Abstract
OBJECTIVE: To explore the relationship between the triglyceride-glucose-waist-to-height ratio (TyG-WHtR) and brachial-ankle pulse wave velocity (baPWV), and to evaluate its utility as an early indicator of arterial stiffness in individuals with Cardiovascular-Kidney-Metabolic (CKM) syndrome. Additionally, its performance was compared with the triglyceride-glucose index (TyG), TyG-waist circumference (TyG-WC), and TyG-body mass index (TyG-BMI). METHODS: This retrospective study included 37,134 adults who underwent health examinations at the Third Xiangya Hospital of Central South University from August 2017 to December 2021. Participants were staged based on CKM diagnostic criteria. Associations between TyG-related indices and baPWV were assessed using correlation and regression analyses. A risk stratification model for arterial stiffness was constructed based on TyG-WHtR quantiles. In addition, a risk stratification model was established by combining quantile analysis, and a comprehensive comparison of the goodness of fit of the model was conducted with TyG, TyG-WC, and TyG-BMI. RESULTS: Progressive arterial stiffness, as measured by baPWV, showed a significant increase from 1226 cm/s (stage 0) to 1441 cm/s (stage 2) (P < 0.001) with advancing CKM stages. Concurrently, the TyG-WHtR index demonstrated a parallel elevation from 3.28 ± 0.51 to 4.85 ± 0.66 (P < 0.001), accompanied by significant worsening of multiple metabolic parameters including BMI, waist circumference, blood pressure, TG, and FBG (all P < 0.001). Notably, the proportion of male patients increased progressively from 36.85% (stage 0) to 63.83% (stage 2) (P < 0.001), suggesting gender-specific patterns in disease progression. TyG-WHtR exhibited a robust positive correlation with baPWV (r = 0.31-0.14, all P < 0.01), with the strongest associations observed in early CKM stages. This correlation significantly outperformed conventional TyG indices (P < 0.01 for all comparisons). Multivariate analysis revealed particularly strong associations between elevated TyG-WHtR levels and abnormal baPWV risk (highest quartile OR = 2.22-12.61), especially in CKM stage 0 (adjusted OR = 3.54). Comparative model evaluation confirmed TyG-WHtR's superior predictive performance (AUC = 0.67) and optimal model fit in regression analyses (β = 0.32, R(2) = 0.10) when compared to traditional indices. CONCLUSIONS: The TyG-WHtR index is significantly associated with arterial stiffness and may offer potential value in vascular risk evaluation in patients with CKM syndrome, demonstrating a particularly strong correlation with baPWV during early disease stages (0-1), independent of conventional cardiovascular risk factors. Notably, this index exhibits superior predictive performance compared to existing TyG variants, with enhanced clinical utility for risk stratification, especially in male populations.