Abstract
OBJECTIVE: The triglyceride-glucose (TyG) index, a measure of insulin resistance, has been confirmed to be associated with adverse clinical outcomes. A new composite indicator, the TyG-A body type index (TyG-ABSI), was developed by integrating the TyG index and the A body type index. This study aimed to thoroughly investigate the association between the TyG-ABSI and the risk of atherosclerotic cardiovascular disease (ASCVD) among individuals with normoglycemia, dysglycemia, and diabetes. METHODS: Participants from the UK Biobank were included and categorized into 3 groups: normoglycemia, dysglycemia (prediabetes), and diabetes. The primary study outcome was the incidence of all-cause ASCVD. Cox regression and restricted cubic spline (RCS) analyses were performed to evaluate the linear and nonlinear associations between the TyG-ABSI and ASCVD. Furthermore, time-dependent receiver operating characteristic (ROC) curves were constructed to evaluate the discriminative performance of the TyG-ABSI and other indices. Additional analyses, including Kaplan-Meier survival curves, subgroup analyses, and sensitivity analyses, were conducted to assess robustness. A mediation analysis was performed to identify potential biomarkers. RESULTS: During an average follow-up of 14.8 years, a total of 29,680 ASCVD events were documented. The results indicated that elevated TyG-ABSI values were positively associated with the risk of ASCVD in the population with normoglycemia (nonlinear, P for nonlinear < 0.001) and diabetes (linear, P for nonlinear = 0.96) (HR = 1.07, 95% CI: 1.05-1.09; HR = 1.10, 95% CI: 1.06-1.14, respectively). No significant associations were detected in the dysglycemia group. Compared with the TyG index and other TyG-derived metrics, the TyG-ABSI demonstrated superior predictive performance (e.g., 10-year AUC = 0.634 in the normoglycemia group). Subgroup analyses and sensitivity analyses confirmed the robustness of our findings. Moreover, the results of the mediation analysis demonstrated that white blood cell (WBC) count (mediation proportions: 3.74-9.73%) and C-reactive protein (CRP) level (mediation proportions: 9.96-26.89%) significantly mediated the association between the TyG-ABSI and ASCVD. CONCLUSIONS: In the normoglycemia subgroup, the association between the TyG-ABSI and ASCVD was nonlinear. Moreover, the TyG-ABSI was linearly associated with an increased risk of ASCVD in the diabetes subgroup but not in the dysglycemia subgroup. The predictive value of the TyG-ABSI across different glycemic statuses provides new evidence for medical practice. Furthermore, the TyG-ABSI may serve as a useful tool for identifying high-risk individuals within the seemingly low-risk normoglycemic population and for further risk identification among diabetic patients.