The Triglyceride-Glucose Index: A Novel Marker for Clinical Atherosclerotic Cardiovascular Disease Risk Stratification

Abstract Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide with a substantial economic burden. It is driven by the intricate pathophysiology of insulin resistance (IR), which has been shown to disrupt glucose and lipid metabolism, vascular function, and drive inflammatory pathways, further accelerating the development and progression of CVD. The triglyceride-glucose (TyG) index, which was first proposed in 2008, has demonstrated strong correlations with the more traditional markers reserved for research settings, namely the hyperglycemic-euglycemic clamp and the homeostatic model assessment of IR. Studies have shown that the TyG index independently predicts cardiovascular outcomes in diabetic and nondiabetic individuals, supporting its potential as a practical tool for cardiovascular risk assessment in patients with or without known metabolic disorders and those that existing risk stratification models would otherwise miss. Several randomized control trials, cohort studies, and meta-analyses performed to date have identified the value of this index in identifying coronary artery calcification, acute coronary syndromes, major adverse cardiovascular and cerebral events and heart failure risk. In this summative review, we explore how incorporating the TyG index into general clinical practice would help identify high-risk individuals more effectively and earlier in the course of their disease, and consequently improve patient outcomes.