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Triglyceride-glucose index: a novel tool to predict elevated coronary calcium
Session:
Sessão de Posters 16 - Mapeamento do risco: dos scores ao cálcio
Speaker:
Ivo Santos Palmeiro
Congress:
CPC 2026
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.2 Risk Factors and Prevention – Cardiovascular Risk Assessment
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Ivo Santos Palmeiro; Joana Silva Ferreira; Cláudia Morais; Fábio Costa; Albano Perdigão; Duarte Maymone; Fernando Pinto; Maria Arminda Mateus; Tânia Teixeira; Patrícia Bernardes; Catarina Lagoas Pohle; Filipe Seixo
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="color:black">Background</span></strong><span style="color:black">: Coronary artery calcium (CAC) score is a strong predictor of cardiovascular risk, with a CAC ≥100 AU often used to guide preventive therapy. The triglyceride-glucose (TyG) index is a surrogate marker for insulin resistance. Being easily accessible and inexpensive, it has been increasingly used for predicting atherosclerotic cardiovascular disease. Its utility in predicting high CAC compared to traditional lipid markers remains unclear.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="color:black">Objective</span></strong><span style="color:black">: To evaluate whether the TyG index can predict coronary artery calcification and coronary artery disease, and compare its performance with conventional lipid biomarkers.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Methods:</strong> In this single-centre retrospective cohort study, patients undergoing cardiac CT (CCT) in 2024-2025 were included. Demographic, clinical, laboratory and CCT data were collected. The TyG index was calculated as Ln [(triglycerides x fasting glucose) / 2]. CAC scores were calculated using the Agatston method from non-contrast cardiac-gated CT scans, with CAC ≥100 AU considered high. </span></span><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">ROC curves were used to evaluate the predictive performance of TyG and other lipid biomarkers, and optimal TyG cutoff was determined by Youden’s index.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Results:</strong> Our cohort included 131 patients (58% male; aged 64.8 ± 13.3 years), with a high burden of cardiovascular risk factors: 64% were hypertensive, 30% had a BMI ≥ 30 Kg/m<sup>2</sup>, 26% had diabetes and 12% were active smokers. 16% of patients had chronic kidney disease (CKD). </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">On average, laboratory measurements were performed within 7 weeks of the CCT. Calculated mean TyG index was 4.57 ± 0.28. Median CAC was 23 [0-404] AU, with a median MESA percentile of 55. Atherosclerotic plaques were detected on a median of 2 vessels [0;3] and median CAD-RADS was 1 [0-3].</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">On ROC analysis, we found that TyG index was a good predictor of CAC score ≥ 100 (AUC 0.76, p<0.01 – fig.1), with optimal cutoff 4.69 (sensitivity 55%, specificity 83%). On the contrary, classical lipid markers including LDL-c (AUC 0.378, p=0.07), Lp(a) (AUC 0.344, p=0.11) and ApoB/A (AUC 0.48, p=0.87) did not predict a high CAC score.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Conclusion</strong>: The TyG index is a useful predictor of elevated CAC score, clearly outperforming other classical lipid markers. Our results support the use of this inexpensive biomarker to identify patients more likely to have subclinical coronary atherosclerosis that may justify initiating preventive pharmacological therapy.</span></span></p>
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