The association between the triglyceride-glucose index and vulnerable plaques in patients with type 2 diabetes mellitus: insights from coronary computed tomography angiography.

Background: The triglyceride‒glucose index (TyG index) has been verified to be a useful predictor of insulin resistance (IR), and is associated with the occurrence of acute coronary syndrome (ACS). However, the effect of the TyG index on vulnerable plaques (VP), which were identified when at least two high-risk features are present within the same lesion, in type 2 diabetes mellitus (T2DM) patients is not fully understood. This study aimed to explore the association between the TyG index and the presence of VP.

Methods: We retrospectively enrolled 2056 T2DM patients who underwent coronary computed tomography angiography (CCTA) examinations at West China Hospital from February 2017 to February 2022. These patients were divided into four groups on the basis of the quartiles of the TyG index. The high-risk coronary plaque features, vulnerable plaques, plaque type, coronary artery stenosis, segment involvement score (SIS), segment stenosis score (SSS) and multivessel disease (MVD) based on CCTA data were evaluated and compared among the four groups.

Results: Patients with a higher TyG index had more noncalcified and mixed plaques, high-risk plaque features, vulnerable plaques and fewer calcified plaques (P < 0.05 for all). The proportion of patients with high-risk plaque features, including low-attenuation noncalcified plaques, positive remodeling and "napkin ring" sign was associated with the TyG index (P for trend < 0.05 for all). Multivariate analysis revealed that the TyG index was significantly associated with vulnerable plaques in T2DM patients [OR = 1.23 (95% CI 1.00-1.51), P = 0.046]. Subgroup analysis revealed that the association between the TyG index and vulnerable plaques varied with age and the prevalence of cardiovascular (CVD) symptoms, even after controlling for confounding factors (P for interaction < 0.05 for both).

Conclusion: The TyG index was independently associated with vulnerable plaques of the coronary artery among patients with T2DM. The TyG index could be regarded as a marker to reduce the incidence of cardiovascular events in the targeted population of T2DM patients.