The Triglyceride-Glucose Index and Coronary Artery Disease

Abstract

Background: Insulin resistance is a fundamental pathophysiological defect underlying a constellation of metabolic disorders, most notably type 2 diabetes mellitus and cardiovascular disease. While the hyperinsulinemic-euglycemic clamp is the gold standard for measuring insulin resistance, its complexity and invasiveness render it impractical for large-scale epidemiological studies and routine clinical use.

Review content: The Triglyceride-Glucose (TyG) index, calculated from fasting triglycerides and fasting glucose, has emerged as a particularly promising tool. Its efficacy is rooted in the deep physiological interconnection between lipid and glucose metabolism, orchestrated by insulin. The association between the TyG index and cardiovascular disease is particularly robust, reflecting the role of insulin resistance as a key driver of atherosclerosis.

Conclusion: The TyG index uses two cheap, routinely measured, and widely available biomarkers. It has been validated against the gold standard and hard clinical outcomes across diverse populations. However, lack of universal cutoff points remains the primary limitation for widespread clinical adoption, and the TyG index remains a surrogate rather than a direct measure of insulin resistance.