TyG-Derived Indices Predict Mortality in Stroke Survivors

A retrospective cohort study published in Cardiovascular Diabetology has identified two specific triglyceride-glucose derived indicators as robust predictors of all-cause mortality among community-dwelling adults with a history of stroke. The research, which utilized data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2018, analyzed a cohort of 1,805 participants. The findings suggest that composite TyG-derived indicators integrating multiple clinical factors may offer superior predictive performance compared with the original TyG index alone.

The study focused on the association between these metabolic markers and all-cause mortality in individuals who had previously experienced a stroke. The TyG index is described as a novel marker of insulin resistance. The researchers extracted data from 1,805 participants with a history of stroke from the NHANES database. During the follow-up period, 937 deaths were recorded within this cohort. To analyze the data, the authors constructed multivariate Cox proportional hazards regression models that incorporated sampling weights. The primary endpoint of the study was all-cause mortality, and the exposure indicators included the standard TyG index and several derived indices such as TyG-ABSI, TyG-WWI, TyG-BMI, and TyG-WHtR.

In the fully adjusted regression model, two specific derived indicators showed significant associations with increased all-cause mortality when compared with the lowest quartile of the respective index. TyG-ABSI was associated with a hazard ratio of 1.218, with a 95% confidence interval ranging from 1.022 to 1.450 and a p-value of 0.027. Similarly, TyG-WWI was associated with a hazard ratio of 1.237, with a 95% confidence interval of 1.023 to 1.497 and a p-value of 0.029. No other tested indicators demonstrated a statistically significant correlation with mortality in this fully adjusted model.

Kaplan-Meier survival curves were plotted to visualize the relationship between the indices and clinical outcomes. The curves indicated that higher levels of TyG, TyG-WWI, and TyG-ABSI were positively associated with all-cause mortality. In contrast, TyG-BMI showed an inverse correlation with mortality risk, suggesting that higher values of this specific index were associated with lower mortality risk in the cohort.

Restricted cubic spline (RCS) analyses were applied to detect potential nonlinear relationships between the exposure indicators and the primary endpoint. The analyses revealed a U-shaped association between all tested indices and mortality, with all p-values for nonlinearity being less than 0.05, with the only exception being TyG-WHtR.

Further analysis explored effect modification by diabetes status. Significant effect modification was observed only for TyG-WHtR, TyG-WWI, and TyG-ABSI, with all p-values for interaction being less than 0.05. This indicates that the association between these specific indices and mortality risk differs depending on whether the participant has diabetes. The robustness of the findings was further verified through stratified subgroup analyses, which help to identify heterogeneity in the research findings across different subgroups of the population.

The study concludes that TyG-WWI and TyG-ABSI serve as robust predictors for all-cause mortality in stroke patients, with better predictive efficacy than the conventional TyG index. This is noted as the first study to confirm this specific predictive capability for these two derived biomarkers. The results suggest that these indicators have promising application value as auxiliary prognostic tools for mortality risk evaluation among individuals with a history of stroke.

Subject of Research: Association between triglyceride-glucose derived indices and all-cause mortality in stroke survivors

Article Title: A retrospective cohort study of the association between triglyceride-glucose index and its derived indicators and all-cause mortality among community-dwelling adults with a history of stroke

Article References: Yang, D., Xiong, Y., Liu, S., Wang, Y., Liu, X., Li, T., Yang, W., & Liu, Y. (2026). A retrospective cohort study of the association between triglyceride-glucose index and its derived indicators and all-cause mortality among community-dwelling adults with a history of stroke. Cardiovascular Diabetology. https://doi.org/10.1186/s12933-026-03400-z

Image Credits: AI Generated

DOI: 10.1186/s12933-026-03400-z

Keywords: stroke, mortality, TyG index, insulin resistance, NHANES, prognosis, cardiovascular, biomarkers, retrospective, cohort, association, between