Evidence map›Paper›PMID 42702103›Full record

ArticleClinics (Sao Paulo, Brazil)2026

Divergent associations of TyG index and HOMA-IR with cardiovascular and cerebrovascular mortality in non-diabetic elderly: a competing risk analysis of NHANES 2003‒2020.

Xintian Xu, Xiaomei Ye, Chen Xiao, Yaozhuo Cai, Hao Chen, Xueli Cai, Jingping Sun

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Article in Clinics (Sao Paulo, Brazil), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

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7 authors.

Xintian XuDepartment of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University (Lishui Central Hospital), Lishui, Zhejiang, China.
Xiaomei YeDepartment of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University (Lishui Central Hospital), Lishui, Zhejiang, China.
Chen XiaoDepartment of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University (Lishui Central Hospital), Lishui, Zhejiang, China.
Yaozhuo CaiDepartment of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University (Lishui Central Hospital), Lishui, Zhejiang, China.
Hao ChenDepartment of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University (Lishui Central Hospital), Lishui, Zhejiang, China.
Xueli CaiDepartment of Neurology, Lishui People's Hospital, Lishui, Zhejiang, China; Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang, China.
Jingping SunDepartment of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University (Lishui Central Hospital), Lishui, Zhejiang, China; Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang, China. Electronic address: lszxyysunjingping@yeah.net.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

background and purposeWhile Triglyceride-Glucose (TyG) index links to Cardiovascular and Cerebrovascular Diseases (CVDs), prior studies neglected competing risks and direct comparisons with Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). We evaluated and compared their associations with CVDs mortality under competing risks among non-diabetic adults aged ≥ 45-years.

methodsUsing NHANES data (2003‒2020), we analyzed 8735 non-diabetic participants. TyG and HOMA-IR were calculated for each participant. Mortality outcomes included all-cause, CVDs, cardiac and cerebrovascular disease. We used Cox proportional hazards regression with C-statistic comparison, along with restricted cubic splines to examine nonlinear associations. To address competing risks, Fine‑Gray models were used to evaluate cause‑specific mortality, followed by a sensitivity analysis excluding participants with baseline CVDs.

resultsAmong 1,804 total deaths (599 CVDs), an elevated TyG index showed linear positive associations with risks of all-cause mortality (Model 3, adjusted Hazard Ratios [HR = 1.19], p = 0.005), CVDs mortality (HR = 1.31, p = 0.02), and cerebrovascular mortality (HR = 1.92, p < 0.001). For HOMA-IR, continuous-variable analysis revealed significant linear associations with several mortality outcomes, whereas tertile and RCS analyses suggested more complex, nonlinear relationships. C-statistic comparisons showed no significant improvement in predictive discrimination with either index beyond traditional risk factors. However, in competing risk models, higher TyG remained associated with increased CVDs mortality, while HOMA-IR was associated with a lower subdistribution hazard.

conclusionAmong non-diabetic older adults, the TyG index demonstrated a linear association with CVDs mortality, while HOMA-IR showed a more complex J-shaped pattern. Future research could explore interventions targeting the TyG index to potentially improve survival in the elderly.

Indexed as

Cardiovascular and cerebrovascular diseasesCompeting riskInsulin resistanceNHANESTriglyceride-glucose index

Identifiers

PMID42702103
PMCPMC13579292

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