RESEARCH ARTICLE SA JOURNAL OF DIABETES & VASCULAR DISEASE 20 VOLUME 21 NUMBER 1 • November 2024 patients, and that the TyG index could be used as an independent predictor of the severity of PCAD. Previous studies have shown that the TyG index can predict cardiovascular events.16,17 Our study found that compared with the non-MACE group, the MACE group had a higher proportion of hypertension and diabetes, higher BMI, FBG and TG levels, and higher TyG index, and a lower HDL-C level. It is well known that individuals with IR are predisposed to developing several metabolic disorders, such as hypertension, hyperglycaemia and dyslipidaemia, all of which are strongly associated with adverse cardiovascular events and outcomes.18 After adjusting for confounding factors, it was found that smoking, hypertension, diabetes and the TyG index were independent risk factors for MACE in PCAD. Wu et al. also proved that smoking, hypertension, diabetes and the TyG index were independent risk factors for MACE in PCAD. In 526 PCAD patients, a high TyG index was independently related to MACE in PCAD.19 This was similar to the results of our study. In a cohort study including 662 elderly patients with ACS, Yang et al. found that the MACE rate of patients increased significantly with an increase in TyG index. The TyG index, as a continuous or categorical variable, was an independent risk factor for MACE.20 We also found a higher incidence of MACE in patients with a high TyG index, especially for re-admission for chest pain, coronary artery revascularisation and in-stent restenosis. Two previous studies have confirmed that a high TyG index was associated with coronary artery revascularisation. Wu et al. found that a high TyG index was an independent risk factor for coronary artery revascularisation in patients with PCAD.19 Guo et al. conducted a follow-up study of 1 414 patients with CAD after percutaneous coronary intervention and found that an elevated TyG index was associated with an increased risk of coronary artery revascularisation and in-stent restenosis.21 Zhu et al. retrospectively enrolled 1 574 ACS patients who were treated with drug-eluting stents and found that the high TyG index group had a higher rate of in-stent restenosis, and a high TyG index was an independent risk factor for in-stent restenosis.22 The exact mechanism underlying the relationship between the TyG index and MACE of PCAD remains unknown. The potential mechanisms underlying it are described as follows. On one hand, first, the coronary artery lesions in PCAD patients are mainly thrombotic plaques, which are unstable.23 Second, IR causes an excessive increase in the number of platelets and excessive activation of platelet adhesion factors, which lead to a hypercoagulable state and makes it easy to form coronary thrombotic obstructions.24 Finally, IR can directly aggravate coronary plaque instability.25 On the other hand, IR can induce disturbances in glucose and lipid metabolism, contributing to hyperglycaemia and hyperlipidaemia, which in turn trigger inflammation, oxidative stress and increase in the numbers of macrophages. These cause damage and necrosis of the coronary endothelial cells26 and circulatory disorders of the coronary collaterals. The coronary collaterals can exert a myocardial salvaging effect to limit the ischaemic area and preserve normal cardiac function.27,28 Limitations There are some limitations to our study. First, this was a single-centre and retrospective study with a relatively small sample size, and the existing selection bias may have affected the results. Second, subjects with diabetes use different types and doses of antidiabetic drugs and insulin, which would have influenced the TyG index. In addition, we included only patients with PCAD diagnosed by CAG, and different subtypes of PCAD were also enrolled in this study. These subtypes included stable and unstable angina, non-STsegment elevation myocardial infarction, and ST-segment elevation myocardial infarction. The presence of these two factors could also have biased the results. Finally, only the first admission and re-admission were recorded in this study, and the follow-up time was relatively short. No long-term follow up was conducted for these patients outside the hospital. Therefore, further multicentre, large-size, prospective studies could strengthen our conclusions. Conclusion We found that for patients with significant PCAD, the TyG index was a simple, economical and reliable surrogate index for IR. It was an independent risk factor for the severity of PCAD and MACE, and had a good ability to predict both. Acknowledgements The Science and Technology Program Fund of Gansu Province (18JR2FA005) and the Natural Science Fund of Gansu Province (20JR5RA357) provided funding for the study. References 1. Roth G A, Mensah G A, Fuster V. The global burden of cardiovascular diseases and risks: a compass for global action. J Am Coll Cardiol 2020; 76(25): 2980–2981. 2. The Writing Committee of the Report on Cardiovascular Health and Diseases in China. Report on Cardiovascular Health and Diseases in China 2021: an updated summary. Biomed Environ Sci 2022; 35(7): 573–603. 3. Qu Y, Zhang F, Yang J, et al. Clinical characteristics and outcomes in asian patients with premature coronary artery disease: insight from the FOCUS Registry. 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