Changes in TyG index status were associated with CAC progression, particularly among individuals without detectable CAC, suggesting serial TyG index assessment may aid in cardiovascular risk stratification.
Key Findings
Results
In 14,407 Korean adults without cardiovascular disease, 4,139 participants experienced coronary artery calcification (CAC) progression over a median follow-up of 5.34 years.
Retrospective cohort of adults who underwent two baseline examinations during 2012-2018 and at least three examinations overall.
CAC progression was defined as a difference of ≥2.5 between the square root-transformed CACS at follow-up and at the index examination.
Participants were classified by TyG index status (low or high by a predefined cutoff) at each baseline examination into L-L, L-H, H-L, and H-H groups.
Results
Risk of CAC progression increased across TyG change groups relative to the persistently low (L-L) group, with the highest risk in the persistently high (H-H) group.
Adjusted HR (95% CI) for L-H vs L-L was 1.07 (0.96-1.19), which was not statistically significant.
Adjusted HR for H-L vs L-L was 1.14 (1.02-1.27).
Adjusted HR for H-H vs L-L was 1.30 (1.20-1.41).
Cox proportional hazards models were used.
Results
The association between TyG index change groups and CAC progression differed by baseline CAC subgroup, being more pronounced in participants with a CACS of zero at both the first and index examinations.
The p for interaction between CAC subgroups was <0.001.
The strongest associations were seen in people without detectable CAC at both examinations.
Results
Linear mixed-effects models showed differences in 5-year fold change in CAC between TyG change groups.
The 5-year fold change was 11% higher in the L-H group than in the L-L group.
The 5-year fold change was 9% lower in the H-L group than in the H-H group.
Conclusions
The authors conclude that changes in TyG index status are associated with CAC progression and that serial TyG assessment may aid cardiovascular risk stratification.
TyG index is a readily available surrogate marker of insulin resistance.
The association between TyG change and CAC progression had previously been unclear.
What This Means
This study followed more than 14,000 Korean adults without known heart disease who had repeated health checkups. Researchers used the triglyceride-glucose (TyG) index, a simple measure calculated from routine blood tests that reflects insulin resistance, and looked at whether people's TyG levels stayed low, stayed high, or changed between two early checkups. They then tracked whether calcium buildup in the heart's arteries (coronary artery calcification, a marker of artery disease) got worse over about five years.
People whose TyG index stayed high had about 30% higher risk of calcification progression than those whose levels stayed low. Those who went from high to low had a smaller increase in risk (about 14%), and those who went from low to high had a small increase that was not statistically clear. The link was strongest among people who had no detectable calcium at the start. Moving from low to high TyG was associated with an 11% greater 5-year increase in calcification compared with staying low, while moving from high to low was associated with a 9% smaller increase compared with staying high.
This research suggests that tracking TyG index over time, using routine blood tests, might help identify people at greater risk of developing or worsening artery calcification, especially those with no calcium yet. Because this was a retrospective observational study, it shows associations rather than proving that changing TyG causes changes in calcification.
Kim M, Kim Y, Kang J, Bae Y. (2026). Changes in triglyceride-glucose index and progression of coronary artery calcification in asymptomatic adults: a longitudinal cohort study.. Frontiers in endocrinology. https://doi.org/10.3389/fendo.2026.1976562