Triglyceride-Glucose Index as a Biochemical Predictor of Hypertension in Patients with Type 2 Diabetes and Prediabetes: Evidence from the NHANES Database
TyG Index and Hypertension in Diabetes/Prediabetes
Keywords:
Triglyceride-glucose index, biochemical marker, hypertension, type 2 diabetes, NHANES
Abstract
Background: The triglyceride-glucose (TyG) index, derived from fasting triglyceride and glucose levels, has emerged as a reliable biochemical marker of insulin resistance. However, its relationship with hypertension (HTN) in diabetic and prediabetic populations remains insufficiently studied.
Methods: Using data from 2,440 adults in the U.S. National Health and Nutrition Examination Survey (NHANES, 2011–2018), we investigated the association between the TyG index and HTN. Biochemical assays included enzymatic measurement of serum triglycerides (Beckman Coulter DxC800) and plasma glucose (hexokinase-based methods on Roche Cobas systems), from which the TyG index and related indices (TyG-BMI, TyG-WC, TyG-WHtR) were calculated. Logistic regression models adjusted for demographic, anthropometric, and biochemical covariates were used to estimate odds ratios (OR) for HTN risk.
Results: Participants with HTN exhibited significantly higher TyG index levels compared with non-hypertensives (8.44 vs. 8.38, P<0.01). In fully adjusted models, each unit increase in TyG was associated with a 31% higher risk of HTN (OR=1.31, 95% CI: 1.02–1.69). Stratified analyses revealed significant associations among Mexican Americans and individuals without prior cardiovascular or hepatic disease. TyG-WC and TyG-WHtR indices also correlated positively with HTN risk, whereas TyG-BMI did not.
Conclusion: Elevated TyG index and related biochemical indices are independently associated with increased HTN risk among individuals with diabetes or prediabetes. As a simple and reproducible biochemical parameter, the TyG index may serve as a valuable tool in laboratory medicine for early HTN risk identification and prevention strategies.
References
1. Oparil S, Acelajado MC, Bakris GL, Berlowitz DR, Cifkova R, Dominiczak AF, et al. Hypertension. Nat Rev Dis Primers 2018; 4: 18014.
2. Forrester SJ, Dolmatova EV, Griendling KK. An acceleration in hypertension-related mortality for middle-aged and older Americans, 1999-2016: An observational study. Plos One 2020; 15(1): e0225207.
3. de Lombera RF, Fernandez CS, Gascuena RR, Lazaro M, Hernandez SP, Saavedra FJ, et al. [Hypertension and dyslipidemia]. Rev Esp Cardiol 1998; 51 Suppl 4: 24-35.
4. Fisher N, Curfman G. Hypertension-A Public Health Challenge of Global Proportions. Jama-J Am Med Assoc 2018; 320(17): 1757-9.
5. Laaksonen DE, Niskanen L, Nyyssonen K, Lakka TA, Laukkanen JA, Salonen JT. Dyslipidaemia as a predictor of hypertension in middle-aged men. Eur Heart J 2008; 29(20): 2561-8.
6. Sesso HD, Buring JE, Chown MJ, Ridker PM, Gaziano JM. A prospective study of plasma lipid levels and hypertension in women. Arch Intern Med 2005; 165(20): 2420-7.
7. Halperin RO, Sesso HD, Ma J, Buring JE, Stampfer MJ, Gaziano JM. Dyslipidemia and the risk of incident hypertension in men. Hypertension 2006; 47(1): 45-50.
8. Berberich AJ, Hegele RA. A Modern Approach to Dyslipidemia. Endocr Rev 2022; 43(4): 611-53.
9. Casino PR, Kilcoyne CM, Quyyumi AA, Hoeg JM, Panza JA. The role of nitric oxide in endothelium-dependent vasodilation of hypercholesterolemic patients. Circulation 1993; 88(6): 2541-7.
10. Creager MA, Cooke JP, Mendelsohn ME, Gallagher SJ, Coleman SM, Loscalzo J, et al. Impaired vasodilation of forearm resistance vessels in hypercholesterolemic humans. J Clin Invest 1990; 86(1): 228-34.
11. Wilkinson IB, Prasad K, Hall IR, Thomas A, MacCallum H, Webb DJ, et al. Increased central pulse pressure and augmentation index in subjects with hypercholesterolemia. J Am Coll Cardiol 2002; 39(6): 1005-11.
12. Sapra A, Bhandari P. Diabetes. 2025:
13. Mancusi C, Izzo R, di Gioia G, Losi MA, Barbato E, Morisco C. Insulin Resistance the Hinge Between Hypertension and Type 2 Diabetes. High Blood Press Car 2020; 27(6): 515-26.
14. Ferrannini E, Cushman WC. Diabetes and hypertension: the bad companions. Lancet 2012; 380(9841): 601-10.
15. Emdin CA, Rahimi K, Neal B, Callender T, Perkovic V, Patel A. Blood pressure lowering in type 2 diabetes: a systematic review and meta-analysis. Jama-J Am Med Assoc 2015; 313(6): 603-15.
16. Laakso M. Hyperglycemia and cardiovascular disease in type 2 diabetes. Diabetes 1999; 48(5): 937-42.
17. DeFronzo RA, Tobin JD, Andres R. Glucose clamp technique: a method for quantifying insulin secretion and resistance. Am J Physiol 1979; 237(3): E214-23.
18. Muniyappa R, Lee S, Chen H, Quon MJ. Current approaches for assessing insulin sensitivity and resistance in vivo: advantages, limitations, and appropriate usage. Am J Physiol-Endoc M 2008; 294(1): E15-26.
19. Zhang Q, Xiao S, Jiao X, Shen Y. The triglyceride-glucose index is a predictor for cardiovascular and all-cause mortality in CVD patients with diabetes or pre-diabetes: evidence from NHANES 2001-2018. Cardiovasc Diabetol 2023; 22(1): 279.
20. Cheng W, Li M, Zhang L, Zhou C, Zhang X, Zhu C, et al. Close association of PFASs exposure with hepatic fibrosis than steatosis: evidences from NHANES 2017-2018. Ann Med 2023; 55(1): 2216943.
21. Zhang HR, Tian W, Qi G, Sun YJ. Combined association of dietary fibre and cognitive function with all-cause and cause-specific mortality in older adults. Ann Med 2023; 55(1): 2221036.
22. Correction to: 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018; 72(3): e33.
23. 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 2020; 7: 628109.
24. Shi YY, Zheng R, Cai JJ, Qian SZ. The association between triglyceride glucose index and depression: data from NHANES 2005-2018. Bmc Psychiatry 2021; 21(1): 267.
25. Raimi TH, Dele-Ojo BF, Dada SA, Fadare JO, Ajayi DD, Ajayi EA, et al. Triglyceride-Glucose Index and Related Parameters Predicted Metabolic Syndrome in Nigerians. Metab Syndr Relat D 2021; 19(2): 76-82.
26. Patel U, Patel N, Khurana M, Parulekar A, Patel A, Ortiz JF, et al. Effect Comparison of E-Cigarette and Traditional Smoking and Association with Stroke-A Cross-Sectional Study of NHANES. Neurol Int 2022; 14(2): 441-52.
27. Dang K, Wang X, Hu J, Zhang Y, Cheng L, Qi X, et al. The association between triglyceride-glucose index and its combination with obesity indicators and cardiovascular disease: NHANES 2003-2018. Cardiovasc Diabetol 2024; 23(1): 8.
28. Wen H, Niu X, Hu L, Sun N, Zhao R, Wang Q, et al. Dietary copper intake and risk of myocardial infarction in US adults: A propensity score-matched analysis. Front Cardiovasc Med 2022; 9: 942000.
29. Liu Y, Geng T, Wan Z, Lu Q, Zhang X, Qiu Z, et al. Associations of Serum Folate and Vitamin B12 Levels With Cardiovascular Disease Mortality Among Patients With Type 2 Diabetes. Jama Netw Open 2022; 5(1): e2146124.
30. Zou X, Zhou X, Zhu Z, Ji L. Novel subgroups of patients with adult-onset diabetes in Chinese and US populations. Lancet Diabetes Endo 2019; 7(1): 9-11.
31. Ritchey M, Yuan K, Gillespie C, Zhang G, Ostchega Y. Development and Validation of a Hypertension Prevalence Estimator Tool For Use in Clinical Settings. J Clin Hypertens 2016; 18(8): 750-61.
32. Borai A, Livingstone C, Kaddam I, Ferns G. Selection of the appropriate method for the assessment of insulin resistance. Bmc Med Res Methodol 2011; 11: 158.
33. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28(7): 412-9.
34. Sanchez-Inigo L, Navarro-Gonzalez D, Fernandez-Montero A, Pastrana-Delgado J, Martinez JA. The TyG index may predict the development of cardiovascular events. Eur J Clin Invest 2016; 46(2): 189-97.
35. Guerrero-Romero F, Simental-Mendia LE, Gonzalez-Ortiz M, Martinez-Abundis E, Ramos-Zavala MG, Hernandez-Gonzalez SO, et al. The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. J Clin Endocr Metab 2010; 95(7): 3347-51.
36. Du T, Yuan G, Zhang M, Zhou X, Sun X, Yu X. Clinical usefulness of lipid ratios, visceral adiposity indicators, and the triglycerides and glucose index as risk markers of insulin resistance. Cardiovasc Diabetol 2014; 13: 146.
37. Zheng R, Mao Y. Triglyceride and glucose (TyG) index as a predictor of incident hypertension: a 9-year longitudinal population-based study. Lipids Health Dis 2017; 16(1): 175.
38. Jian S, Su-Mei N, Xue C, Jie Z, Xue-Sen W. Association and interaction between triglyceride-glucose index and obesity on risk of hypertension in middle-aged and elderly adults. Clin Exp Hypertens 2017; 39(8): 732-9.
39. Zhang F, Zhang Y, Guo Z, Yang H, Ren M, Xing X, et al. The association of triglyceride and glucose index, and triglyceride to high-density lipoprotein cholesterol ratio with prehypertension and hypertension in normoglycemic subjects: A large cross-sectional population study. J Clin Hypertens 2021; 23(7): 1405-12.
40. Ren H, Guo Y, Wang D, Kang X, Yuan G. Association of normal-weight central obesity with hypertension: a cross-sectional study from the China health and nutrition survey. Bmc Cardiovasc Disor 2023; 23(1): 120.
41. Gao W, Qiao X, Wang Y, Wan L, Wang Z, Wang X, et al. The Interactive Association of General Obesity and Central Obesity with Prevalent Hypertension in Rural Lanzhou, China. Plos One 2016; 11(10): e0164409.
42. Zhao D, Zhou J, Su D, Li Y, Sun W, Tan B, et al. Combined associations of general obesity and central obesity with hypertension stages and phenotypes among children and adolescents in Zhejiang, China. J Clin Hypertens 2023; 25(11): 983-92.
43. Makarem N, German CA, Zhang Z, Diaz KM, Palta P, Duncan DT, et al. Rest-Activity Rhythms Are Associated With Prevalent Cardiovascular Disease, Hypertension, Obesity, and Central Adiposity in a Nationally Representative Sample of US Adults. J Am Heart Assoc 2024; 13(1): e032073.
44. Wang T, Li M, Zeng T, Hu R, Xu Y, Xu M, et al. Association Between Insulin Resistance and Cardiovascular Disease Risk Varies According to Glucose Tolerance Status: A Nationwide Prospective Cohort Study. Diabetes Care 2022; 45(8): 1863-72.
45. Liu Y, Zhu B, Zhou W, Du Y, Qi D, Wang C, et al. Triglyceride-glucose index as a marker of adverse cardiovascular prognosis in patients with coronary heart disease and hypertension. Cardiovasc Diabetol 2023; 22(1): 133.
46. Chen Y, Hu P, He Y, Qin H, Hu L, Yang R. Association of TyG index and central obesity with hypertension in middle-aged and elderly Chinese adults: a prospective cohort study. Sci Rep-Uk 2024; 14(1): 2235.
47. Dong X, Han B, Huang W, Song Z, Huang N, Zhao Y, et al. Association of TyG index with hypertension in Chinese adults: the China Health Examination Collaborative Study (CHEC Study). Asia Pac J Clin Nutr 2023; 32(3): 362-73.
48. Tuğçenur TGA, Asfuroğlu KE, Zengin O, Erel Ö, Ateş İ. Effects of use of metformin or combination of metformin and pioglitazone on oxidative stress in type 2 diabetes mellitus. J Med Biochem. 2025 Mar 21;44(2):347-354.
49. Steinberg HO, Chaker H, Leaming R, Johnson A, Brechtel G, Baron AD. Obesity/insulin resistance is associated with endothelial dysfunction. Implications for the syndrome of insulin resistance. J Clin Invest 1996; 97(11): 2601-10.
50. Fukuda N, Satoh C, Hu WY, Nakayama M, Kishioka H, Kanmatsuse K. Endogenous angiotensin II suppresses insulin signaling in vascular smooth muscle cells from spontaneously hypertensive rats. J Hypertens 2001; 19(9): 1651-8.
51. Lembo G, Napoli R, Capaldo B, Rendina V, Iaccarino G, Volpe M, et al. Abnormal sympathetic overactivity evoked by insulin in the skeletal muscle of patients with essential hypertension. J Clin Invest 1992; 90(1): 24-9.
52. Manrique C, Lastra G, Sowers JR. New insights into insulin action and resistance in the vasculature. Ann Ny Acad Sci 2014; 1311(1): 138-50.
53. Jenkins HN, Rivera-Gonzalez O, Gibert Y, Speed JS. Endothelin-1 in the pathophysiology of obesity and insulin resistance. Obes Rev 2020; 21(12): e13086.
54. Wellen KE, Hotamisligil GS. Inflammation, stress, and diabetes. J Clin Invest 2005; 115(5): 1111-9.
55. Litwin M, Kulaga Z. Obesity, metabolic syndrome, and primary hypertension. Pediatr Nephrol 2021; 36(4): 825-37.
56. Zheng S, Shi S, Ren X, Han T, Li Y, Chen Y, et al. Triglyceride glucose-waist circumference, a novel and effective predictor of diabetes in first-degree relatives of type 2 diabetes patients: cross-sectional and prospective cohort study. J Transl Med 2016; 14(1): 260.
57. Xu H, Short SE, Liu T. Dynamic relations between fast-food restaurant and body weight status: a longitudinal and multilevel analysis of Chinese adults. J Epidemiol Commun H 2013; 67(3): 271-9.
58. Knowles KM, Paiva LL, Sanchez SE, Revilla L, Lopez T, Yasuda MB, et al. Waist Circumference, Body Mass Index, and Other Measures of Adiposity in Predicting Cardiovascular Disease Risk Factors among Peruvian Adults. Int J Hypertens 2011; 2011: 931402.
59. Kuller LH. Ethnic differences in atherosclerosis, cardiovascular disease and lipid metabolism. Curr Opin Lipidol 2004; 15(2): 109-13.
60. Sharma S, Malarcher AM, Giles WH, Myers G. Racial, ethnic and socioeconomic disparities in the clustering of cardiovascular disease risk factors. Ethnic Dis 2004; 14(1): 43-8.
61. Tian N, Song L, Hou T, Fa W, Dong Y, Liu R, et al. Association of Triglyceride-Glucose Index With Cognitive Function and Brain Atrophy: A Population-Based Study. Am J Geriat Psychiat 2024; 32(2): 151-62.
62. He J, Yuan S, Song C, Song Y, Bian X, Gao G, et al. High triglyceride-glucose index predicts cardiovascular events in patients with coronary bifurcation lesions: a large-scale cohort study. Cardiovasc Diabetol 2023; 22(1): 289.
63. Min Y, Wei X, Wei Z, Song G, Zhao X, Lei Y. Prognostic effect of triglyceride glucose-related parameters on all-cause and cardiovascular mortality in the United States adults with metabolic dysfunction-associated steatotic liver disease. Cardiovasc Diabetol 2024; 23(1): 188.
64. Hill MA, Yang Y, Zhang L, Sun Z, Jia G, Parrish AR, et al. Insulin resistance, cardiovascular stiffening and cardiovascular disease. Metabolism 2021; 119: 154766.
2. Forrester SJ, Dolmatova EV, Griendling KK. An acceleration in hypertension-related mortality for middle-aged and older Americans, 1999-2016: An observational study. Plos One 2020; 15(1): e0225207.
3. de Lombera RF, Fernandez CS, Gascuena RR, Lazaro M, Hernandez SP, Saavedra FJ, et al. [Hypertension and dyslipidemia]. Rev Esp Cardiol 1998; 51 Suppl 4: 24-35.
4. Fisher N, Curfman G. Hypertension-A Public Health Challenge of Global Proportions. Jama-J Am Med Assoc 2018; 320(17): 1757-9.
5. Laaksonen DE, Niskanen L, Nyyssonen K, Lakka TA, Laukkanen JA, Salonen JT. Dyslipidaemia as a predictor of hypertension in middle-aged men. Eur Heart J 2008; 29(20): 2561-8.
6. Sesso HD, Buring JE, Chown MJ, Ridker PM, Gaziano JM. A prospective study of plasma lipid levels and hypertension in women. Arch Intern Med 2005; 165(20): 2420-7.
7. Halperin RO, Sesso HD, Ma J, Buring JE, Stampfer MJ, Gaziano JM. Dyslipidemia and the risk of incident hypertension in men. Hypertension 2006; 47(1): 45-50.
8. Berberich AJ, Hegele RA. A Modern Approach to Dyslipidemia. Endocr Rev 2022; 43(4): 611-53.
9. Casino PR, Kilcoyne CM, Quyyumi AA, Hoeg JM, Panza JA. The role of nitric oxide in endothelium-dependent vasodilation of hypercholesterolemic patients. Circulation 1993; 88(6): 2541-7.
10. Creager MA, Cooke JP, Mendelsohn ME, Gallagher SJ, Coleman SM, Loscalzo J, et al. Impaired vasodilation of forearm resistance vessels in hypercholesterolemic humans. J Clin Invest 1990; 86(1): 228-34.
11. Wilkinson IB, Prasad K, Hall IR, Thomas A, MacCallum H, Webb DJ, et al. Increased central pulse pressure and augmentation index in subjects with hypercholesterolemia. J Am Coll Cardiol 2002; 39(6): 1005-11.
12. Sapra A, Bhandari P. Diabetes. 2025:
13. Mancusi C, Izzo R, di Gioia G, Losi MA, Barbato E, Morisco C. Insulin Resistance the Hinge Between Hypertension and Type 2 Diabetes. High Blood Press Car 2020; 27(6): 515-26.
14. Ferrannini E, Cushman WC. Diabetes and hypertension: the bad companions. Lancet 2012; 380(9841): 601-10.
15. Emdin CA, Rahimi K, Neal B, Callender T, Perkovic V, Patel A. Blood pressure lowering in type 2 diabetes: a systematic review and meta-analysis. Jama-J Am Med Assoc 2015; 313(6): 603-15.
16. Laakso M. Hyperglycemia and cardiovascular disease in type 2 diabetes. Diabetes 1999; 48(5): 937-42.
17. DeFronzo RA, Tobin JD, Andres R. Glucose clamp technique: a method for quantifying insulin secretion and resistance. Am J Physiol 1979; 237(3): E214-23.
18. Muniyappa R, Lee S, Chen H, Quon MJ. Current approaches for assessing insulin sensitivity and resistance in vivo: advantages, limitations, and appropriate usage. Am J Physiol-Endoc M 2008; 294(1): E15-26.
19. Zhang Q, Xiao S, Jiao X, Shen Y. The triglyceride-glucose index is a predictor for cardiovascular and all-cause mortality in CVD patients with diabetes or pre-diabetes: evidence from NHANES 2001-2018. Cardiovasc Diabetol 2023; 22(1): 279.
20. Cheng W, Li M, Zhang L, Zhou C, Zhang X, Zhu C, et al. Close association of PFASs exposure with hepatic fibrosis than steatosis: evidences from NHANES 2017-2018. Ann Med 2023; 55(1): 2216943.
21. Zhang HR, Tian W, Qi G, Sun YJ. Combined association of dietary fibre and cognitive function with all-cause and cause-specific mortality in older adults. Ann Med 2023; 55(1): 2221036.
22. Correction to: 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018; 72(3): e33.
23. 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 2020; 7: 628109.
24. Shi YY, Zheng R, Cai JJ, Qian SZ. The association between triglyceride glucose index and depression: data from NHANES 2005-2018. Bmc Psychiatry 2021; 21(1): 267.
25. Raimi TH, Dele-Ojo BF, Dada SA, Fadare JO, Ajayi DD, Ajayi EA, et al. Triglyceride-Glucose Index and Related Parameters Predicted Metabolic Syndrome in Nigerians. Metab Syndr Relat D 2021; 19(2): 76-82.
26. Patel U, Patel N, Khurana M, Parulekar A, Patel A, Ortiz JF, et al. Effect Comparison of E-Cigarette and Traditional Smoking and Association with Stroke-A Cross-Sectional Study of NHANES. Neurol Int 2022; 14(2): 441-52.
27. Dang K, Wang X, Hu J, Zhang Y, Cheng L, Qi X, et al. The association between triglyceride-glucose index and its combination with obesity indicators and cardiovascular disease: NHANES 2003-2018. Cardiovasc Diabetol 2024; 23(1): 8.
28. Wen H, Niu X, Hu L, Sun N, Zhao R, Wang Q, et al. Dietary copper intake and risk of myocardial infarction in US adults: A propensity score-matched analysis. Front Cardiovasc Med 2022; 9: 942000.
29. Liu Y, Geng T, Wan Z, Lu Q, Zhang X, Qiu Z, et al. Associations of Serum Folate and Vitamin B12 Levels With Cardiovascular Disease Mortality Among Patients With Type 2 Diabetes. Jama Netw Open 2022; 5(1): e2146124.
30. Zou X, Zhou X, Zhu Z, Ji L. Novel subgroups of patients with adult-onset diabetes in Chinese and US populations. Lancet Diabetes Endo 2019; 7(1): 9-11.
31. Ritchey M, Yuan K, Gillespie C, Zhang G, Ostchega Y. Development and Validation of a Hypertension Prevalence Estimator Tool For Use in Clinical Settings. J Clin Hypertens 2016; 18(8): 750-61.
32. Borai A, Livingstone C, Kaddam I, Ferns G. Selection of the appropriate method for the assessment of insulin resistance. Bmc Med Res Methodol 2011; 11: 158.
33. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28(7): 412-9.
34. Sanchez-Inigo L, Navarro-Gonzalez D, Fernandez-Montero A, Pastrana-Delgado J, Martinez JA. The TyG index may predict the development of cardiovascular events. Eur J Clin Invest 2016; 46(2): 189-97.
35. Guerrero-Romero F, Simental-Mendia LE, Gonzalez-Ortiz M, Martinez-Abundis E, Ramos-Zavala MG, Hernandez-Gonzalez SO, et al. The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. J Clin Endocr Metab 2010; 95(7): 3347-51.
36. Du T, Yuan G, Zhang M, Zhou X, Sun X, Yu X. Clinical usefulness of lipid ratios, visceral adiposity indicators, and the triglycerides and glucose index as risk markers of insulin resistance. Cardiovasc Diabetol 2014; 13: 146.
37. Zheng R, Mao Y. Triglyceride and glucose (TyG) index as a predictor of incident hypertension: a 9-year longitudinal population-based study. Lipids Health Dis 2017; 16(1): 175.
38. Jian S, Su-Mei N, Xue C, Jie Z, Xue-Sen W. Association and interaction between triglyceride-glucose index and obesity on risk of hypertension in middle-aged and elderly adults. Clin Exp Hypertens 2017; 39(8): 732-9.
39. Zhang F, Zhang Y, Guo Z, Yang H, Ren M, Xing X, et al. The association of triglyceride and glucose index, and triglyceride to high-density lipoprotein cholesterol ratio with prehypertension and hypertension in normoglycemic subjects: A large cross-sectional population study. J Clin Hypertens 2021; 23(7): 1405-12.
40. Ren H, Guo Y, Wang D, Kang X, Yuan G. Association of normal-weight central obesity with hypertension: a cross-sectional study from the China health and nutrition survey. Bmc Cardiovasc Disor 2023; 23(1): 120.
41. Gao W, Qiao X, Wang Y, Wan L, Wang Z, Wang X, et al. The Interactive Association of General Obesity and Central Obesity with Prevalent Hypertension in Rural Lanzhou, China. Plos One 2016; 11(10): e0164409.
42. Zhao D, Zhou J, Su D, Li Y, Sun W, Tan B, et al. Combined associations of general obesity and central obesity with hypertension stages and phenotypes among children and adolescents in Zhejiang, China. J Clin Hypertens 2023; 25(11): 983-92.
43. Makarem N, German CA, Zhang Z, Diaz KM, Palta P, Duncan DT, et al. Rest-Activity Rhythms Are Associated With Prevalent Cardiovascular Disease, Hypertension, Obesity, and Central Adiposity in a Nationally Representative Sample of US Adults. J Am Heart Assoc 2024; 13(1): e032073.
44. Wang T, Li M, Zeng T, Hu R, Xu Y, Xu M, et al. Association Between Insulin Resistance and Cardiovascular Disease Risk Varies According to Glucose Tolerance Status: A Nationwide Prospective Cohort Study. Diabetes Care 2022; 45(8): 1863-72.
45. Liu Y, Zhu B, Zhou W, Du Y, Qi D, Wang C, et al. Triglyceride-glucose index as a marker of adverse cardiovascular prognosis in patients with coronary heart disease and hypertension. Cardiovasc Diabetol 2023; 22(1): 133.
46. Chen Y, Hu P, He Y, Qin H, Hu L, Yang R. Association of TyG index and central obesity with hypertension in middle-aged and elderly Chinese adults: a prospective cohort study. Sci Rep-Uk 2024; 14(1): 2235.
47. Dong X, Han B, Huang W, Song Z, Huang N, Zhao Y, et al. Association of TyG index with hypertension in Chinese adults: the China Health Examination Collaborative Study (CHEC Study). Asia Pac J Clin Nutr 2023; 32(3): 362-73.
48. Tuğçenur TGA, Asfuroğlu KE, Zengin O, Erel Ö, Ateş İ. Effects of use of metformin or combination of metformin and pioglitazone on oxidative stress in type 2 diabetes mellitus. J Med Biochem. 2025 Mar 21;44(2):347-354.
49. Steinberg HO, Chaker H, Leaming R, Johnson A, Brechtel G, Baron AD. Obesity/insulin resistance is associated with endothelial dysfunction. Implications for the syndrome of insulin resistance. J Clin Invest 1996; 97(11): 2601-10.
50. Fukuda N, Satoh C, Hu WY, Nakayama M, Kishioka H, Kanmatsuse K. Endogenous angiotensin II suppresses insulin signaling in vascular smooth muscle cells from spontaneously hypertensive rats. J Hypertens 2001; 19(9): 1651-8.
51. Lembo G, Napoli R, Capaldo B, Rendina V, Iaccarino G, Volpe M, et al. Abnormal sympathetic overactivity evoked by insulin in the skeletal muscle of patients with essential hypertension. J Clin Invest 1992; 90(1): 24-9.
52. Manrique C, Lastra G, Sowers JR. New insights into insulin action and resistance in the vasculature. Ann Ny Acad Sci 2014; 1311(1): 138-50.
53. Jenkins HN, Rivera-Gonzalez O, Gibert Y, Speed JS. Endothelin-1 in the pathophysiology of obesity and insulin resistance. Obes Rev 2020; 21(12): e13086.
54. Wellen KE, Hotamisligil GS. Inflammation, stress, and diabetes. J Clin Invest 2005; 115(5): 1111-9.
55. Litwin M, Kulaga Z. Obesity, metabolic syndrome, and primary hypertension. Pediatr Nephrol 2021; 36(4): 825-37.
56. Zheng S, Shi S, Ren X, Han T, Li Y, Chen Y, et al. Triglyceride glucose-waist circumference, a novel and effective predictor of diabetes in first-degree relatives of type 2 diabetes patients: cross-sectional and prospective cohort study. J Transl Med 2016; 14(1): 260.
57. Xu H, Short SE, Liu T. Dynamic relations between fast-food restaurant and body weight status: a longitudinal and multilevel analysis of Chinese adults. J Epidemiol Commun H 2013; 67(3): 271-9.
58. Knowles KM, Paiva LL, Sanchez SE, Revilla L, Lopez T, Yasuda MB, et al. Waist Circumference, Body Mass Index, and Other Measures of Adiposity in Predicting Cardiovascular Disease Risk Factors among Peruvian Adults. Int J Hypertens 2011; 2011: 931402.
59. Kuller LH. Ethnic differences in atherosclerosis, cardiovascular disease and lipid metabolism. Curr Opin Lipidol 2004; 15(2): 109-13.
60. Sharma S, Malarcher AM, Giles WH, Myers G. Racial, ethnic and socioeconomic disparities in the clustering of cardiovascular disease risk factors. Ethnic Dis 2004; 14(1): 43-8.
61. Tian N, Song L, Hou T, Fa W, Dong Y, Liu R, et al. Association of Triglyceride-Glucose Index With Cognitive Function and Brain Atrophy: A Population-Based Study. Am J Geriat Psychiat 2024; 32(2): 151-62.
62. He J, Yuan S, Song C, Song Y, Bian X, Gao G, et al. High triglyceride-glucose index predicts cardiovascular events in patients with coronary bifurcation lesions: a large-scale cohort study. Cardiovasc Diabetol 2023; 22(1): 289.
63. Min Y, Wei X, Wei Z, Song G, Zhao X, Lei Y. Prognostic effect of triglyceride glucose-related parameters on all-cause and cardiovascular mortality in the United States adults with metabolic dysfunction-associated steatotic liver disease. Cardiovasc Diabetol 2024; 23(1): 188.
64. Hill MA, Yang Y, Zhang L, Sun Z, Jia G, Parrish AR, et al. Insulin resistance, cardiovascular stiffening and cardiovascular disease. Metabolism 2021; 119: 154766.
Published
2025/10/11
Issue
Section
Original paper
Copyright (c) 2025 Tianyu Dai, Fangze Wang, Hanqing Deng, Muyuan Li, Jihu Zhang, Jian Wang
This work is licensed under a Creative Commons Attribution 4.0 International License.
The published articles will be distributed under the Creative Commons Attribution 4.0 International License (CC BY). It is allowed to copy and redistribute the material in any medium or format, and remix, transform, and build upon it for any purpose, even commercially, as long as appropriate credit is given to the original author(s), a link to the license is provided and it is indicated if changes were made. Users are required to provide full bibliographic description of the original publication (authors, article title, journal title, volume, issue, pages), as well as its DOI code. In electronic publishing, users are also required to link the content with both the original article published in Journal of Medical Biochemistry and the licence used.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.