Introduction
Materials and methods
Sources and methods of data retrieval
Inclusion and exclusion criteria
Data abstraction
Quality assessment
Statistical analysis
Results
Study | Country | Design | Characteristics of participants | Number of participants | Mean age (years) | Male (%) | TyG index analysis | Outcomes reported | Variables adjusted | NOS |
---|---|---|---|---|---|---|---|---|---|---|
Hong S, et al.(1) | South Korea | Cohort | General population aged over 40 years | 5,586,048 | — | 50.7 | Categorized (Q4:Q1) | Vascular dementia | Age, sex, smoking status, alcohol consumption, physical activity, low income, BMI, hypertension and TC | 8 |
Hong S, et al.(2) | South Korea | Cohort | General population aged over 40 years | 5,593,134 | — | 50.5 | Categorized (Q4:Q1) | Stroke | Age, sex, smoking, alcohol consumption, regular physical activity, low socioeconomic status, BMI, hypertension, TC, hypertension medications, warfarin and aspirin | 8 |
Hu LL, et al. | China | Cohort | hypertension aged over 60 years | 8487 | 68.8 | 52.8 | Categorized (Q4:Q1); Continuous | Stroke | Age, sex, BMI, WC, education, physical activity, duration of hypertension, current smoking, current drinking, SBP, DBP, serum homocysteine, SUA, LDL-C, eGFR, diabetes mellitus, atrial fibrillation, CHD, anti-hypertensive drugs and anti-platelet drugs | 8 |
Kim J, et al. | South Korea | Cohort | General population aged 40–79 years | 144,603 | — | 54.0 | Categorized (Q4:Q1) | Unclassified | Age, smoking status, drinking status, physical activity, BMI, SBP, LDL-C, economic status and anti-hypertensive medications | 8 |
Alizargar J, et al. | China | Case control | General population aged over 30 years | 276 | 56.2 ± 10.7 | 56.5 | Continuous | Carotid artery disease | — | 6 |
Laura S, et al. | Spain | Cohort | Internal medicine outpatient | 5014 | — | 61.2 | Categorized (Q5:Q1) | Unclassified | Age, sex, BMI, cigarette smoking, daily alcohol intake, lifestyle pattern, hypertension, type 2 diabetes, anti aggregation therapy, HDL-C, LDL-C | 6 |
Li SS, et al. | China | Cohort | General population aged over 60 years | 6078 | 70.5 ± 6.8 | 53.1 | Categorized (Q4:Q1) | Unclassified | Age, sex, current smoking, alcohol consumption, exercise, BMI, resting heart rate, SBP, HDL-C, LDL-C, diabetic status | 8 |
Liu Q, et al. | China | Cohort | General population | 96,541 | 51.2 ± 12.6 | 79.6 | Categorized (Q4:Q1); Continuous | Stroke | Age, sex, education, current smoking status, current drinking status, physical activity, BMI, hypertension, diabetes, HDL-C, LDL-C, hs-CRP, lipid-lowering medication, antidiabetic medication and antihypertensive medication | 8 |
C. Irace, et al. (a) | Italy | Cross sectional | General population | 330 | — | 56.7 | Continuous | Carotid artery disease | — | 5 |
C. Irace, et al. (b) | Italy | Cross sectional | General population | 1432 | — | 57.6 | Continuous | Carotid artery disease | — | 5 |
Mao Q, et al. | China | Cohort | NSTE-ACS | 438 | 62.5(53.0–68.0) | 67.4 | Categorized; cutoff: 8.805 | Stroke | Age, gender, metabolic syndrome, LDL-C, HDL-C, SYNTAX score, CRP, basal insulin, sulfonylurea, metformin, α-glucosidase inhibitor, ACEI/ARB, beta-blocker and PCI/CABG | 7 |
Nam Ki-W, et al. | South Korea | Cross sectional | General population aged 40–79 years | 2615 | 56.0 | 53.0 | Continuous | Cerebral small vessel disease | — | 8 |
Shi WR, et al. | China | Case control | General population aged over 40 years | 10,900 | — | 40.2 | Categorized (Q4:Q1); Continuous | Stroke | Age, sex, education level, family annual income level, exercise level, current smoking, current drinking, WC, hypertension, BMI, HDL-C, LDL-C, history of cardiovascular diseases | 7 |
Si S, et al. | England | Case control | General population aged 40–69 years | 273,368 | — | 57.3 | Categorized (Q4:Q1) | Unclassified | Age, sex, BMI, smoke status, fasting time and LDL-C | 7 |
Wang AX, et al.(1) | China | Cohort | General population aged 18–98 years | 62,443 | 49.1 ± 11.8 | 76.6 | Categorized (Q4:Q1) | Stroke | Age, sex, TyG index at baseline, education, income, smoking status, drinking status, physical activity, BMI, SBP, DBP, history of hypertension, diabetes mellitus and dyslipidemia, antidiabetic agents, lipid-lowering agents, antihypertensive agents, HDL-C and hs-CRP at baseline | 9 |
Wang AX, et al.(2) | China | Cohort | General population aged 18–98 years | 97,653 | 51.7(43.5–59.0) | 79.6 | Categorized (Q4:Q1) | Stroke | Age, sex, level of education, income, smoking, alcohol abuse, physical activity, BMI, SBP, DBP, history of myocardial infarction, hypertension, diabetes mellitus, dyslipidemia, HDL-C, LDL-C, hs-CRP, antidiabetic drugs, lipid-lowering drugs and antihypertensive drugs | 9 |
Wang AX, et al.(3) | China | Cross sectional | General population aged 18–98 years | 4748 | 51.8(45.3–60.4) | 58.9 | Categorized (Q4:Q1); Continuous | Carotid artery disease | Age, sex, education, income, physical activity, smoking status, drinking status, history of hypertension and dyslipidemia, BMI, SBP, DBP, antihypertensive agents, lipid-lowering agents, HDL-C, LDL-C and hs-CRP | 7 |
Wang AX, et al.(4 A) | China | Cross sectional | General population aged over 40 years | 5381 | 52.5(45.6–61.6) | 59.8 | Categorized (Q4:Q1); Continuous | Intracranial arterial disease | Age, sex, BMI, education, income, physical activity, smoking status, drinking status, history of hypertension, diabetes, dyslipidemia, antihypertensive agents, antidiabetic agents, lipid-lowering agents, HDL-C, LDL-C and hs-CRP | 8 |
Wang AX, et al.(4B) | China | Cohort | General population aged over 40 years | 5381 | 52.5(45.6–61.6) | 59.8 | Categorized (Q4:Q1); Continuous | Intracranial arterial disease | Age, sex, BMI, education, income, physical activity, smoking status, drinking status, history of hypertension, diabetes, dyslipidemia, antihypertensive agents, antidiabetic agents lipid-lowering agents, HDL-C, LDL-C and hs-CRP | 7 |
Chen L, et al. | China | Cohort | T2DM | 1578 | 62.9 ± 8.0 | 70.7 | Categorized (Q3:Q1) | Stroke | — | 7 |
Chiu H, et al. | China | Cross sectional | T2DM | 1990 | — | 43.0 | Categorized (Q4:Q1) | Unclassified | — | 5 |
Wang L, et al. | China | Cohort | diabetes and acute coronary syndrome | 2531 | 66.3 ± 6.8 | 55.9 | Categorized (Q3:Q1) | Stroke | Age, male, smoker, previous MI, previous CABG, BMI, LVEF, left main disease, multi-vessel disease, HbA1c, hs-CRP, statin and insulin | 5 |
Wu ZY, et al.(a) | China | Cohort | General population aged over 18 years | 6955 | 44.6 ± 10.1 | 61.3 | Categorized (Q4:Q1); Continuous | Carotid artery disease | Age, sex, BMI, waist-hip ratio, hypertension, diabetes, dyslipidemia, SBP, fasting blood glucose, triglyceride, TC, SUA, eGFR, smoking status, drinking status, physical activity and IMT value at baseline | 8 |
Wu ZY, et al.(b) | China | Cohort | General population aged over 18 years | 8473 | 44.7 ± 9.8 | 56.8 | Categorized (Q4:Q1); Continuous | Carotid artery disease | Age, sex, BMI, waist-hip ratio, hypertension, diabetes, dyslipidemia, SBP, fasting blood glucose, triglyceride, TC, SUA, eGFR, smoking status, drinking status, physical activity and IMT value at baseline | 8 |
Zhang NN, et al. | China | Cross sectional | General population aged over 40 years | 1938 | — | 47.7 | Continuous | Intracranial arterial disease | Age, gender, hypertension, smoking habit, drinking habit, LDL-C, HDL-C, TC and obesity | 8 |
Zhang Y, et al.(1) | China | Cohort | ACS | 1655 | — | 73.9 | Categorized; cutoff: 8.33 | Stroke | — | 5 |
Zhang Y, et al.(2) | China | Cohort | T2DM and acute MI | 1932 | 65.4 ± 12.0 | 68.5 | Categorized (Q3:Q1) | Stroke | Age, BMI, history of stroke and PCI, antiplatelet agent used before admission, WBC, hemoglobin, albumin, eGFR, LVEF, angiography findings, in-hospital treatment and hypoglycemic agents | 7 |
Zhao Q, et al. | China | Cohort | NSTE-ACS without Diabetes | 1510 | 59.7 ± 9.3 | 73.7 | Continuous | Stroke | Age, gender, BMI, smoking history, hypertension, dyslipidemia, previous history of MI, PCI, stroke and PAD, diagnosis, TC, HDL-C, eGFR, HbA1c, LVEF, LM disease, three-vessel disease, chronic total occlusion, diffuse lesion, in-stent restenosis, SYNTAX score, treatment of LM, LCX, RCA, DES implantation, DCB application, complete revascularization, and number of stents, DAPT at admission, statins at admission, and ACEI/ARB at discharge | 8 |
Guo QY, et al. | China | Cohort | prediabetes and ACS | 2030 | 58.9 ± 10.3 | 74.1 | Categorized; cutoff: 8.83 | Stroke | — | 5 |
Zhao S, et al. | China | Cross sectional | General population aged over 65 years | 2830 | 71.5 ± 6.2 | 55.5 | Categorized (Q4:Q1) | Carotid artery disease | Age, sex, BMI, WC, smoking habit, hypertension, family history of premature CVD, diabetes, HDL-C, LDL-C, insulin and statin therapy | 7 |
Zhao Y, et al. | China | Cohort | General population aged over 40 years | 11,777 | — | 40.9 | Categorized (Q4:Q1) | Stroke | Age, gender, marital status, income, education level, smoking, alcohol drinking, physical activity, family history of stroke, SBP, DBP, resting heart rate, BMI, WC, TC, LDL-C and HDL-C | 8 |
High level of triglyceride glucose index compared with low level triglyceride glucose index in risk of cerebrovascular diseases. | |||
Population: Subjects with high level of triglyceride glucose index vs. low level triglyceride glucose index. | |||
Settings: Thirteen studies were conducted in Asia, one study were conducted in Europe. | |||
Cases: Subjects with high level of triglyceride glucose index. | |||
Controls: Subjects with low level of triglyceride glucose index. | |||
Outcomes | RR/HR (95% CI)a | No of participants (studies) | Quality of the evidence Comments (GRADE) |
Risk of cerebrovascular diseases | 1.22(1.14,1.30) | 11,644,261 (19cohort studies) | ⊕⊕⊕⊕ HIGH b,c |
The level of triglyceride glucose index in people with cerebrovascular diseases compared with without cerebrovascular diseases. | |||
Population: Subjects with cerebrovascular diseases vs. normal subjects. | |||
Settings: Eight studies were conducted in Asia, two studies were conducted in Europe. | |||
Cases: Subjects with cerebrovascular diseases. | |||
Controls: normal subjects. | |||
Outcomes | OR (95% CI)a | No of participants (studies) | Quality of the evidence Comments (GRADE) |
Risk of cerebrovascular diseases | 1.15(1.07,1.23) | 305,808 (10 case‒control /cross‒sectional studies) | ⊕⊕⊕ MODERATE b |
Results of included cohort studies
Subgrouped by | No. of studies | RR/HR (95%CI) | I2(%) |
P
overall effect
|
P
interaction
|
---|---|---|---|---|---|
Region | 26 | 1.22(1.14,1.30) | 80.1 | < 0.001 | 0.54 |
Asia | 25 | 1.22 (1.13,1.30) | 80.8 | < 0.001 | |
Europe | 1 | 1.45(0.83,2.54) | — | 0.19 | |
Basic illness | 26 | 1.22(1.14,1.30) | 80.1 | < 0.001 | < 0.001 |
no | 18 | 1.17(1.09,1.25) | 83.5 | < 0.001 | |
yes | 8 | 1.98(1.59,2.46) | 0.0 | < 0.001 | |
Cerebrovascular disease | 26 | 1.22(1.14,1.30) | 80.1 | < 0.001 | 0.004 |
stroke | 13 | 1.39(1.25,1.55) | 84.9 | < 0.001 | |
unclassified | 8 | 1.03(0.86,1.22) | 72.0 | 0.78 | |
vascular dementia | 1 | 1.09(1.00,1.19) | — | 0.06 | |
carotid artery disease | 2 | 1.23(1.13,1.35) | 0.0 | < 0.001 | |
intracranial arterial disease | 2 | 1.17(0.86,1.59) | 74.0 | 0.31 | |
Sex | 20 | 1.15(1.10,1.21) | 69.7 | < 0.001 | 0.78 |
male | 10 | 1.17(1.12,1.22) | 32.7 | < 0.001 | |
female | 10 | 1.15 (1.04,1.27) | 81.4 | 0.007 | |
Age | 12 | 1.17(1.11,1.24) | 60.2 | < 0.001 | 0.03 |
< 60 | 5 | 1.29(1.15,1.43) | 39.0 | < 0.001 | |
≥ 60 | 7 | 1.12(1.07,1.18) | 51.6 | < 0.001 | |
BMI | 9 | 1.15(1.09,1.21) | 84.2 | < 0.001 | 0.002 |
normal | 3 | 1.19(1.15,1.24) | 59.9 | < 0.001 | |
Overweight/obesity | 6 | 1.09(1.05,1.14) | 22.3 | < 0.001 | |
Central obesity | 4 | 1.12(1.09,1.16) | 78.0 | < 0.001 | 0.12 |
no | 2 | 1.15(1.11,1.19) | 64.0 | < 0.001 | |
yes | 2 | 1.10(1.06,1.14) | 33.1 | < 0.001 | |
Diabetes | 16 | 1.20(1.14,1.28) | 73.3 | < 0.001 | 0.70 |
no | 8 | 1.20(1.12,1.28) | 80.2 | < 0.001 | |
yes | 8 | 1.23(1.12,1.35) | 14.4 | < 0.001 | |
Smoking | 6 | 1.15(1.11,1.20) | 77.9 | < 0.001 | 0.58 |
no | 3 | 1.18(1.08,1.28) | 90.8 | < 0.001 | |
yes | 3 | 1.15(1.12,1.18) | 0.0 | < 0.001 | |
Drinking | 6 | 1.15(1.10,1.21) | 75.7 | < 0.001 | 0.64 |
no | 3 | 1.16(1.09,1.25) | 88.8 | < 0.001 | |
yes | 3 | 1.14(1.06,1.22) | 13.1 | < 0.001 | |
Exercise | 5 | 1.18(1.07,1.31) | 69.1 | 0.001 | 0.08 |
no | 1 | 1.10(1.05,1.15) | — | < 0.001 | |
yes | 4 | 1.48(1.07,2.04) | 75.4 | 0.02 | |
Blood pressure | 6 | 1.16(1.09,1.22) | 89.7 | < 0.001 | 0.03 |
normal | 3 | 1.20(1.13,1.27) | 64.1 | < 0.001 | |
hypertension | 3 | 1.10(1.04,1.16) | 63.1 | < 0.001 |
Results of included case-control/cross-sectional studies
Subgrouped by | No. of studies | OR (95%CI) | I2(%) |
P
overall effect
|
P
interaction
|
---|---|---|---|---|---|
Region | 15 | 1.15(1.07,1.23) | 63.3 | < 0.001 | 0.21 |
Asia | 12 | 1.13(1.05,1.22) | 63.0 | 0.001 | |
Europe | 3 | 1.56(0.95,2.57) | 73.4 | 0.08 | |
Basic illness | 15 | 1.15(1.07,1.23) | 63.3 | < 0.001 | 0.02 |
no | 14 | 1.13(1.06,1.21) | 60.5 | < 0.001 | |
yes | 1 | 2.26(1.24,4.12) | — | 0.008 | |
Cerebrovascular disease | 15 | 1.15(1.07,1.23) | 63.3 | < 0.001 | 0.85 |
stroke | 1 | 1.17(1.06,1.29) | — | 0.001 | |
unclassified | 2 | 1.50(0.78,2.91) | 79.8 | 0.23 | |
cerebral small vessel disease | 2 | 1.19(0.94,1.49) | 66.8 | 0.14 | |
carotid artery disease | 6 | 1.10(0.94,1.29) | 72.9 | 0.24 | |
intracranial arterial disease | 4 | 1.20(1.05,1.37) | 31.8 | 0.006 | |
Sex | 6 | 1.12(1.10,1.24) | 44.4 | 0.03 | 0.39 |
male | 3 | 1.08(0.98,1.19) | 0.0 | 0.12 | |
female | 3 | 1.23 (0.92,1.64) | 77.0 | 0.16 | |
Diabetes | 5 | 1.30(1.05,1.61) | 34.7 | 0.02 | 0.04 |
no | 2 | 1.18(1.03,1.36) | 0.0 | 0.02 | |
yes | 3 | 1.98(1.25,3.14) | 0.0 | 0.004 |