1. Basic characteristics of the participants according to quartile of TG/HDL-C ratio
The study included total 7341 patients diagnosed with MI, with an average age 61.39±13.13 years. Among these patients, 62.23% were male.
Table 1 presents the baseline characteristics of all participants categorized into quartiles based on the TG/HDL ratio. The subjects were divided into subgroups using TG/HDL-C ratio quartiles: Q1 0.64(0.51-0.76); Q2 1.06(0.96-1.17); Q3 1.56(1.42-1.73); Q4 2.67(2.22-3.45). Various parameters including proportion of males, SBP, DBP, MAP, TG, cholesterol, LDL-C, hs-cTnT, FPG, creatinine, HbA1c, albumin, ALT, WBC, platelet, and hemoglobin showed a significant increase with increasing quartiles of the TG/HDL-C ratio (all p<0.05). While age and HDL-C were decreased as quartiles of TG/HDL-C ratio increased (all p<0.05). Notably, the Q2 group of TG/HDL-C exhibited the highest levels of NT-proBNP and lowest levels of AST (all p<0.05). The distribution and variations of MAP among the four group are depicted in Figure 1. The levels of MAP increased with TG/HDL-C increased(p<0.05).
Table 1. Characteristics of the study population according to quartiles of TG/HDL ratio
|
Q1(n=1835)
|
Q2(n=1835)
|
Q3(n=1834)
|
Q4(n=1837)
|
P value
|
TG/HDL ratio
|
0.64 (0.51-0.76)
|
1.06 (0.96-1.17)
|
1.56 (1.42-1.73)
|
2.67 (2.22-3.45)
|
<0.001
|
Age, years
|
65.00 (56.00-73.00)
|
64.00 (56.00-72.00)
|
62.00 (54.00-69.00)
|
59.00 (50.00-67.00)
|
<0.001
|
Male, %
|
995 (54.22%)
|
1123 (61.20%)
|
1183 (64.50%)
|
1267 (68.97%)
|
<0.001
|
SBP, mmHg
|
128.00 (114.00-144.00)
|
131.00 (117.00-147.00)
|
131.00 (117.00-147.00)
|
133.00 (118.00-149.00)
|
<0.001
|
DBP, mmHg
|
74.00 (66.00-82.00)
|
75.00 (67.00-85.00)
|
76.00 (69.00-86.00)
|
78.00 (70.00-89.00)
|
<0.001
|
MAP, mmHg
|
91.67 (83.33-101.67)
|
94.33 (85.00-104.00)
|
95.00 (86.00-104.67)
|
96.67 (87.33-107.33)
|
<0.001
|
Triglyceride, mmol/L
|
0.72 (0.59-0.87)
|
1.07 (0.93-1.23)
|
1.44 (1.25-1.66)
|
2.20 (1.82-2.82)
|
<0.001
|
Cholesterol, mmol/L
|
3.59 (3.04-4.24)
|
3.73 (3.11-4.37)
|
3.87 (3.23-4.55)
|
4.01 (3.39-4.70)
|
<0.001
|
HDL-C, mmol/L
|
1.17 (1.01-1.35)
|
1.00 (0.87-1.15)
|
0.91 (0.81-1.04)
|
0.79 (0.69-0.91)
|
<0.001
|
LDL-C, mmol/L
|
1.84 (1.42-2.37)
|
2.10 (1.61-2.68)
|
2.30 (1.77-2.87)
|
2.42 (1.87-2.95)
|
<0.001
|
hs-cTnT, pg/mL
|
0.01 (0.01-0.03)
|
0.01 (0.01-0.04)
|
0.01 (0.01-0.05)
|
0.01 (0.01-0.07)
|
<0.001
|
NT-proBNP, pg/mL
|
210.60 (79.41-962.90)
|
218.00 (72.63-1218.50)
|
174.85 (56.42-821.82)
|
152.70 (49.22-611.45)
|
<0.001
|
FPG, mmol/L
|
5.70 (4.75-7.22)
|
5.92 (4.91-7.61)
|
5.96 (5.01-7.67)
|
6.24 (5.12-8.30)
|
<0.001
|
Creatinine, mg/dL
|
59.00 (50.00-72.00)
|
62.00 (53.00-75.00)
|
63.00 (53.00-74.00)
|
64.00 (55.00-76.00)
|
<0.001
|
HbA1c, %
|
5.50 (5.30-5.90)
|
5.60 (5.30-6.10)
|
5.70 (5.30-6.20)
|
5.70 (5.40-6.60)
|
<0.001
|
Albumin, g/L
|
38.30 (36.20-40.90)
|
38.60 (36.30-40.90)
|
38.90 (36.80-41.10)
|
39.40 (37.40-41.60)
|
<0.001
|
AST, U/L
|
22.00 (18.00-28.00)
|
21.00 (17.00-28.00)
|
22.00 (18.00-30.00)
|
23.00 (18.00-31.00)
|
0.003
|
ALT, U/L
|
17.00 (12.00-26.00)
|
19.00 (13.00-28.00)
|
21.00 (14.00-32.00)
|
23.00 (16.00-37.00)
|
<0.001
|
WBC, 109/L
|
5.92 (4.85-7.32)
|
6.27 (5.12-7.71)
|
6.58 (5.40-8.22)
|
6.66 (5.50-8.30)
|
<0.001
|
Platelet, 109/L
|
188.00 (148.00-228.00)
|
190.00 (155.00-233.75)
|
202.00 (164.00-247.00)
|
204.00 (165.00-245.00)
|
<0.001
|
Hemoglobin, g/L
|
132.00 (122.00-143.00)
|
136.00 (125.00-147.00)
|
139.00 (128.00-151.00)
|
141.00 (129.00-153.00)
|
<0.001
|
DBP diastolic blood pressure; SBP systolic blood pressure; DBP diastolic blood pressure; MBP mean blood pressure; HDL: high density lipoprotein; LDL: low density lipoprotein; hs-cTnT: high-sensitivity cardiac troponin T; NT-proBNP: N-terminal prohormone of brain natriuretic peptide; HbA1c: glycosylated hemoglobin A1c; AST: aspartate aminotransferase; ALT: alanine transaminase;WBC white blood cell.
2. Basic characteristics of the participants according to quartile of TyG index
The baseline characteristics of all participants by quartiles of the TyG index are presented in Table 2. The subjects were divided into subgroups using TyG index quartiles: Q1 1.91(1.52-2.24); Q2 3.17(2.86-3.47); Q3 4.65(4.22-5.24); Q4 8.49(6.93-11.97). SBP, DBP, MAP, TG, cholesterol, LDL-C, hs-cTnT, FPG, creatinine, HbA1c, albumin, AST, ALT, WBC, platelet and hemoglobin were increased with quartiles of TyG index (all p<0.05). While age, HDL-C and NT-proBNP decreased with quartiles of TyG index (all p<0.05). There had no statistical difference of sex among the four groups. The distributions and difference of MAP among the quartile groups according to the TyG index are shown in Figure2. Similarly, the levels of MAP were increased with quartiles of TyG index(p<0.05).
Table 2. Characteristics of the study population according to quartiles of TyG index
TyG index
|
Q1(n=1820)
|
Q2(n=1823)
|
Q3(n=1823)
|
Q4(n=1822)
|
P value
|
TyG index
|
1.91 (1.54-2.24)
|
3.17 (2.86-3.47)
|
4.65 (4.22-5.24)
|
8.49 (6.93-11.97)
|
<0.001
|
Age,years
|
64.00 (54.00-72.00)
|
63.00 (54.00-71.00)
|
63.00 (54.00-70.00)
|
61.00 (53.00-69.00)
|
<0.001
|
Male,%
|
1146 (62.97%)
|
1144 (62.75%)
|
1112 (61.00%)
|
1135 (62.29%)
|
0.612
|
SBP, mmHg
|
128.00 (115.00-144.00)
|
130.00 (116.00-145.00)
|
132.00 (117.00-148.00)
|
134.00 (120.00-149.00)
|
<0.001
|
DBP, mmHg
|
74.00 (67.00-83.00)
|
75.00 (67.00-84.00)
|
76.00 (68.00-86.50)
|
78.00 (70.00-88.00)
|
<0.001
|
MAP, mmHg
|
92.33 (83.67-102.33)
|
93.33 (84.50-103.33)
|
95.33 (85.33-105.67)
|
96.67 (87.67-107.25)
|
<0.001
|
Triglyceride, mmol/L
|
0.74 (0.60-0.89)
|
1.13 (0.95-1.31)
|
1.48 (1.20-1.76)
|
2.12 (1.66-2.81)
|
<0.001
|
Cholesterol, mmol/L
|
3.39 (2.87-3.97)
|
3.69 (3.13-4.28)
|
3.94 (3.33-4.60)
|
4.24 (3.56-4.93)
|
<0.001
|
HDL-C, mmol/L
|
1.04 (0.87-1.23)
|
0.97 (0.83-1.16)
|
0.94 (0.81-1.11)
|
0.89 (0.76-1.04)
|
<0.001
|
LDL-C, mmol/L
|
1.77 (1.35-2.28)
|
2.09 (1.61-2.61)
|
2.31 (1.79-2.89)
|
2.54 (1.93-3.10)
|
<0.001
|
hs-cTnT, pg/mL
|
0.01 (0.01-0.03)
|
0.01 (0.01-0.04)
|
0.01 (0.01-0.04)
|
0.01 (0.01-0.06)
|
0.011
|
NT-proBNP, pg/mL
|
230.55 (77.34-1223.25)
|
208.60 (72.91-964.90)
|
169.90 (53.81-714.80)
|
164.55 (54.83-673.70)
|
<0.001
|
FPG, mmol/L
|
4.92 (4.24-5.76)
|
5.58 (4.83-6.58)
|
6.27 (5.28-7.78)
|
8.28 (6.50-11.42)
|
<0.001
|
Creatinine, mg/dL
|
62.00 (52.00-73.00)
|
62.00 (52.00-74.00)
|
63.00 (53.00-74.00)
|
63.00 (53.00-76.00)
|
0.003
|
HbA1c, %
|
5.50 (5.20-5.80)
|
5.50 (5.30-5.90)
|
5.70 (5.40-6.10)
|
6.10 (5.50-7.50)
|
<0.001
|
Albumin, g/L
|
38.00 (35.80-40.40)
|
38.60 (36.50-40.90)
|
39.10 (37.10-41.50)
|
39.40 (37.40-41.70)
|
<0.001
|
AST, U/L
|
21.00 (18.00-27.00)
|
22.00 (18.00-29.00)
|
22.00 (18.00-30.00)
|
22.00 (17.00-31.00)
|
<0.001
|
ALT, U/L
|
17.00 (12.00-26.00)
|
19.00 (13.00-30.00)
|
21.00 (15.00-33.00)
|
22.00 (15.00-35.00)
|
<0.001
|
WBC, 109/L
|
5.87 (4.77-7.22)
|
6.17 (5.12-7.80)
|
6.57 (5.36-8.04)
|
6.78 (5.63-8.59)
|
<0.001
|
Platelet, 109/L
|
185.00 (147.00-227.00)
|
193.00 (156.00-237.00)
|
201.00 (164.00-245.00)
|
204.00 (165.00-245.00)
|
<0.001
|
Hemoglobin, g/L
|
134.00 (123.00-144.00)
|
136.00 (126.00-147.00)
|
138.00 (127.00-150.00)
|
140.00 (128.00-152.00)
|
<0.001
|
3.Correlation of the TG/HDL-C ratio and TyG index with the MAP
As shown in Table 3 and Figure 3, the Spearman linear correlation analysis showed that MAP was positively associated with TG/HDL-C ratio (r=0.1218, p <0.001) and TyG index (r=0.1197, p <0.001).
Table 3. Correlation of the TG/HDL-C ratio and TyG index with the MAP
|
Correlation
|
P value
|
TG/HDL ratio
|
0.1218
|
<0.001
|
TyG index
|
0.1197
|
<0.001
|
4.Relationship between the TG/HDL-C ratio and TyG index with MAP, according to univariable and multivariable regression analysis
Univariate regression analysis (Table 4) showed that TG/HDL-C ratio (continuous) (β=0.90, p<0.0001) and TyG index (continuous) (β=0.29, p<0.0001) were positively associated with MAP in the patients with MI. Each one unit increase in the TG/HDL-C ratio and TyG index was response for a 0.90 and 0.29 mmHg increase in MAP.
When TG/HDL-C ratio was analyzed as quartiles, using the lowest quartiles (Q1 group) as the references, univariate regression analysis revealed that the levels of MAP in the Q2, Q3 and Q4 groups of TG/HDL-C ratio were significantly higher than those in the Q1 group. Compared with Q1 group, MAP increased 2.25 mmHg (95%CI 1.31-3.20, p <0.0001) in Q2 group, 3.02 mmHg (95%CI 2.07-3.97, p <0.0001) in Q3 group and 4.87 mmHg (95%CI 3.93-5.82, p <0.0001) in Q4 group. Similarly, when TyG index was analyzed as quartiles, using the lowest quartiles (Q1 group) as the references, univariate regression analysis revealed that the levels of MAP in the Q3 and Q4 groups of TyG index were significantly higher than those in the Q1 group. Compared with Q1 group, MAP increased 2.58 mmHg (95%CI 1.62-3.53, p <0.0001) in Q3 group and 4.36 mmHg (95%CI 3.40-5.31, p <0.0001) in Q4 group.
Multiple regression analyses revealed that, upon adjusting for age and sex, the levels of MAP in the Q2, Q3 and Q4 groups of the TG/HDL-C ratio were higher than those in the Q1 group (Q2 vs. Q1: β =2.11, 95%CI: 1.16-3.06; Q3 vs. Q1: β=2.78, 95%CI: 1.83-3.73; Q4 vs. Q1: β=4.50, 95%CI: 3.54-5.45). The levels of MAP in the Q3 and Q4 group were higher than in the Q1 group of the TyG index when adjusted for age and sex (Q3 vs. Q1: β=2.61, 95%CI: 1.66-3.56; Q4 vs. Q1: β=4.33, 95%CI: 3.38-5.28). Furthermore, after adjustment for age, sex, cholesterol, hs-cTnT, NT-proBNP, HbA1c, albumin, WBC, platelet and creatinine, the levels of MAP in the Q2, Q3 and Q4 group of the TG/HDL-C ratio were higher than those in the Q1 group (Q2 vs. Q1: β =1.42, 95%CI: 0.16-2.67; Q3 vs. Q1: β=2.04, 95%CI: 0.78-3.30; Q4 vs. Q1: β=2.55, 95%CI: 1.26-3.85). Similarly, the MAP level increased 1.99 mmHg in Q4 group of the TyG index when compared with the Q1 group (Q4 vs. Q1: β=1.99, 95%CI: 0.57-3.42).
Table 4. Univariable and Multivariable regression analysis of the TG/HDL ratio and TyG index with the MAP
|
Statistics
|
Unadjusted β
|
Model 1
|
Model 2
|
|
|
β (95% CI) P value
|
β (95% CI) P value
|
β (95% CI) P value
|
TG/HDL-C ratio(continuous)
|
1.65 ± 1.70
|
0.90 (0.70, 1.10) <0.0001
|
0.83 (0.63, 1.03) <0.0001
|
0.48 (0.22, 0.74) 0.0003
|
TyG index(continuous)
|
5.22 ± 5.61
|
0.29 (0.23, 0.35) <0.0001
|
0.28 (0.22, 0.34) <0.0001
|
0.15 (0.07, 0.24) 0.0004
|
TG/HDL-C ratio
|
|
|
|
|
Q1
|
1835 (25.00%)
|
Reference
|
Reference
|
Reference
|
Q2
|
1835 (25.00%)
|
2.25 (1.31, 3.20) <0.0001
|
2.11 (1.16, 3.06) <0.0001
|
1.42 (0.16, 2.67) 0.0269
|
Q3
|
1834 (24.98%)
|
3.02 (2.07, 3.97) <0.0001
|
2.78 (1.83, 3.73) <0.0001
|
2.04 (0.78, 3.30) 0.0015
|
Q4
|
1837 (25.02%)
|
4.87 (3.93, 5.82) <0.0001
|
4.50 (3.54, 5.45) <0.0001
|
2.55 (1.26, 3.85) 0.0001
|
TyG index
|
|
|
|
|
Q1
|
1820 (24.97%)
|
Reference
|
Reference
|
Reference
|
Q2
|
1823 (25.01%)
|
0.56 (-0.39, 1.51) 0.2479
|
0.56 (-0.39, 1.50) 0.2507
|
-0.92 (-2.23, 0.40) 0.1715
|
Q3
|
1823 (25.01%)
|
2.58 (1.62, 3.53) <0.0001
|
2.61 (1.66, 3.56) <0.0001
|
1.26 (-0.07, 2.60) 0.0632
|
Q4
|
1822 (25.00%)
|
4.36 (3.40, 5.31) <0.0001
|
4.33 (3.38, 5.28) <0.0001
|
1.99 (0.57, 3.42) 0.0061
|
Model 1: age; sex
Model 2: age; sex; cholesterol; hs-cTnT; NT-proBNP; HbA1c; albumin; WBC; Platelet; creatinine
5.Association of the TG/HDL ratio and TyG index stratified by sex and age
To identify the significant interaction of the TG/HDL ratio and TyG index with other covariates, such as sex and age, we tested the interaction terms according to model 3 expect for sex or age. As shown in Table 5, the interaction test showed no significant interactions between TG/HDL-C ratio with age and sex. Only the association of the TyG index with MAP were more significant in male patients than in females (β=0.25 vs 0.007, p for interaction=0.023).
Table 5. Association of the TG/HDL ratio and TyG index stratified by sex and age
|
N
|
TG/HDL ratio
|
TyG index
|
GENDER
|
|
|
|
Men
|
4568
|
0.69 (0.39, 1.00) <0.0001
|
0.25 (0.14, 0.35) <0.0001
|
Women
|
2773
|
0.21 (-0.27, 0.69) 0.3896
|
0.07 (-0.06, 0.20) 0.3060
|
P for interaction
|
|
0.061
|
0.023
|
AGE categorical
|
|
|
|
<65
|
4159
|
0.56 (0.26, 0.87) 0.0003
|
0.21 (0.10, 0.31) 0.0002
|
>=65
|
3182
|
0.67 (0.15, 1.18) 0.0117
|
0.10 (-0.04, 0.25) 0.1744
|
P for interaction
|
|
0.912
|
0.283
|
Adjust for: cholesterol; hs-cTnT; NT-proBNP; HbA1c; Albumin; WBC; Platelet; Creatinine