Introduction: The triglyceride-glucose (TyG) index is reported to be related to poor functional outcomes and all-cause mortality post-stroke. However, the association between TyG index and recurrent stroke after acute ischemic stroke (AIS) has not been well described. We aimed to identify whether the TyG index was associated with 1-year recurrent stroke after AIS. Methods: Baseline patient information was collected at admission, and the TyG index was calculated. Recurrent stroke events were followed up at 1, 3, 6, and 12 months after diagnosis. We then examined the association between the TyG index and risk of 1-year recurrent stroke using multivariable Cox regression models and restricted cubic spline analyses. Results: Among 2,288 participants, the mean TyG index was 8.8 ± 0.7. Those in the fourth quartile (Q4) demonstrated higher recurrent stroke risk than those in Q1 (adjusted hazard ratio [HR] = 1.63; 95% confidence interval [CI], 0.98–2.72; p = 0.059). Subgroup analysis revealed a sex-specific association between TyG index and recurrent stroke (p for interaction = 0.022). Additionally, restricted cubic splines analyses showed a nonlinear association between the TyG index and 1-year recurrent stroke. In females, patients in the Q4 had a 2.95-fold increased recurrent stroke risk than did patients in the Q1 (adjusted HR = 2.95; 95% CI: 1.09–7.94; p = 0.032); the risk increased when the TyG index was >8.73. However, no significant correlation was observed in males. Conclusion: A nonlinear association was found between the TyG index and 1-year recurrent stroke risk. Subsequently, a high TyG index could predict an increased 1-year recurrent stroke risk in female AIS patients.

1.
Wang W, Jiang B, Sun H, Ru X, Sun D, Wang L, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480 687 adults. Circulation. 2017;135(8):759–71.
2.
Feigin VL, Stark BA, Johnson CO, Roth GA, Bisignano C, Abady GG, et al. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021;20(10):795–820.
3.
Kang DW, Han MK, Kim HJ, Sohn H, Kim BJ, Kwon SU, et al. Silent new ischemic lesions after index stroke and the risk of future clinical recurrent stroke. Neurology. 2016;86(3):277–85.
4.
Simental-Mendia LE, Rodríguez-Morán M, Guerrero-Romero F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord. 2008;6(4):299–304.
5.
Ormazabal V, Nair S, Elfeky O, Aguayo C, Salomon C, Zuniga A. Association between insulin resistance and the development of cardiovascular disease. Cardiovasc Diabetol. 2018;17(1):122.
6.
Kernan WN, Inzucchi IS, Viscoli CM, Brass LM, Bravata DM, Horwitz RI. Insulin resistance and risk for stroke. Neurology. 2002;59(6):908–15.
7.
Deng XL, Liu Z, Wang C, Li Y, Cai Z. Insulin resistance in ischemic stroke. Metab Brain Dis. 2017;32(5):1323–34.
8.
Nigro J, Osman N, Dart AM, Little J. Insulin resistance and atherosclerosis. Endocr Rev. 2006;27(3):242–59.
9.
Hong S, Han K, Park Y. The triglyceride glucose index is a simple and low-cost marker associated with atherosclerotic cardiovascular disease: a population-based study. BMC Med. 2020;18(1):361.
10.
Irace C, Carallo C, Scavelli FB, De Franceschi MS, Esposito T, Tripolino C, et al. Markers of insulin resistance and carotid atherosclerosis. A comparison of the homeostasis model assessment and triglyceride glucose index. Int J Clin Pract. 2013;67(7):665–72.
11.
Guerrero-Romero F, Simental-Mendia LE, Gonzalez-Ortiz M, Martinez-Abundis E, Ramos-Zavala MG, Hernandez-Gonzalez SO, et al. The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab. 2010;95(7):3347–51.
12.
Wang L, Cong HL, Zhang JX, Hu YC, Wei A, Zhang YY, et al. Triglyceride-glucose index predicts adverse cardiovascular events in patients with diabetes and acute coronary syndrome. Cardiovasc Diabetol. 2020;19(1):80.
13.
Lee SB, Ahn CW, Lee BK, Kang S, Nam JS, You JH, et al. Association between triglyceride glucose index and arterial stiffness in Korean adults. Cardiovasc Diabetol. 2018;17(1):41.
14.
Wang A, Li Y, Zhou L, Liu K, Li S, Song B, et al. Triglyceride-glucose index is related to carotid plaque and its stability in nondiabetic adults: a cross-sectional study. Front Neurol. 2022;13:823611.
15.
Guo Q, Feng X, Zhang B, Zhai G, Yang J, Liu Y, et al. Influence of the triglyceride-glucose index on adverse cardiovascular and cerebrovascular events in prediabetic patients with acute coronary syndrome. Front Endocrinol. 2022;13:843072.
16.
Shi W, Xing L, Jing L, Tian Y, Yan H, Sun Q, et al. Value of triglyceride-glucose index for the estimation of ischemic stroke risk: insights from a general population. Nutr Metab Cardiovasc Dis. 2020;30(2):245–53.
17.
Wang A, Wang G, Liu Q, Zuo Y, Chen S, Tao B, et al. Triglyceride-glucose index and the risk of stroke and its subtypes in the general population: an 11-year follow-up. Cardiovasc Diabetol. 2021;20(1):46.
18.
Zhang B, Liu L, Ruan H, Zhu Q, Yu D, Yang Y, et al. Triglyceride-glucose index linked to hospital mortality in critically ill stroke: an observational multicentre study on eICU database. Front Med. 2020;7:591036.
19.
Zhou Y, Pan Y, Yan H, Wang Y, Li Z, Zhao X, et al. Triglyceride glucose index and prognosis of patients with ischemic stroke. Front Neurol. 2020;11:456.
20.
Lee M, Kim CH, Kim Y, Jang MU, Mo HJ, Lee SH, et al. High triglyceride glucose index is associated with poor outcomes in ischemic stroke patients after reperfusion therapy. Cerebrovasc Dis. 2021;50(6):691–9.
21.
Toh EMS, Lim AYL, Ming C, Yeo LLL, Sia CH, Tan BWQ, et al. Association of triglyceride-glucose index with clinical outcomes in patients with acute ischemic stroke receiving intravenous thrombolysis. Sci Rep. 2022;12(1):1596.
22.
Lin SF, Hu HH, Chao HL, Ho BL, Chen CH, Chan L, et al. Triglyceride-glucose index and intravenous thrombolysis outcomes for acute ischemic stroke: a multicenter prospective-cohort study. Front Neurol. 2022;13:737441.
23.
Yang X, Wang G, Jing J, Wang A, Zhang X, Jia Q, et al. Association of triglyceride-glucose index and stroke recurrence among nondiabetic patients with acute ischemic stroke. BMC Neurol. 2022;22(1):79.
24.
Wang F, Wang J, Han Y, Shi X, Xu X, Hou C, et al. Triglyceride-glucose index and stroke recurrence in elderly patients with ischemic stroke. Front Endocrinol. 2022;13:1005614.
25.
Wu L, Wang A, Wang X, Zhao X, Wang C, Liu L, et al. Factors for short-term outcomes in patients with a minor stroke: results from China National Stroke Registry. BMC Neurol. 2015;15:253.
26.
Mendelson SJ, Prabhakaran S. Diagnosis and management of transient ischemic attack and acute ischemic stroke: a review. JAMA. 2021;325(11):1088–98.
27.
Claassen J, Park S. Spontaneous subarachnoid haemorrhage. Lancet. 2022;400(10355):846–62.
28.
Greenberg SM, Ziai WC, Cordonnier C, Dowlatshahi D, Francis B, Goldstein JN, et al. 2022 guideline for the management of patients with spontaneous intracerebral hemorrhage: a guideline from the American heart association/American stroke association. Stroke. 2022;53(7):e282–361.
29.
Zhao Y, Sun H, Zhang W, Xi Y, Shi X, Yang Y, et al. Elevated triglyceride-glucose index predicts risk of incident ischaemic stroke: the Rural Chinese cohort study. Diabetes Metab. 2021;47(4):101246.
30.
Chen T, Wang X, Wang X, Chen H, Xiao H, Tang H, et al. Comparison of novel metabolic indices in estimation of chronic kidney diseases in a southern Chinese population. Diabetes Metab Syndr Obes. 2020;13:4919–27.
31.
Nakagomi A, Sunami Y, Kawasaki Y, Fujisawa T, Kobayashi Y. Sex difference in the association between surrogate markers of insulin resistance and arterial stiffness. J Diabetes Complications. 2020;34(6):107442.
32.
Zou S, Xu Y. Association of the triglyceride-glucose index and major adverse cardiac and cerebrovascular events in female patients undergoing percutaneous coronary intervention with drug-eluting stents: a retrospective study. Diabetes Res Clin Pract. 2021;181:109073.
33.
Liu Z, Lin X, Lin W, Lu Q, Liu P, Wang J, et al. A J-shaped curve relationship between baseline fasting blood glucose and 1-year stroke recurrence in non-diabetic patients with acute cerebral infarction in Xi’an, China: a multicenter observational cohort study. Front Neurol. 2021;12:698793.
34.
Chen KN, He L, Zhong LM, Ran YQ, Liu Y. Meta-analysis of dyslipidemia management for the prevention of ischemic stroke recurrence in China. Front Neurol. 2020;11:483570.
35.
Manktelow BN, Potter JF. Interventions in the management of serum lipids for preventing stroke recurrence. Cochrane Database Syst Rev. 2009;2009(3):CD002091.
36.
Wang H, Li L, Yang XF, Wang H. Insulin resistance metabolic stress and atherosclerosis. Front Biosci. 2012;S4(3):916–31.
37.
Guo Y, Zhao J, Zhang Y, Wu L, Yu Z, He D, et al. Triglyceride glucose index influences platelet reactivity in acute ischemic stroke patients. BMC Neurol. 2021;21(1):409.
38.
Flemming KD, Brown RDJr. Secondary prevention strategies in ischemic stroke: identification and optimal management of modifiable risk factors. Mayo Clin Proc. 2004;79(10):1330–40.
39.
Khan NI, Naz L, Mushtaq S, Rukh L, Ali S, Hussain Z. Ischemic stroke:prevalence of modifiable risk factors in male and female patients in Pakistan. Pak J Pharm Sci. 2009;22(1):62–7.
40.
Geer EB, Shen W. Gender differences in insulin resistance, body composition, and energy balance. Gend Med. 2009;6(Suppl 1):60–75.
41.
Pellegrini M, Pallottini V, Marin R, Marino, M. Role of the sex hormone estrogen in the prevention of lipid disorder. Curr Med Chem. 2014;21(24):2734–42.
42.
Wang M, Ding J, Levi DM, Cooper EA. Menopausal status, age at natural menopause and risk of diabetes in China: a 10-year prospective study of 300,000 women. J Vis. 2022;22(12):7.
43.
Joint Committee for Guideline Revision. 2018 Chinese guidelines for prevention and treatment of hypertension-a report of the revision committee of Chinese guidelines for prevention and treatment of hypertension. J Geriatr Cardiol. 2019;16(3):182–241.
44.
Mustanoja S, Putaala J, Gordin D, Tulkki L, Aarnio K, Pirinen J, et al. Acute-phase blood pressure levels correlate with a high risk of recurrent strokes in young-onset ischemic stroke. Stroke. 2016;47(6):1593–8.
45.
Ling Y, Fu C, Fan Q, Liu J, Jiang L, Tang S. Triglyceride-glucose index and new-onset atrial fibrillation in ST-segment elevation myocardial infarction patients after percutaneous coronary intervention. Front Cardiovasc Med. 2022;9:838761.
46.
Wei Z, Zhu E, Ren C, Dai J, Li J, Lai Y. Triglyceride-glucose index independently predicts new-onset atrial fibrillation after septal myectomy for hypertrophic obstructive cardiomyopathy beyond the traditional risk factors. Front Cardiovasc Med. 2021;8:692511.
47.
Chan YH, Chang GJ, Lai YJ, Chen WJ, Chang SH, Hung LM, et al. Atrial fibrillation and its arrhythmogenesis associated with insulin resistance. Cardiovasc Diabetol. 2019;18(1):125.
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