Triglyceride-glucose indices predict all-cause mortality after stroke in NHANES 1999-2018

Jiaqian Zheng; Weiwen Mao; Mengqian Sang; Xinyu Pan; Yiluo Xie; Yichi Xie

doi:10.3389/fnagi.2025.1617419

Triglyceride-glucose indices predict all-cause mortality after stroke in NHANES 1999-2018

Front Aging Neurosci. 2025 May 30:17:1617419. doi: 10.3389/fnagi.2025.1617419. eCollection 2025.

Authors

Jiaqian Zheng^{1

2

3}, Weiwen Mao², Mengqian Sang³, Xinyu Pan⁴, Yiluo Xie³, Yichi Xie^{1

2}

Affiliations

¹ Department of Respiratory Medicine, Changzhou Geriatric Hospital Affiliated to Soochow University, Changzhou, China.
² Department of Respiratory Medicine, Changzhou No.7 People's Hospital, Changzhou, China.
³ Department of Clinical Medicine, Bengbu Medical University, Bengbu, China.
⁴ Department of Radiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China.

Abstract

Objective: The present study explores the prognostic relevance of triglyceride-glucose-based indices in assessing post-stroke survival among affected individuals.

Methods: This study utilized a multifaceted analytical approach to assess how triglyceride-glucose-based indicators relate to death risk in stroke patients. This study was analyzed using a multivariate Cox proportional risk regression model incorporating sampling weights, while a restricted cubic spline function was introduced to assess trends in non-linear associations between exposure variables and outcomes. In addition, interaction terms were set and stratified analyses were conducted to verify the robustness and heterogeneity of the model results.

Results: This research ultimately included 796 individuals diagnosed with stroke. When adjusting for a wide range of potential confounders, those in the top TyG-BMI quartile exhibited the most pronounced reduction in mortality risk compared to individuals in the lowest category, with a hazard ratio of 0.20 (95% CI: 0.08-0.50), highlighting its protective potential across TyG-BMI. In contrast, individuals falling within the fourth quartile of the TyG-WHtR index demonstrated the strongest positive correlation with the risk of all-cause mortality (Hazard Ratio = 4.61, 95% CI: 1.77-12.00). Moreover, analysis using restricted cubic splines indicated a significant non-linear association between TyG-BMI levels and mortality outcomes (p < 0.05). No statistical interactions were observed between mortality outcomes and demographic or clinical variables including age, sex, smoking, asthma, coronary artery disease, diabetes, or hypertension across any TyG-related indices (p > 0.05).

Conclusion: The study outcomes suggest that stroke patients with reduced TyG-BMI and elevated TyG-WHtR levels tend to face increased mortality risks. Nonetheless, addressing obesity may be crucial in exploring potential causal pathways.

Keywords: NHANES; TyG-related index; mortality; retrospective cohort analysis; stroke.