Title : The synergistic effect of the triglyceride-glucose index and lipoprotein(a) on the prediction of major adverse cardiovascular events after coronary artery bypass grafting
Abstract:
Background: Lipoprotein(a) has been implicated as a pathogenic risk factor for atherosclerosis and its complications. The triglyceride-glucose (TyG) index, a novel surrogate marker for insulin resistance (IR), has been identified as an independent predictor of adverse cardiac events. However, no study has specifically addressed the interaction between these two metabolic risk factors. Whether the combination of lipoprotein(a) and the TyG index can more accurately predict prognosis in patients undergoing coronary artery bypass grafting (CABG) remains unclear.
Methods: A total of 15,648 participants from a registry-based cohort were enrolled. The TyG index was calculated using ln[fasting triglycerides (mg/dL) × fasting blood glucose (mg/dL)/2]. Patients were categorized based on the cut-off values for lipoprotein(a) and the TyG index. The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCEs), including all-cause death, myocardial infarction, cerebrovascular accidents, or repeat revascularization. Following comprehensive adjustments for potential confounders, Cox regression analysis was performed. The interaction between lipoprotein(a) and the TyG index was estimated by the relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (SI). The model's performance improvement, brought by including lipoprotein(a) and the TyG index, was assessed through net reclassification improvement (NRI) and integrated discrimination improvement (IDI).
Results: During a median follow-up of 3.3 years, 487 patients (31.1%) experienced at least one endpoint event. Significant independent and combined associations of lipoprotein(a) and the TyG index with adverse events were observed. Patients with higher levels of lipoprotein(a) and the TyG index had a higher risk of MACCEs (Kaplan-Meier analysis: log-rank P < 0.001; HR = 2.19; 95% CI 1.61–4.28, P < 0.001). There was a significant synergistic interaction between lipoprotein(a) and the TyG index [RERI (95% CI): 1.02 (0.11–2.25), P = 0.022; AP (95% CI): 0.23 (0.08-0.49), P = 0.002; SI (95% CI): 1.13 (0.57–2.99), P = 0.031]. The addition of lipoprotein(a) and the TyG index significantly improved prognosis prediction and model fitting [continuous NRI (95% CI): 0.197 (0.071–0.301), P < 0.001; IDI (95% CI): 0.017 (0.006–0.036), P < 0.001].
Conclusion: The synergistic interaction between lipoprotein(a) and the TyG index increases the risk of MACCEs in patients undergoing CABG, underscoring the need to consider both factors and their interaction in cardiovascular risk assessment.
Audience Take Away
- The role of lipoprotein(a) and the triglyceride-glucose (TyG) index as independent and combined predictors of adverse cardiac events in patients undergoing coronary artery bypass grafting (CABG).
- Medical professionals can incorporate the assessment of lipoprotein(a) and the TyG index into their preoperative evaluations to better identify CABG patients at higher risk of developing MACCEs.
- Researchers can use the findings to explore further the mechanisms underlying the synergistic effects of lipoprotein(a) and the TyG index, potentially uncovering new therapeutic targets.low the progression or reduce the incidence of MACCE among at-risk individuals.
