Heart, Lung and Circulation
Original Article| Volume 27, ISSUE 6, P716-724, June 2018

The TyG Index as a Marker of Subclinical Atherosclerosis and Arterial Stiffness in Lean and Overweight Postmenopausal Women


      The present study aims to examine the association of the metabolic syndrome (MS) as well as of the triglyceride-glucose index (TyG-Index), a novel marker of insulin resistance, with subclinical atherosclerosis in a cohort of postmenopausal women, stratified according to their body mass index.


      A total of 473 informed-consenting, non-diabetic postmenopausal women, without overt cardiovascular disease, were included in this study. We aimed to compare the association between structural and functional indices of subclinical atherosclerosis (i.e. carotid artery intima-media thickness (IMT), flow-mediated dilation of the brachial artery, pulse wave velocity (PWV)) with the TyG-index or MS, separately for lean and overweight/obese women.


      The TyG-Index correlated significantly with carotid IMT (r = 0.155, p = 0.012) and PWV (r = 0.157, p = 0.013) only in the group of lean women. Multivariate analysis showed that subclinical atherosclerosis was predicted by MS, in the overweight/obese group (OR = 2.517, 95% CI: 1.078–5.878, p = 0.033), and by the TyG-Index the lean group (OR = 3.119, 95% CI: 1.187–8.194, p < 0.001). Using a TyG-Index cut-off value of 8.0 in the lean subpopulation, women above the cut-off had 44.1% prevalence of subclinical atherosclerosis compared to 29.4% in women below the cut-off (p = 0.043).


      The TyG-Index is associated with carotid atherosclerosis and arterial stiffness mainly in lean postmenopausal women, while the MS serves as a better predictor of subclinical atherosclerosis in overweight/obese women. The TyG-Index may prove a useful marker for identifying high-risk women in the normal-weight postmenopausal population.


      MS (metabolic syndrome), TyG-index (triglyceride–glucose index), CVD (cardiovascular disease), BMI (body mass index), WHR (waist-to-hip ratio), SBP (systolic blood pressure), DBP (diastolic blood pressure), HDL-cholesterol (high density lipoprotein cholesterol), LDL-cholesterol (low density lipoprotein cholesterol), CCA (common carotid artery), CB (carotid bulb), ICA (internal carotid artery), IMT (intima-media thickness), FMD (flow mediated dilation), PWV (pulse wave velocity), HOMA-IR (homeostasis model assessment of insulin resistance)


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Heart, Lung and Circulation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Woodard G.A.
        • Brooks M.M.
        • Barinas-Mitchell E.
        • Mackey R.H.
        • Matthews K.A.
        • Sutton-Tyrrell K.
        Lipids, menopause, and early atherosclerosis in Study of Women’s Health Across the Nation Heart women.
        Menopause. 2011; 18: 376-384
        • Fantin F.
        • Rossi A.P.
        • Cazzadori M.
        • Comellato G.
        • Mazzali G.
        • Gozzoli M.P.
        • et al.
        Central and peripheral fat and subclinical vascular damage in older women.
        Age and Ageing. 2013; 42: 359-365
        • Polotsky H.N.
        • Polotsky A.J.
        Metabolic implications of menopause.
        Seminars in Reproductive Medicine. 2010; 28: 426-434
        • Davis S.R.
        • Castelo-Branco C.
        • Chedraui P.
        • Lumsden M.A.
        • Nappi R.E.
        • Shah D.
        • et al.
        Understanding weight gain at menopause.
        Climacteric: the journal of the International Menopause Society. 2012; 15: 419-429
        • Peppa M.
        • Koliaki C.
        • Boutati E.
        • Garoflos E.
        • Papaefstathiou A.
        • Siafakas N.
        • et al.
        Association of lean body mass with cardiometabolic risk factors in healthy postmenopausal women.
        Obesity. 2014; 22: 828-835
        • Kaaja R.J.
        Metabolic syndrome and the menopause.
        Menopause Int. 2008; 14: 21-25
        • Whitcroft S.
        • Herriot A.
        Insulin resistance and management of the menopause: a clinical hypothesis in practice.
        Menopause Int. 2011; 17: 24-28
        • Guerrero-Romero F.
        • Simental-Mendia L.E.
        • Gonzalez-Ortiz M.
        • Martinez-Abundis E.
        • Ramos-Zavala M.G.
        • Hernandez-Gonzalez S.O.
        • et al.
        The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp.
        The Journal of Clinical Endocrinology and Metabolism. 2010; 95: 3347-3351
        • Simental-Mendia L.E.
        • Rodriguez-Moran 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: 299-304
        • Sanchez-Inigo L.
        • Navarro-Gonzalez D.
        • Fernandez-Montero A.
        • Pastrana-Delgado J.
        • Martinez J.A.
        The TyG index may predict the development of cardiovascular events.
        Eur J Clin Invest. 2016; 46: 189-197
        • Vasques A.C.
        • Novaes F.S.
        • de Oliveira Mda S.
        • Souza J.R.
        • Yamanaka A.
        • Pareja J.C.
        • et al.
        TyG index performs better than HOMA in a Brazilian population: a hyperglycemic clamp validated study.
        Diabetes Research and Clinical Practice. 2011; 93: e98-e100
        • Navarro-Gonzalez D.
        • Sanchez-Inigo L.
        • Pastrana-Delgado J.
        • Fernandez-Montero A.
        • Martinez J.A.
        Triglyceride-glucose index (TyG index) in comparison with fasting plasma glucose improved diabetes prediction in patients with normal fasting glucose: The Vascular-Metabolic CUN cohort.
        Preventive Medicine. 2016; 86: 99-105
        • Alberti K.G.
        • Eckel R.H.
        • Grundy S.M.
        • Zimmet P.Z.
        • Cleeman J.I.
        • Donato K.A.
        • et al.
        Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity.
        Circulation. 2009; 120: 1640-1645
        • Touboul P.J.
        • Hennerici M.G.
        • Meairs S.
        • Adams H.
        • Amarenco P.
        • Bornstein N.
        • et al.
        Mannheim carotid intima-media thickness consensus (2004-2006). An update on behalf of the Advisory Board of the 3rd and 4th Watching the Risk Symposium, 13th and 15th European Stroke Conferences, Mannheim, Germany, 2004, and Brussels, Belgium, 2006.
        Cerebrovasc Dis. 2007; 23: 75-80
        • Stein J.H.
        • Korcarz C.E.
        • Post W.S.
        Use of Carotid Ultrasound to Identify Subclinical Vascular Disease and Evaluate Cardiovascular Disease Risk: Summary and Discussion of the American Society of Echocardiography Consensus Statement.
        Preventive Cardiology. 2009; 12: 34-38
        • Samson S.L.
        • Garber A.J.
        Metabolic syndrome.
        Endocrinol Metab Clin North Am. 2014; 43: 1-23
        • Grundy S.M.
        Metabolic syndrome update.
        Trends Cardiovasc Med. 2016; 26: 364-373
        • McAlpine C.S.
        • Bowes A.J.
        • Werstuck G.H.
        Diabetes, hyperglycemia and accelerated atherosclerosis: evidence supporting a role for endoplasmic reticulum (ER) stress signaling.
        Cardiovasc Hematol Disord Drug Targets. 2010; 10: 151-157
        • Wallace T.M.
        • Levy J.C.
        • Matthews D.R.
        Use and abuse of HOMA modeling.
        Diabetes Care. 2004; 27: 1487-1495
        • An X.
        • Yu D.
        • Zhang R.
        • Zhu J.
        • Du R.
        • Shi Y.
        • et al.
        Insulin resistance predicts progression of de novo atherosclerotic plaques in patients with coronary heart disease: a one-year follow-up study.
        Cardiovasc Diabetol. 2012; 11: 1475-2840
        • Sourij H.
        • Schmoelzer I.
        • Dittrich P.
        • Paulweber B.
        • Iglseder B.
        • Wascher T.C.
        Insulin resistance as a risk factor for carotid atherosclerosis: a comparison of the Homeostasis Model Assessment and the short insulin tolerance test.
        Stroke. 2008; 39: 1349-1351
        • Bonora E.
        • Tessari R.
        • Micciolo R.
        • Zenere M.
        • Targher G.
        • Padovani R.
        • et al.
        Intimal-medial thickness of the carotid artery in nondiabetic and NIDDM patients. Relationship with insulin resistance.
        Diabetes Care. 1997; 20: 627-631
        • 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.
        Cardiovascular Diabetology. 2014; 13: 146
        • Lee S.H.
        • Han K.
        • Yang H.K.
        • Kim M.K.
        • Yoon K.H.
        • Kwon H.S.
        • et al.
        Identifying subgroups of obesity using the product of triglycerides and glucose: the Korea National Health and Nutrition Examination Survey, 2008–2010.
        Clin Endocrinol. 2015; 82: 213-220
        • Irace C.
        • Carallo C.
        • Scavelli F.B.
        • De Franceschi M.S.
        • Esposito T.
        • Tripolino C.
        • et al.
        Markers of insulin resistance and carotid atherosclerosis:A comparison of the homeostasis model assessment and triglyceride glucose index.
        Int J Clin Pract. 2013; 67: 665-672
        • Kelley D.E.
        • Goodpaster B.H.
        Skeletal muscle triglyceride. An aspect of regional adiposity and insulin resistance.
        Diabetes Care. 2001; 24: 933-941
        • Pan D.A.
        • Lillioja S.
        • Kriketos A.D.
        • Milner M.R.
        • Baur L.A.
        • Bogardus C.
        • et al.
        Skeletal muscle triglyceride levels are inversely related to insulin action.
        Diabetes. 1997; 46: 983-988
        • Williams K.J.
        • Wu X.
        Imbalanced insulin action in chronic over nutrition: Clinical harm, molecular mechanisms, and a way forward.
        Atherosclerosis. 2016; 247: 225-282
        • Lambrinoudaki I.
        • Armeni E.
        • Georgiopoulos G.
        • Kazani M.
        • Kouskouni E.
        • Creatsa M.
        • et al.
        Subclinical atherosclerosis in menopausal women with low to medium calculated cardiovascular risk.
        International Journal of Cardiology. 2013; 164: 70-76