Triglyceride Glucose Index as an Indicator of Cardiovascular Risk in Syrian Refugees

Figures & data

Figure 1 Flow chart of refugees’ data included in the analysis.

Table 1 Participant Demographics (Frequency (%) or Mean ± SD)

	Frequency (%) or Mean ± SD
Age	56.76 ‎± 10.78
Sex
Female	429 (56.75)
Male	327 (43.25)
BMI (kg/m^2)	27.42 ± 4.03
Smoking status
Smoker	216 (28.57)
Non-smoker	540 (71.43)
Participants’ health status
Asthma	14 (1.85)
Cancer	1 (0.13)
Cardiovascular diseases (other)	75 (9.92)
COPD	15 (1.98)
Type 1 Diabetes Mellitus	24 (3.17)
Type 2 Diabetes Mellitus	534 (70.60)
IHD	149 (19.71)
Hypertension	525 (69.44)
Heart Failure	1 (0.13)
Nephrotic syndrome	1 (0.13)
Thyroid conditions	36 (4.76)
Vitals and laboratory tests
Systolic blood pressure (mmHg)	137.64 ± 8.33
Diastolic blood pressure (mmHg)	90.37 ± 6.43
Fasting blood glucose (mg/dL)	145.65 ± 25.46
Thyroid stimulating hormone (mU/L)	12.83 ± 13.86
Thyroxin (µg/dL)	7.78 ± 11.00
AST (U/L)	37.39 ± 12.56
ALT (U/L)	41.69 ± 14.07
HbA1c%	8.43 ± 1.34
GFR (mL/min/1.73 m^2)	74.57 ± 16.77
Uric acid (mmol/L)	341.26 ±‎ 110.72
Triglycerides (mg/dL)	180.56 ±‎ 26.93
HDL (mg/dL)	34.40 ± 4.00
LDL (mg/dL)	104.40 ± ‎13.53
Triglyceride Glucose Index	9.40‎ ±‎ 0.22

Table 2 Correlation Between Triglyceride Glucose Index, HbA1c%, Fasting Blood Glucose as Well as Fasting Triglyceride with Different Variables

Tested Variables	Triglyceride Glucose Index		HbA1c%		Fasting Blood Glucose		Fasting Triglyceride
	Correlation Coefficient (r)	p-value	Correlation Coefficient (r)	p-value	Correlation Coefficient (r)	p-value	Correlation Coefficient (r)	p-value
Framingham score (n=729)	0.43	<0.001	0.02	0.659	0.14	<0.001	0.49	<0.001
GFR (n=348)	0.03	0.533	0.02	0.715	−0.01	0.829	0.07	0.204
SBP (n=729)	0.24	<0.001	−0.08	0.061	−0.06	0.120	0.40	<0.001
DBP (n=729)	0.12	‎<0.001	−0.04	0.334	−0.06	0.095	0.24	<0.001
MAP (n=729)	0.21	‎<0.001‎	−0.07	0.094	−0.08	0.042	0.38	<0.001
PP (n=729)	0.13	‎<0.001‎	−0.04	0.325	−0.01	0.810	0.18	<0.001
PP+MAP (n=729)	0.22	‎<0.001‎	−0.07	0.085	−0.05	0.204	0.36	<0.001
SBP+DBP (n=729)	0.24	‎<0.001‎	−0.08	0.058	−0.08	0.043	0.42	<0.001
Uric acid (n-137)	0.19	0.026	0.16	0.136	−0.05	0.568	0.32	<0.001
HbA1c% (n=572)	0.43	<0.001	-	-	0.78	<0.001	0.01	0.799
Fasting Blood Glucose (n=756)	0.67	<0.001	0.78	<0.001	-	-	−0.004	0.908

Abbreviations: GFR, Glomerular Filtration Rate, SBP, Systolic Blood Pressure, DBP, Diastolic Blood Pressure, MAP, Mean Arterial Pressure, PP, Pulse Pressure, HbA1c%, Hemoglobin A1C%.

Figure 2 (A) Operational characteristic curve of the ROC for the TyG index to predict ten-year cardiovascular risk as assessed by the FRS in Syrian Refugees (n = 756). (B) Operational characteristic curve of the ROC for the HbA1c to predict ten-year cardiovascular risk as assessed by the FRS in Syrian Refugees (n = 756). (C) Operational characteristic curve of the ROC for the Fasting blood glucose to predict ten-year cardiovascular risk as assessed by the FRS in Syrian Refugees (n = 756). (D) Operational characteristic curve of the ROC for the Fasting triglyceride to predict ten-year cardiovascular risk as assessed by the FRS in Syrian Refugees (n = 756).

Table 3 Demographic, Smoking Status, Participant Health-Status, and Vitals and Laboratory Tests of the Sample According to TyG Index Categories (n = 756)

Characteristics	Tyg Index		p-values
	Lowest (< 9.33) (n=312)	Highest (≥ 9.33) (n=444)
Age (years)	56.69 ± 11.37	56.80 ± 10.35	0.571
Sex
Female (%)	210 (49.00)	219 (51.00)	<0.001
Male (%)	102 (31.20)	225 (68.80)
BMI (kg/m2)	26.98 ± 4.21	27.71 ± 3.89	0.004
Smoking status
Smoking (%)	46 (21.30)	170 (78.70)	<0.001
Participants’ health status
Type 1 Diabetes Mellitus	2 (8.30)	22 (91.70)	0.001
Type 2 Diabetes Mellitus	157 (29.50)	376 (70.50)	<0.001
IHD	93 (52.00)	86 (48.00)	0.001
Hypertension	225 (42.90)	300 (57.10)	0.181
Cardiovascular diseases (other)	32 (42.70)	43 (57.30)	0.796
Asthma	6 (42.90)	8 (57.10)	0.841
COPD	9 (60.00)	6 (40.00)	0.137
Thyroid conditions	18 (50.00)	18 (50.00)	0.276
Vitals and laboratory tests
Triglyceride Glucose Index	9.18 ‎± 0.11	9.54 ± 0.14	<0.001
Triglycerides (mg/dL)	166.03 ± 17.89	190.76 ‎± 27.54	<0.001
Fasting blood glucose (mg/dL)	127.88 ± 20.15	158.15 ± 20.99	<0.001
HbA1c%	7.66 (1.16)	8.77 (1.27)	<0.001
Systolic blood pressure (mmHg)	135.79 ± 7.39	138.95 ± 8.71	<0.001
Diastolic blood pressure (mmHg)	89.82 ± 6.15	90.77 ± 6.59	0.077
Thyroid stimulating hormone (mU/L)	14.23 ± 14.58	11.30 ± 13.17	0.470
Thyroxin (T4) (µg/dL)	7.84 ± 11.66	7.73 ± 10.56	0.976
AST (U/L)	36.98 ± 10.94	37.58 ± 13.29	0.783
ALT (U/L)	41.59 ± 10.61	41.74 ± 15.46	0.953
GFR (mL/min/1.73m^2)	74.69 ± 14.31	74.47 ± 18.41	0.293
Uric acid (mmol/L)	322.85 ± 102.30	351.18 ± 114.33	0.110
HDL (mg/dL)	35.46 ± 4.04	33.65 ± 3.79	<0.001
LDL (mg/dL)	102.71 ± 13.59	105.59 ± 13.37	0.004
Framingham risk score
Low risk (%)	81 (75.00)	27 (25.00)	<0.001
Intermediate/high risk (%)	222 (35.70)	399 (64.30)

Notes: Data are mean ± SD, or absolute and relative frequencies [%]. P values are based on the Mann–Whitney test or Student’s t-test, depending on the normality of quantitative variables, and Pearson’s chi-square for categorical variables.

Abbreviations: BMI, body mass index; SBP, Systolic blood pressure; DBP, diastolic blood pressure; ALT, Alanine aminotransferase; AST, Aspartate aminotransferase; HDL, high-density lipoprotein; LDL, low-density lipoprotein. GFR, glomerular filtration rate, IHD, ischemic heart disease; COPD, Chronic obstructive pulmonary disease.

Table 4 Logistic Regression Analysis of the Association Between the TyG Index and Framingham Risk Score

Model	OR (95% CI)	p-value
1	5.39 (3.38–8.58)	<0.001
2	4.41 (1.78–10.93)	0.001

Notes: Model 1, unadjusted. Model 2, adjusted for sex, age, diabetes, high blood pressure, and BMI.

Data Sharing Statement

All data generated or analysed during this study are included in this published article.