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Non-alkolik yağlı karaciğer hastalığında erken aterosklerozun öngörülmesinde trigliserid-glukoz indeksi ve diğer aterojenik indekslerin rolü

Year 2025, Volume: 7 Issue: 6, 886 - 892, 26.10.2025
https://doi.org/10.38053/acmj.1789383
https://izlik.org/JA32XT83YK

Abstract

Amaç

Kardiyovasküler risk, non-alkolik yağlı karaciğer hastalığı (NAYKH) olan bireylerde, esas olarak aterosklerozun erken gelişimi nedeniyle belirgin şekilde artmaktadır. Bu araştırmanın temel amacı, trigliserid-glukoz (TyG) indeksi, aterojenik lipid belirteçleri ile bunların NAYKH’de prematür aterosklerozu saptamadaki etkinliği arasındaki ilişkiyi açıklığa kavuşturmaktır.

Yöntem

Bu retrospektif, kesitsel çalışmaya 80 NAYKH hastası ve 64 sağlıklı kontrol dahil edildi. Demografik, klinik ve biyokimyasal parametreler değerlendirildi. Prematür aterosklerozu tanımlamak için ortalama karotis intima-media kalınlığı (cIMT) ≥0,800 mm eşik değeri kullanıldı. Çeşitli aterojenik indeksler hesaplandı: Castelli risk indeksleri (CRI-1 ve CRI-2), aterojenik katsayı (AC), plazma aterojenik indeksi (AIP) ve TyG indeksi. Gruplar karşılaştırıldıktan sonra, bağımsız yordayıcılar tek değişkenli ve çok değişkenli lojistik regresyon ile belirlendi; tanısal etkinlik ise ROC (Receiver Operating Characteristics) analiziyle değerlendirildi. Tüm analizler SPSS 26.0 kullanılarak yapıldı.

Bulgular

Prematür ateroskleroz NAYKH grubunda daha sık görüldü (%33,8’e karşı %12,5; p=0,003). Çok değişkenli modellemede, TyG indeksi ve hiperlipidemi (HL), prematür aterosklerozun bağımsız belirleyicileri olarak saptandı. ROC analizi, TyG indeksinin 5,0 kesim değeriyle NAYKH’de prematür aterosklerozu öngörmede orta düzey ayırt edici güce sahip olduğunu gösterdi (duyarlılık %59,3; özgüllük %60,4; AUC=0,687; p=0,007).

Sonuç

NAYKH hastalarında, TyG indeksi ve hiperlipidemi prematür aterosklerozun bağımsız öngörücüleriydi. Buna karşılık, diğer aterojenik indeksler ve geleneksel kardiyovasküler risk faktörleri ile anlamlı bir ilişki bulunmadı.

References

  • Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016; 64(1):73-84. doi:10.1002/hep.28431
  • Linero PL, Castilla-Guerra L. Management of cardiovascular risk in the non-alcoholic fatty liver disease setting. Eur Cardiol. 2024;19:e02. doi: 10.15420/ecr.2023.19
  • Adams LA, Anstee QM, Tilg H, Targher G. Non-alcoholic fatty liver disease and its relationship with cardiovascular disease and other extrahepatic diseases. Gut. 2017;66(6):1138-1153. doi:10.1136/gutjnl- 2017-313884
  • Byrne CD, Targher G. NAFLD: a multisystem disease. J Hepatol. 2015; 62(1):47-64. doi:10.1016/j.jhep.2014.12.012
  • Lonardo A, Sookoian S, Pirola CJ, Targher G. Non-alcoholic fatty liver disease and risk of cardiovascular disease. Metabolism. 2016;65(8):1136-1150. doi:10.1016/j.metabol.2015.09.017
  • Stein JH, Korcarz CE, Hurst RT, et al. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr. 2008;21(2):93-111. doi:10.1016/j.echo.2007.11.011
  • Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328-357. doi:10.1002/hep.29367
  • Francque SM, van der Graaff D, Kwanten WJ. Non-alcoholic fatty liver disease and cardiovascular risk: pathophysiological mechanisms and implications. J Hepatol. 2016;65(2):425-443. doi:10.1016/j.jhep.2016.04.005
  • Simental-Mendía LE, Rodríguez-Morán M, Guerrero-Romero F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord. 2008;6(4):299-304. doi:10.1089/met.2008.0034
  • Zhao J, Fan H, Wang T, et al. TyG index is positively associated with risk of CHD and coronary atherosclerosis severity among NAFLD patients. Cardiovasc Diabetol. 2022;21(1):123. doi:10.1186/s12933-022-01548-y
  • Won KB, Heo R, Park HB, et al. Atherogenic index of plasma and the risk of rapid progression of coronary atherosclerosis beyond traditional risk factors. Atherosclerosis. 2021;324:46-51. doi:10.1016/j.atherosclerosis. 2021.03.009
  • Salcedo-Cifuentes M, Belalcazar S, Acosta EY, Medina-Murillo JJ. Conventional biomarkers for cardiovascular risks and their correlation with the castelli risk index-indices and TG/HDL-c. Archivos de Medicina. 2020;20(1):11-22. doi:10.30554/archmed.20.1.3534.2020
  • Rezaee M, Kamrani F, Imannezhad M, et al. Beyond traditional metrics: evaluating the triglyceride-total cholesterol-body weight index (TCBI) in cardiovascular risk assessment. BMC Cardiovasc Disord. 2025;25(1): 39. doi:10.1186/s12872-025-04500-6
  • Sajdeya O, Beran A, Mhanna M, et al. Triglyceride glucose index for the prediction of subclinical atherosclerosis and arterial stiffness: a meta-analysis of 37,780 individuals. Curr Probl Cardiol. 2022;47(12):101390. doi:10.1016/j.cpcardiol.2022.101390
  • Kaynak C, Geyik B. Relation between premature atherosclerosis and lipoprotein (a) in non-alcoholic fatty liver disease. HealthMED. 2017;180.
  • Dong W, Gong Y, Zhao J, Wang Y, Li B, Yang Y. A combined analysis of TyG index, SII index, and SIRI index: positive association with CHD risk and coronary atherosclerosis severity in patients with NAFLD. Front Endocrinol (Lausanne). 2024;14:1281839. doi:10.3389/fendo.2023. 1281839
  • Cui H, Liu Q, Wu Y, Cao L. Cumulative triglyceride-glucose index is a risk for CVD: a prospective cohort study. Cardiovasc Diabetol. 2022; 21(1):22. doi:10.1186/s12933-022-01456-1
  • Huang W, Wang H, Shen Z, Wang X, Yu X. Association between TyG index and risk of carotid atherosclerosis in NAFLD patients: a retrospective cohort study. Front Endocrinol (Lausanne). 2024;15: 1448359. doi:10.3389/fendo.2024.1448359
  • Wu Z, Liu L, Wang W, et al. Triglyceride-glucose index in the prediction of adverse cardiovascular events in patients with premature coronary artery disease: a retrospective cohort study. Cardiovasc Diabetol. 2022; 21(1):142. doi:10.1186/s12933-022-01576-8
  • Liu H, Chen J, Qin Q, et al. Association between TyG index trajectory and new-onset lean NAFLD: a longitudinal study. Front Endocrinol (Lausanne). 2024;15:1321922. doi:10.3389/fendo.2024.1321922
  • Adeli K, Taghibiglou C, Van Iderstine SC, Lewis GF. Mechanisms of hepatic very low-density lipoprotein overproduction in insulin resistance. Trends Cardiovasc Med. 2001;11(5):170-176. doi:10.1016/s1050-1738(01)00084-6
  • Ormazabal V, Nair S, Elfeky O, Aguayo C, Salomon C, Zuñiga FA. Association between insulin resistance and the development of cardiovascular disease. Cardiovasc Diabetol. 2018;17(1):122. doi:10.1186/s12933-018-0762-4
  • Liu XC, He GD, Lo K, Huang YQ, Feng YQ. The triglyceride-glucose index, an insulin resistance marker, was non-linear associated with all-cause and cardiovascular mortality in the general population. Front Cardiovasc Med. 2021;7:628109. doi:10.3389/fcvm.2020.628109
  • Wang X, Liu J, Yu K, Huang Z, Liu H, Li X. Association between TyG-related parameters and NAFLD risk in Japanese non-obese population. Sci Rep. 2025;15(1):7119. doi:10.1038/s41598-025-88478-3
  • Zhang Y, Wang F, Tang J, Shen L, He J, Chen Y. Association of triglyceride glucose-related parameters with all-cause mortality and cardiovascular disease in NAFLD patients: NHANES 1999-2018. Cardiovasc Diabetol. 2024;23(1):262. doi:10.1186/s12933-024-02354-4
  • Teeman S. The effect of the TyG index on liver steatosis, immune activation, oxidative stress, liver fibrosis pathways and liver fibrosis in the miami adult studies on HIV (MASH) cohort. FIU Electronic Theses and Dissertations. 2021;4737. doi:10.25148/etd.FIDC010264
  • Zhang S, Du T, Zhang J, et al. The triglyceride and glucose index (TyG) is an effective biomarker to identify nonalcoholic fatty liver disease. Lipids Health Dis. 2017;16(1):15. doi:10.1186/s12944-017-0409-6
  • Kim KS, Hong S, Ahn HY, Park CY. Triglyceride and glucose index is a simple and easy-to-calculate marker associated with nonalcoholic fatty liver disease. Obesity (Silver Spring). 2022;30(6):1279-1288. doi:10.1002/oby.23438

The role of triglyceride-glucose index and other atherogenic indices in predicting premature atherosclerosis in non-alcoholic fatty liver disease

Year 2025, Volume: 7 Issue: 6, 886 - 892, 26.10.2025
https://doi.org/10.38053/acmj.1789383
https://izlik.org/JA32XT83YK

Abstract

Aims: Cardiovascular risk is significantly heightened in individuals with non-alcoholic fatty liver disease (NAFLD), primarily due to the early development of atherosclerosis. The primary objective of this research was to clarify the association between the triglyceride-glucose (TyG) index, atherogenic lipid markers and their effectiveness in identifying premature atherosclerosis in NAFLD.
Methods: This retrospective, cross-sectional study included 80 NAFLD patients and 64 healthy controls. Demographic, clinical and biochemical parameters were evaluated. A mean carotid intima-media thickness (cIMT) threshold of ≥0.800 mm was used to characterize premature atherosclerosis. Several atherogenic indices were calculated, including Castelli risk indices (CRI-1 and CRI-2), atherogenic coefficient (AC), atherogenic index of plasma (AIP) and the TyG index. After comparing the groups, independent predictors were identified through univariate and multivariate logistic regression and the evaluation of diagnostic effectiveness was conducted through the analysis of receiver operating characteristics (ROC). All analyses were performed using SPSS 26.0.
Results: Premature atherosclerosis was more frequent in the NAFLD group (33.8% vs. 12.5%, p=0.003). Multivariate modeling revealed TyG index and hyperlipidemia (HL) as independent correlates of premature atherosclerosis. ROC analysis demonstrated that a TyG index cutoff value of 5.0 provided a moderate discriminatory ability for predicting premature atherosclerosis in NAFLD, with a sensitivity of 59.3% and a specificity of 60.4% (AUC=0.687; p=0.007).
Conclusion: In NAFLD patients, the TyG index and HL were independent predictors of premature atherosclerosis, whereas other atherogenic indices and conventional cardiovascular risk factors showed no significant association.

References

  • Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016; 64(1):73-84. doi:10.1002/hep.28431
  • Linero PL, Castilla-Guerra L. Management of cardiovascular risk in the non-alcoholic fatty liver disease setting. Eur Cardiol. 2024;19:e02. doi: 10.15420/ecr.2023.19
  • Adams LA, Anstee QM, Tilg H, Targher G. Non-alcoholic fatty liver disease and its relationship with cardiovascular disease and other extrahepatic diseases. Gut. 2017;66(6):1138-1153. doi:10.1136/gutjnl- 2017-313884
  • Byrne CD, Targher G. NAFLD: a multisystem disease. J Hepatol. 2015; 62(1):47-64. doi:10.1016/j.jhep.2014.12.012
  • Lonardo A, Sookoian S, Pirola CJ, Targher G. Non-alcoholic fatty liver disease and risk of cardiovascular disease. Metabolism. 2016;65(8):1136-1150. doi:10.1016/j.metabol.2015.09.017
  • Stein JH, Korcarz CE, Hurst RT, et al. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr. 2008;21(2):93-111. doi:10.1016/j.echo.2007.11.011
  • Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328-357. doi:10.1002/hep.29367
  • Francque SM, van der Graaff D, Kwanten WJ. Non-alcoholic fatty liver disease and cardiovascular risk: pathophysiological mechanisms and implications. J Hepatol. 2016;65(2):425-443. doi:10.1016/j.jhep.2016.04.005
  • Simental-Mendía LE, Rodríguez-Morán M, Guerrero-Romero F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord. 2008;6(4):299-304. doi:10.1089/met.2008.0034
  • Zhao J, Fan H, Wang T, et al. TyG index is positively associated with risk of CHD and coronary atherosclerosis severity among NAFLD patients. Cardiovasc Diabetol. 2022;21(1):123. doi:10.1186/s12933-022-01548-y
  • Won KB, Heo R, Park HB, et al. Atherogenic index of plasma and the risk of rapid progression of coronary atherosclerosis beyond traditional risk factors. Atherosclerosis. 2021;324:46-51. doi:10.1016/j.atherosclerosis. 2021.03.009
  • Salcedo-Cifuentes M, Belalcazar S, Acosta EY, Medina-Murillo JJ. Conventional biomarkers for cardiovascular risks and their correlation with the castelli risk index-indices and TG/HDL-c. Archivos de Medicina. 2020;20(1):11-22. doi:10.30554/archmed.20.1.3534.2020
  • Rezaee M, Kamrani F, Imannezhad M, et al. Beyond traditional metrics: evaluating the triglyceride-total cholesterol-body weight index (TCBI) in cardiovascular risk assessment. BMC Cardiovasc Disord. 2025;25(1): 39. doi:10.1186/s12872-025-04500-6
  • Sajdeya O, Beran A, Mhanna M, et al. Triglyceride glucose index for the prediction of subclinical atherosclerosis and arterial stiffness: a meta-analysis of 37,780 individuals. Curr Probl Cardiol. 2022;47(12):101390. doi:10.1016/j.cpcardiol.2022.101390
  • Kaynak C, Geyik B. Relation between premature atherosclerosis and lipoprotein (a) in non-alcoholic fatty liver disease. HealthMED. 2017;180.
  • Dong W, Gong Y, Zhao J, Wang Y, Li B, Yang Y. A combined analysis of TyG index, SII index, and SIRI index: positive association with CHD risk and coronary atherosclerosis severity in patients with NAFLD. Front Endocrinol (Lausanne). 2024;14:1281839. doi:10.3389/fendo.2023. 1281839
  • Cui H, Liu Q, Wu Y, Cao L. Cumulative triglyceride-glucose index is a risk for CVD: a prospective cohort study. Cardiovasc Diabetol. 2022; 21(1):22. doi:10.1186/s12933-022-01456-1
  • Huang W, Wang H, Shen Z, Wang X, Yu X. Association between TyG index and risk of carotid atherosclerosis in NAFLD patients: a retrospective cohort study. Front Endocrinol (Lausanne). 2024;15: 1448359. doi:10.3389/fendo.2024.1448359
  • Wu Z, Liu L, Wang W, et al. Triglyceride-glucose index in the prediction of adverse cardiovascular events in patients with premature coronary artery disease: a retrospective cohort study. Cardiovasc Diabetol. 2022; 21(1):142. doi:10.1186/s12933-022-01576-8
  • Liu H, Chen J, Qin Q, et al. Association between TyG index trajectory and new-onset lean NAFLD: a longitudinal study. Front Endocrinol (Lausanne). 2024;15:1321922. doi:10.3389/fendo.2024.1321922
  • Adeli K, Taghibiglou C, Van Iderstine SC, Lewis GF. Mechanisms of hepatic very low-density lipoprotein overproduction in insulin resistance. Trends Cardiovasc Med. 2001;11(5):170-176. doi:10.1016/s1050-1738(01)00084-6
  • Ormazabal V, Nair S, Elfeky O, Aguayo C, Salomon C, Zuñiga FA. Association between insulin resistance and the development of cardiovascular disease. Cardiovasc Diabetol. 2018;17(1):122. doi:10.1186/s12933-018-0762-4
  • Liu XC, He GD, Lo K, Huang YQ, Feng YQ. The triglyceride-glucose index, an insulin resistance marker, was non-linear associated with all-cause and cardiovascular mortality in the general population. Front Cardiovasc Med. 2021;7:628109. doi:10.3389/fcvm.2020.628109
  • Wang X, Liu J, Yu K, Huang Z, Liu H, Li X. Association between TyG-related parameters and NAFLD risk in Japanese non-obese population. Sci Rep. 2025;15(1):7119. doi:10.1038/s41598-025-88478-3
  • Zhang Y, Wang F, Tang J, Shen L, He J, Chen Y. Association of triglyceride glucose-related parameters with all-cause mortality and cardiovascular disease in NAFLD patients: NHANES 1999-2018. Cardiovasc Diabetol. 2024;23(1):262. doi:10.1186/s12933-024-02354-4
  • Teeman S. The effect of the TyG index on liver steatosis, immune activation, oxidative stress, liver fibrosis pathways and liver fibrosis in the miami adult studies on HIV (MASH) cohort. FIU Electronic Theses and Dissertations. 2021;4737. doi:10.25148/etd.FIDC010264
  • Zhang S, Du T, Zhang J, et al. The triglyceride and glucose index (TyG) is an effective biomarker to identify nonalcoholic fatty liver disease. Lipids Health Dis. 2017;16(1):15. doi:10.1186/s12944-017-0409-6
  • Kim KS, Hong S, Ahn HY, Park CY. Triglyceride and glucose index is a simple and easy-to-calculate marker associated with nonalcoholic fatty liver disease. Obesity (Silver Spring). 2022;30(6):1279-1288. doi:10.1002/oby.23438
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Details

Primary Language English
Subjects Cardiology
Journal Section Research Article
Authors

Çağdaş Kaynak 0000-0002-7629-9796

Bilal Geyik This is me 0000-0001-8911-9793

Submission Date September 23, 2025
Acceptance Date October 10, 2025
Publication Date October 26, 2025
DOI https://doi.org/10.38053/acmj.1789383
IZ https://izlik.org/JA32XT83YK
Published in Issue Year 2025 Volume: 7 Issue: 6

Cite

AMA 1.Kaynak Ç, Geyik B. The role of triglyceride-glucose index and other atherogenic indices in predicting premature atherosclerosis in non-alcoholic fatty liver disease. Anatolian Curr Med J / ACMJ / acmj. 2025;7(6):886-892. doi:10.38053/acmj.1789383

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