Triglyceride-Glucose Index Predicts Instability in the Natural History of Intracranial Aneurysms: Insights From a Large-Scale Chinese Multicenter Cohort.

Background: The triglyceride-glucose (TyG) index is associated with various cerebrovascular diseases. However, the association between the TyG index and the instability (growth or rupture) of unruptured intracranial aneurysms (UIAs) remains underexplored.

Methods: This multicenter retrospective analysis used data from 2 prospective Chinese cohorts with UIAs. Participants with UIAs were categorized on the basis of TyG (calculated by the Ln (triglycerides [mg/dL]×fasting blood glucose [mg/dL]/2) quartiles. Kaplan-Meier survival analysis was used to estimate survival disparities among the TyG subgroups. Multivariable-adjusted Cox proportional hazards regression models and restricted cubic spline analyses were applied to assess the relationship between the TyG index and the onset of UIA instability.

Results: This study included 5484 participants with UIAs with a median TyG index of 8.6 (interquartile range [IQR], 7.6-9.6). During a median follow-up of 57.3 (interquartile range, 50.1-67.1) months, 778 (14.2%) patients developed UIA instability. Restricted cubic spline analysis revealed a linear dose-response relationship between the TyG index and UIA instability risk. The TyG index was positively associated with risk of incident UIA instability after adjusting for potential confounding factors with adjusted hazard ratios of 1.0 (reference), 2.33 (95% CI, 1.72-3.17), 2.01 (95% CI, 2.23-4.05), and 4.39 (95% CI, 3.28-5.88) for TyG index quartiles 2, 3, and 4, respectively. Similar and consistent results were obtained in sensitivity analyses (<0.001).

Conclusions: The TyG index is independently associated with a higher risk of incident UIA growth or rupture, indicating the importance of applying the index in stratifying the instability risk of UIAs.