Triglyceride–Glucose Index and TyG-BMI for Identifying Advanced Cardiovascular–Kidney–Metabolic Syndrome: A Cross-Sectional Study
This study aimed to investigate the associations of TyG and TyG-BMI with the presence of advanced CKM syndrome, and to compare their discriminatory performance for advanced CKM Syndrome. This cross-sectional study included 2, 060 patients with CKM, including 1, 216 patients with early CKM, stages 1 to 2, and 844 patients with advanced CKM syndrome, stages 3 to 4. Patients with advanced CKM syndrome had significantly higher levels of total cholesterol, low-density lipoprotein cholesterol, triglycerides, fasting blood glucose, TyG, and TyG-BMI than those with early CKM, whereas highdensity lipoprotein cholesterol levels were significantly lower, all P < 0.001. Multivariable logistic regression analysis showed that, compared with the lowest quartile (Q1), the odds of advanced CKM syndrome were significantly increased in the Q3 group of the TyG (OR = 1.894, 95%CI: 1.270-2.825) and the Q4 group (OR = 6.503, 95%CI: 4.310-9.813). Similarly, compared with Q1, the odds of advanced CKM syndrome were higher in the Q3 group of the TyG-BMI (OR = 1.976, 95%CI: 1.327-2.944) and the Q4 group (OR = 6.926, 95%CI: 4.583-10.466). Receiver operating characteristic curve analysis showed that the areas under the curves for the TyG and the TyG-BMI in discriminating advanced CKM syndrome were 0.678 and 0.699, respectively. In conclusion, patients with advanced CKM syndrome exhibited more pronounced insulin resistance-related metabolic abnormalities. TyG and TyG-BMI were independently associated with advanced CKM syndrome. Both indices demonstrated moderate discriminatory ability and may serve as simple screening tools; however, prospective studies are needed to validate their predictive value.
[1] Cheng, Y., Fang, Z., Zhang, X., Wen, Y., Lu, J., He, S., & Xu, B. (2023). Association between triglyceride glucose-body mass index and cardiovascular outcomes in patients undergoing percutaneous coronary intervention: A retrospective study. Cardiovascular Diabetology, 22(1), 75. https://doi.org/10.1186/s12933-023-01794-8
[2] Dang, K., Wang, X., Hu, J., Zhang, Y., Cheng, L., Qi, X., ... & Li, Y. (2024). The association between triglyceride-glucose index and its combination with obesity indicators and cardiovascular disease: NHANES 2003-2018. Cardiovascular Diabetology, 23(1), 8. https://doi.org/10.1186/s12933-023-02115-9
[3] Gao, H. (2024). Association of TyG index, TyG-BMI, and remnant cholesterol with carotid atherosclerosis in young patients with ischemic stroke [Master's thesis]. Jilin University.
[4] Hill, M. A., Yang, Y., Zhang, L., Sun, Z., Jia, G., Parrish, A. R., & Sowers, J. R. (2021). Insulin resistance, cardiovascular stiffening and cardiovascular disease. Metabolism, 119, 154766. https://doi.org/10.1016/j.metabol.2021.154766
[5] Hong, S., Han, K., & Park, C. Y. (2020). The triglyceride glucose index is a simple and low-cost marker associated with atherosclerotic cardiovascular disease: A population-based study. BMC Medicine, 18(1), 361. https://doi.org/10.1186/s12916-020-01824-2
[6] Hua, Y., Chen, Z., Cheng, L., Ding, N., Xie, Y., Wu, H., ... & Lan, B. (2025). TyG-BMI index as a valuable risk of acute kidney injury in patients with heart failure: Insights from the MIMIC-IV and eICU cohorts. Journal of Diabetes Investigation, 16(10), 1844-1858. https://doi.org/10.1111/jdi.70133
[7] Jin, Y. (2024). Association between triglyceride-glucose body mass index (TyG-BMI) and diabetic kidney disease in patients with type 2 diabetes mellitus [Master's thesis]. Hebei Medical University.
[8] Li, M., Chi, X., Wang, Y., Setrerrahmane, S., Xie, W., & Xu, H. (2022). Trends in insulin resistance: Insights into mechanisms and therapeutic strategy. Signal Transduction and Targeted Therapy, 7, 216. https://doi.org/10.1038/s41392-022-01073-0
[9] Li, W., Shen, C., Kong, W., Zhou, X., Fan, H., Zhang, Y., ... & Zheng, L. (2024). Association between the triglyceride glucose-body mass index and future cardiovascular disease risk in a population with Cardiovascular-Kidney-Metabolic syndrome stage 0-3: A nationwide prospective cohort study. Cardiovascular Diabetology, 23(1), 292. https://doi.org/10.1186/s12933-024-02352-6
[10] Liu, K., Hu, J., Huang, Y., He, D., & Zhang, J. (2025). Triglyceride-glucose-related indices and risk of cardiovascular disease and mortality in individuals with cardiovascular-kidney-metabolic (CKM) syndrome stages 0-3: A prospective cohort study of 282,920 participants in the UK Biobank. Cardiovascular Diabetology, 24(1), 277. https://doi.org/10.1186/s12933-025-02842-1
[11] Miao, Y., Wang, Y., He, Y., Yan, P., & Wan, Q. (2025). TyG-BMI as a predictor of ischemic stroke over 10 years in middle-aged and older adults: Findings from the China cardiometabolic disease and cancer cohort (4C) study. Frontiers in Neurology, 16, 1609853. https://doi.org/10.3389/fneur.2025.1609853
[12] Ndumele, C. E., Rangaswami, J., Chow, S. L., Neeland, I. J., Tuttle, K. R., Khan, S. S., ... & Elkind, M. S. V. (2023a). Cardiovascular-kidney-metabolic health: A presidential advisory from the American Heart Association. Circulation, 148(20), 1606-1635. https://doi.org/10.1161/cir.0000000000001184
[13] Ndumele, C. E., Neeland, I. J., Tuttle, K. R., Chow, S. L., Mathew, R. O., Khan, S. S., ... & Elkind, M. S. V. (2023b). A synopsis of the evidence for the science and clinical management of cardiovascular-kidney-metabolic (CKM) syndrome: A scientific statement from the American Heart Association. Circulation, 148(20), 1636-1664. https://doi.org/10.1161/cir.000000000 0001186
[14] Pan, W., Ji, T. F., Hu, B. T., Yang, J., Lu, L., & Wei, J. (2025). Association between triglyceride glucose body mass index and 1 year all cause mortality in stage 4 CKM syndrome patients. Scientific Reports, 15(1), 17019. https://doi.org/10.1038/s41598-025-01549-3
[15] Peng, S., Yang, S., Yang, J., Lu, X., & Zhang, M. (2025). Advances in the pathophysiological mechanisms of cardiovascular-kidney-metabolic syndrome. Chinese Journal of Chronic Disease Prevention and Control, 33(1), 61-65.
[16] Schleh, M. W., Caslin, H. L., Garcia, J. N., Mashayekhi, M., Srivastava, G., Bradley, A. B., & Hasty, A. H. (2023). Metaflammation in obesity and its therapeutic targeting. Science Translational Medicine, 15(723), eadf9382. https://doi.org/10.1126/scitranslmed.adf9382
[17] Song, K., Xu, Y., Wu, S., Zhang, X., Wang, Y., & Pan, S. (2025). Research status of triglyceride glucose-body mass index (TyG-BMI index). Frontiers in Cardiovascular Medicine, 12, 1597112. https://doi.org/10.3389/fcvm.2025.1597112
[18] Tuo, J., Li, Z., & Xie, L. (2025). Association between triglyceride-glucose index and clinical outcomes among patients with chronic kidney disease: A meta-analysis. BMC Nephrology, 26(1), 61. https://doi.org/10.1186/s12882-025-03984-w
[19] Xia, J. G., Yuan, M. X., Cai, X. L., Wang, Z. J., Zheng, B., Feng, X., ... & Ji, X. M. (2025). Chinese expert consensus on the comprehensive management of patients with cardiovascular-kidney-metabolic syndrome. Chinese Journal of Cardiovascular Research, 23(3), 193-228.
[20] Zhang, P., Mo, D., Zeng, W., & Dai, H. (2025). Association between triglyceride-glucose related indices and all-cause and cardiovascular mortality among the population with cardiovascular-kidney-metabolic syndrome stage 0-3: A cohort study. Cardiovascular Diabetology, 24(1), 92. https://doi.org/10.1186/s12933-025-02642-7
[21] Zhao, Y., Wang, L., Li, J., Guo, B., Zhang, J., Guo, X., ... & Zhao, X. (2025). Association between surrogate markers of insulin resistance and incident cardiovascular disease in individuals with stages 0-3 cardiovascular-kidney-metabolic syndrome: A prospective cohort study. Journal of Sichuan University (Medical Sciences Edition), 56(2), 495-505.
[22] Zhao, Q., Wang, Y., Zhang, H., Wan, W., Wang, L., Zhang, Z., ... & Lan, L. (2026). Comparative evaluation of insulin resistance surrogate indices for predicting cardiovascular risk in adults with CKM syndrome stages 0-3. Journal of Sun Yat-Sen University (Medical Science Edition), 47(3), 539-550.