Association of dynamic changes in triglyceride-glucose index with lipid profiles and target attainments in coronary artery disease patients undergoing lipid-lowering therapy

Abstract Background The triglyceride-glucose (TyG) index, a reliable biomarker of insulin resistance, reflects metabolic risk. However, the impact of its dynamic changes on lipid metabolism and treatment responses remains inadequately explored. Purpose This study aims to investigate how baseline TyG and its variations influence lipid profiles and target attainments in coronary artery disease (CAD) patients undergoing lipid-lowering therapy (LLT). Methods We conducted a longitudinal cohort study of CAD patients receiving either low/moderate-intensity LLT (low/moderate-dose statin or ezetimibe monotherapy) or high-intensity LLT (statin plus ezetimibe or PCSK9 inhibitor). Participants were followed for one year, and correlations, logistic regression, and change-to-change analyses were performed to assess associations between baseline, longitudinal change, and status transitions of TyG and lipid parameters, adjusting for potential confounders. Results A total of 1,393 participants were included. At baseline, the TyG index was positively correlated with triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), remnant cholesterol (RC), and apolipoprotein B (ApoB), while exhibiting negative correlations with lipoprotein(a) Lp(a) and high-density lipoprotein cholesterol (HDL-C). Higher baseline TyG levels were independently associated with increased LDL-C (β = 0.22, P 0.001) and a reduced likelihood of achieving non-HDL-C 2.2 mmol/L (OR = 0.81, P = 0.040) and RC 0.5 mmol/L (OR = 0.72, P = 0.008). Percent changes in TyG were significantly associated with concurrent changes in LDL-C, TC, and non-HDL-C, with stronger associations observed in patients receiving low/moderate-intensity LLT and in female patients. Furthermore, patients whose TyG index transitioned from the lowest to the highest tertile during follow-up exhibited significant increases in LDL-C, TC, non-HDL-C, and LDL-C levels adjusted for Lp(a). These findings demonstrate the dynamic change of TyG and its influence on lipid metabolism, particularly in patients on non-intensive LLT. Conclusion The TyG index is an effective biomarker for metabolic and cardiovascular risk assessment in CAD patients. Its evolving relationship with lipid parameters, particularly in those receiving low/moderate-intensity LLT, underscore the importance of routine monitoring. Lower TyG levels may stabilize atherogenic lipids, supporting its role in risk stratification and treatment optimization.Stratified analysis Table.Change-to-Change Analysis