J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://jocmr.elmerjournals.com

Original Article

Volume 18, Number 6, June 2026, pages 407-419

The Association Between Triglyceride-Glucose Index and Mortality Risk in Cardiovascular Disease Patients: A Meta-Analysis

↓ Figure 2. (a) All-cause mortality (high vs. low). (b) CVD mortality (high vs. low). HR: hazard ratio; CI: confidence interval.

↓ Figure 3. (a) All-cause-dose-response. (b) CVD- dose-response. CVD: cardiovascular disease; TyG: triglyceride-glucose.

↓ **Table 1.** Characteristics With Regard to the Seventeen Included Studies
Study	Country	Design	Patients	Acute, %	Cut-off for TyG	N, M/F	Age, years	BMI, kg/m²	T2DM, %	Follow-up, years
^aData are expressed as median (interquartile range). ACS: acute coronary syndrome; AHF: acute heart failure; AMI: acute myocardial infarction; BMI: body mass index; CHD: coronary heart disease; CHF: chronic heart failure; HF: heart failure; iHF: ischemic heart failure; M/F: male/female; NR: not reported; NSTE-ACS: non-ST-segment elevation acute coronary syndrome; PCS: prospective cohort study; RCS: retrospective cohort study; ROC: receiver operating characteristic; T2DM: type 2 diabetes mellitus; TyG: triglyceride-glucose index.
Guo et al, 2021 [19]	China	RCS	CHF	0	Tertiles	546, 362/184	65.18 (12.01)	21.07 (1.83)	100	1, median
Hao et al, 2024 [13]	China	PCS	CHD	74.6	Quintile	3,321, 2,404/917	61.7 ± 11.7	25.6 ± 3.5	32.4	9.79, median
Hao et al, 2023 [14]	China	RCS	AMI	100	Tertiles	1,144, 902/242	62.1 ± 12.8	24.8 ± 3.3	18.9	1
Huang et al, 2022 [20]	China	RCS	AHF	100	Tertiles	932, 579/353	70 (61, 80)^a	24.2 (21.6, 27.1)^a	32.8	1.31
Jiao et al, 2022 [21]	China	PCS	ACS	100	Tertiles	662, 476/186	81.87 ± 2.14	24.57 ± 3.40	34.9	≤ 10
Mao et al, 2019 [8]	China	RCS	NSTE-ACS	100	Median	438, 295/143	62.5 (53.0, 68.0)^a	24 33 ± 3 17	32.6	1
Ozcan et al, 2023 [22]	Turkey	RCS	HF	NR	Tertiles	773, 633/140	63 (53, 72)^a	NR	35.6	3.17
Shen et al, 2023 [23]	China	PCS	ACS	100	Tertiles	231, 156/75	81.58 ± 1.93	24.78 ± 3.42	100	4.08
Sun et al, 2023 [24]	China	RCS	iHF	0	Quartiles	2,055, 1,690/365	60.3 ± 11.0	25.9 ± 3.2	38.5	3
Wang et al, 2020 [25]	China	RCS	ACS	100	Tertiles	2,531, 1,415/1,116	66.3 ± 6.8	25.9 ± 2.7	100	3
Xie et al, 2023 [26]	China	RCS	CHD	59.2	Tertiles	1,061, 789/272	61.8 ± 10.5	NR	52.7	1.83
Zhang et al, 2021 [9]	China	RCS	AMI	100	Tertiles	1,932, 1,324/608	65.4 ± 12.0	25.8 ± 3.5	100	2.23
Zhang et al, 2022 [27]	China	RCS	ACS	100	Median	1,010, 735/275	65.8 ± 10.1	25.6 ± 3.4	0	2.97
Zhao et al, 2020 [28]	China	RCS	NSTE-ACS	100	ROC	798, 545/253	60.9 ± 8.3	26.7 ± 3.2	100	3
Zhao, et al, 2021 [10]	China	RCS	NSTE-ACS	100	Median	1,510, 1,113/397	59.7 ± 9.3	25.8 ± 3.1	0	4
Zhou et al, 2023 [11]	China	RCS	AHF	100	Tertiles	823, 396/427	73.0 ± 12.7	25.5 ± 4.7	42	3.16
Zhou et al, 2023 [29]	China	RCS	CHF	0	Tertiles	6,697, 4,579/2,118	63.3 ± 14.2	25.2 (22.8, 27.8)^a	44.6	3.9

↓ Table 1. Characteristics With Regard to the Seventeen Included Studies

Study

Country

Design

Patients

Acute, %

Cut-off for TyG

N, M/F

Age, years

BMI, kg/m²

T2DM, %

Follow-up, years

^aData are expressed as median (interquartile range). ACS: acute coronary syndrome; AHF: acute heart failure; AMI: acute myocardial infarction; BMI: body mass index; CHD: coronary heart disease; CHF: chronic heart failure; HF: heart failure; iHF: ischemic heart failure; M/F: male/female; NR: not reported; NSTE-ACS: non-ST-segment elevation acute coronary syndrome; PCS: prospective cohort study; RCS: retrospective cohort study; ROC: receiver operating characteristic; T2DM: type 2 diabetes mellitus; TyG: triglyceride-glucose index.

Guo et al, 2021 [19]

China

RCS

CHF

Tertiles

546, 362/184

65.18 (12.01)

21.07 (1.83)

100

1, median

Hao et al, 2024 [13]

China

PCS

CHD

74.6

Quintile

3,321, 2,404/917

61.7 ± 11.7

25.6 ± 3.5

32.4

9.79, median

Hao et al, 2023 [14]

China

RCS

AMI

100

Tertiles

1,144, 902/242

62.1 ± 12.8

24.8 ± 3.3

18.9

Huang et al, 2022 [20]

China

RCS

AHF

100

Tertiles

932, 579/353

70 (61, 80)^a

24.2 (21.6, 27.1)^a

32.8

1.31

Jiao et al, 2022 [21]

China

PCS

ACS

100

Tertiles

662, 476/186

81.87 ± 2.14

24.57 ± 3.40

34.9

≤ 10

Mao et al, 2019 [8]

China

RCS

NSTE-ACS

100

Median

438, 295/143

62.5 (53.0, 68.0)^a

24 33 ± 3 17

32.6

Ozcan et al, 2023 [22]

Turkey

RCS

Tertiles

773, 633/140

63 (53, 72)^a

35.6

3.17

Shen et al, 2023 [23]

China

PCS

ACS

100

Tertiles

231, 156/75

81.58 ± 1.93

24.78 ± 3.42

100

4.08

Sun et al, 2023 [24]

China

RCS

iHF

Quartiles

2,055, 1,690/365

60.3 ± 11.0

25.9 ± 3.2

38.5

Wang et al, 2020 [25]

China

RCS

ACS

100

Tertiles

2,531, 1,415/1,116

66.3 ± 6.8

25.9 ± 2.7

100

Xie et al, 2023 [26]

China

RCS

CHD

59.2

Tertiles

1,061, 789/272

61.8 ± 10.5

52.7

1.83

Zhang et al, 2021 [9]

China

RCS

AMI

100

Tertiles

1,932, 1,324/608

65.4 ± 12.0

25.8 ± 3.5

100

2.23

Zhang et al, 2022 [27]

China

RCS

ACS

100

Median

1,010, 735/275

65.8 ± 10.1

25.6 ± 3.4

2.97

Zhao et al, 2020 [28]

China

RCS

NSTE-ACS

100

ROC

798, 545/253

60.9 ± 8.3

26.7 ± 3.2

100

Zhao, et al, 2021 [10]

China

RCS

NSTE-ACS

100

Median

1,510, 1,113/397

59.7 ± 9.3

25.8 ± 3.1

Zhou et al, 2023 [11]

China

RCS

AHF

100

Tertiles

823, 396/427

73.0 ± 12.7

25.5 ± 4.7

3.16

Zhou et al, 2023 [29]

China

RCS

CHF

Tertiles

6,697, 4,579/2,118

63.3 ± 14.2

25.2 (22.8, 27.8)^a

44.6

3.9

↓ **Table 2.** Quality Assessment of the Cohort Studies With Newcastle-Ottawa Quality Assessment Scale
Study	Representativeness of the exposed cohort	Selection of the unexposed cohort	Ascertainment of exposure	Outcome of interest not present at start of study	Control for important factor or additional factor	Outcome assessment	Follow-up long enough for outcomes to occur	Adequacy of follow-up of cohorts	Total quality scores
Quality assessment was performed using the Newcastle-Ottawa Quality Assessment Scale (NOS) for cohort studies. One star (☆) indicates that one star was awarded for meeting the quality criteria for the specific item. Two stars (☆☆) indicate two stars were awarded (typically for adequate control of both the primary and additional confounding factors). Em dash (—) indicates that the study did not meet the criterion for that item and received no star.
Guo et al, 2021 [19]	☆	☆	☆	—	—	☆	—	☆	5
Hao et al, 2024 [13]	☆	☆	☆	—	☆☆	☆	☆	☆	8
Hao et al, 2023 [14]	☆	☆	☆	☆	☆☆	☆	—	☆	8
Huang et al, 2022 [20]	☆	☆	☆	—	☆☆	☆	—	☆	7
Jiao et al, 2022 [21]	☆	☆	☆	☆	☆☆	☆	—	☆	8
Mao et al, 2019 [8]	☆	☆	☆	—	☆☆	☆	—	☆	7
Ozcan et al, 2023 [22]	☆	☆	☆	—	☆☆	☆	—	☆	7
Shen et al, 2023 [23]	☆	☆	☆	☆	☆☆	☆	—	☆	8
Sun et al, 2023 [24]	☆	☆	☆	—	☆☆	☆	—	☆	7
Wang et al, 2020 [25]	☆	☆	☆	—	☆☆	☆	—	☆	7
Xie et al, 2023 [26]	☆	☆	☆	—	☆☆	☆	—	☆	7
Zhang et al, 2021 [9]	☆	☆	☆	—	☆☆	☆	—	☆	7
Zhang et al, 2022 [27]	☆	☆	☆	—	☆☆	☆	—	☆	7
Zhao et al, 2020 [28]	☆	☆	☆	—	☆☆	☆	—	☆	7
Zhao et al, 2021 [10]	☆	☆	☆	—	☆☆	☆	—	☆	7
Zhou et al, 2023 [11]	☆	☆	☆	—	☆☆	☆	—	☆	7
Zhou et al, 2023 [29]	☆	☆	☆	—	☆☆	☆	—	☆	7

↓ Table 2. Quality Assessment of the Cohort Studies With Newcastle-Ottawa Quality Assessment Scale

Study

Representativeness of the exposed cohort

Selection of the unexposed cohort

Ascertainment of exposure

Outcome of interest not present at start of study

Control for important factor or additional factor

Outcome assessment

Follow-up long enough for outcomes to occur

Adequacy of follow-up of cohorts

Total quality scores

Quality assessment was performed using the Newcastle-Ottawa Quality Assessment Scale (NOS) for cohort studies. One star (☆) indicates that one star was awarded for meeting the quality criteria for the specific item. Two stars (☆☆) indicate two stars were awarded (typically for adequate control of both the primary and additional confounding factors). Em dash (—) indicates that the study did not meet the criterion for that item and received no star.

Guo et al, 2021 [19]

☆

—

☆

—

☆

Hao et al, 2024 [13]

☆

—

☆☆

☆

Hao et al, 2023 [14]

☆

☆☆

☆

—

☆

Huang et al, 2022 [20]

☆

—

☆☆

☆

—

☆

Jiao et al, 2022 [21]

☆

☆☆

☆

—

☆

Mao et al, 2019 [8]

☆

—

☆☆

☆

—

☆

Ozcan et al, 2023 [22]

☆

—

☆☆

☆

—

☆

Shen et al, 2023 [23]

☆

☆☆

☆

—

☆

Sun et al, 2023 [24]

☆

—

☆☆

☆

—

☆

Wang et al, 2020 [25]

☆

—

☆☆

☆

—

☆

Xie et al, 2023 [26]

☆

—

☆☆

☆

—

☆

Zhang et al, 2021 [9]

☆

—

☆☆

☆

—

☆

Zhang et al, 2022 [27]

☆

—

☆☆

☆

—

☆

Zhao et al, 2020 [28]

☆

—

☆☆

☆

—

☆

Zhao et al, 2021 [10]

☆

—

☆☆

☆

—

☆

Zhou et al, 2023 [11]

☆

—

☆☆

☆

—

☆

Zhou et al, 2023 [29]

☆

—

☆☆

☆

—

☆

↓ **Table 3.** Subgroup Analysis
Effect size	Coefficient	Standard error	t	P>\|t\|^a	95% confidence interval
^aThe two-tailed P value evaluating the statistical significance of each covariate. TyG: triglyceride-glucose; ACS: Acute coronary syndrome.
Country	0.6861984	0.381515	1.80	0.110	−0.1935768 to 1.565974
With ACS	0.0349545	0.0891832	0.39	0.705	−0.1707022 to 0.2406113
Cut-off for TyG	–0.0165432	0.1436475	−0.12	0.911	−0.3477949 to 0.3147084
With diabetes	–0.4669322	0.3607914	−1.29	0.232	−1.298919 to 0.3650543
Follow-up	–0.12924	0.1357905	−0.95	0.369	−0.4423735 to 0.1838936
Intercept	0.2928392	0.5261956	0.56	0.593	−0.9205701 to 1.506248

↓ Table 3. Subgroup Analysis

Effect size

Coefficient

Standard error

P>|t|^a

95% confidence interval

^aThe two-tailed P value evaluating the statistical significance of each covariate. TyG: triglyceride-glucose; ACS: Acute coronary syndrome.

Country

0.6861984

0.381515

1.80

0.110

−0.1935768 to 1.565974

With ACS

0.0349545

0.0891832

0.39

0.705

−0.1707022 to 0.2406113

Cut-off for TyG

–0.0165432

0.1436475

−0.12

0.911

−0.3477949 to 0.3147084

With diabetes

–0.4669322

0.3607914

−1.29

0.232

−1.298919 to 0.3650543

Follow-up

–0.12924

0.1357905

−0.95

0.369

−0.4423735 to 0.1838936

Intercept

0.2928392

0.5261956

0.56

0.593

−0.9205701 to 1.506248

↓ **Table 4.** Outcomes of the Stratified Analysis
Outcomes	Number of studies	HR (95%CI)	P_A	Heterogeneity test
P_A: P for association; it represents the statistical significance P value for the pooled effect size (HR) to test whether the HR is significantly different from 1. CVD: cardiovascular disease; T2DM: type 2 diabetes mellitus; HR: hazard ratio; CI: confidence interval.
All-cause mortality	14	1.43 (1.27, 1.62)	< 0.001	0.150	28.5
Type of CVD
Acute	9	1.38 (1.13, 1.68)	0.001	0.217	25.5
Chronic	2	1.62 (1.28, 2.05)	< 0.001	0.699	0.0
With T2DM
Yes	5	1.50 (1.10, 2.05)	0.011	0.120	45.4
No	4	1.76 (0.53, 5.86)	0.358	< 0.001	90.9
CVD mortality	7	1.62 (1.33, 1.97)	< 0.001	0.249	22.7
Type of CVD
Acute	5	1.47 (1.09, 1.99)	0.012	0.323	14.3
Chronic	2	2.21 (1.03, 4.73)	0.042	0.073	68.9

↓ Table 4. Outcomes of the Stratified Analysis

Outcomes

Number of studies

HR (95%CI)

P_A

Heterogeneity test

I² (%)

P_A: P for association; it represents the statistical significance P value for the pooled effect size (HR) to test whether the HR is significantly different from 1. CVD: cardiovascular disease; T2DM: type 2 diabetes mellitus; HR: hazard ratio; CI: confidence interval.

All-cause mortality

1.43 (1.27, 1.62)

< 0.001

0.150

28.5

Type of CVD

Acute

1.38 (1.13, 1.68)

0.001

0.217

25.5

Chronic

1.62 (1.28, 2.05)

< 0.001

0.699

0.0

With T2DM

Yes

1.50 (1.10, 2.05)

0.011

0.120

45.4

1.76 (0.53, 5.86)

0.358

< 0.001

90.9

CVD mortality

1.62 (1.33, 1.97)

< 0.001

0.249

22.7

Type of CVD

Acute

1.47 (1.09, 1.99)

0.012

0.323

14.3

Chronic

2.21 (1.03, 4.73)

0.042

0.073

68.9

↓ **Table 5.** Outcomes With Regard to the Sensitivity Analysis and the Test of Publication Bias
Outcomes	Number of studies	Sensitivity analysis	Egger’ s test
CVD: cardiovascular disease; HR: hazard ratio; CI: confidence interval.
All-cause mortality	14	1.38 (1.23, 1.54) to 1.47 (1.29, 1.69)	Yes	0.619
CVD mortality	8	1.55 (1.32, 1.82) to 1.70 (1.38, 2.10)	Yes	0.549

↓ Table 5. Outcomes With Regard to the Sensitivity Analysis and the Test of Publication Bias

Outcomes

Number of studies

Sensitivity analysis

Egger’ s test

HR (95% CI)

Robust

P value

CVD: cardiovascular disease; HR: hazard ratio; CI: confidence interval.

All-cause mortality

1.38 (1.23, 1.54) to 1.47 (1.29, 1.69)

Yes

0.619

CVD mortality

1.55 (1.32, 1.82) to 1.70 (1.38, 2.10)

Yes

0.549