Association between glycerol triglyceride glucose-related index and cardiovascular disease in individuals with metabolic dysfunction-associated steatotic liver disease: NHANES 1999–2023

Abstract

Background Cardiovascular disease (CVD) is more common in those with metabolic dysfunction-associated steatotic liver disease (MASLD). Although the triglyceride-glucose index (TyG) and its composite indices are straightforward indicators of insulin resistance, it is yet unknown how they relate to the risk of CVD in the MASLD population. Objectives To explore the correlation of TyG and TyG-waist-to-height ratio (TyG-WHtR) with cardiovascular disease risk in the MASLD population. Design This was a population-based cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) 1999–2023. Methods Adults with MASLD were included using cross-sectional data from the National Health and Nutrition Examination Survey (NHANES). ROC curve assessments, subgroup analyses, smooth curve fitting, and multivariate logistic regression were carried out. Results Among 1,860 participants, TyG (OR=1.27) and TyG-WHtR (OR=1.20) were independently associated with elevated CVD risk after full covariate adjustment (all P<0.05). TyG exhibited a nonlinear association with CVD risk, with an inflection point at 9.28: below this cutoff, higher TyG was strongly linked to greater CVD risk (OR=2.23, 95% CI: 1.56–3.19), whereas no significant association was detected above the threshold. TyG-WHtR also presented a potential inflection point at 5.54. Stratified analyses revealed stronger associations between both indices and CVD among participants without diabetes, and the magnitude of associations varied across racial subgroups. ROC curve analyses indicated that both markers only achieved modest discriminatory performance for identifying prevalent CVD (AUC: 0.606 for TyG; 0.613 for TyG-WHtR). Conclusion TyG and TyG-WHtR showed positive associations with CVD in patients with MASLD, with a remarkable threshold effect observed for TyG. Both indices are simple auxiliary markers to screen high-risk subgroups during population epidemiological surveys.