucose-body mass index and 365-day mortality in patients with critical coronary heart disease. Front Endocrinol (Lausanne). 2025;16:1513898. Published 2025 Apr 4. doi:10.3389/fendo.2025.1513898

2. Cui H, Liu Q, Wu Y, Cao L. Cumulative triglyceride-glucose index is a risk for CVD: a prospective cohort study. Cardiovasc Diabetol. 2022;21(1):22. Published 2022 Feb 10. doi:10.1186/s12933-022-01456-1

3. Horwich TB, Fonarow GC, Clark AL. Obesity and the obesity paradox in heart failure. Progress in Cardiovascular Diseases. 2018;61(2):151-156. doi:10.1016/j.pcad.2018.05.005