Summary: In a post-hoc analysis of 9,323 SPRINT participants with controlled hypertension (SBP under 140 mmHg), a higher triglyceride-glucose (TyG) index was associated with more cardiovascular events over a median 3.33 years (725 events). The highest quartile carried an adjusted hazard ratio of 1.57 (95% CI 1.18 to 2.08) versus the lowest, with a significant trend seen only in the standard blood-pressure treatment arm, not the intensive arm.
PICO Summary
| Element | Detail |
|---|---|
| Population | 9,323 adults with controlled hypertension (SBP under 140 mmHg) drawn from the SPRINT randomized trial cohort (United States and Puerto Rico); post-hoc observational analysis. |
| Intervention | Exposure (not a randomized intervention): higher baseline triglyceride-glucose (TyG) index as a surrogate for insulin resistance; highest quartile Q4 (8.93 to under 12.47). |
| Comparison | Lowest TyG quartile Q1 (6.74 to under 8.21) as reference; secondary stratification by standard versus intensive blood-pressure treatment. |
| Outcome | Over a median 3.33 years, 725 composite CVD events occurred. Adjusted Q4 versus Q1 hazard ratio 1.57 (95% CI 1.18 to 2.08). The dose-response trend across quartiles was significant only in the standard treatment arm (p for trend = 0.001) and not in the intensive arm. No risk difference, ARR, or NNT was reported for this observational exposure. |
Expert Commentary
This is a post-hoc, observational analysis of the SPRINT trial, so the finding is best read as an association rather than proof that the TyG index causes cardiovascular events or that lowering it would reduce them. Within those limits, the signal is coherent: insulin resistance, captured cheaply by fasting triglycerides and glucose, tracked with a roughly 57 percent higher adjusted hazard in the top quartile, and the gradient across quartiles was orderly. The most important caveat is the subgroup interpretation. A significant trend in the standard arm but not the intensive arm is being read as effect modification, yet the intensive arm had fewer events and the analysis was not powered for this interaction, so the apparent attenuation may reflect limited power as much as true biology. The estimates were adjusted for established risk factors, but residual confounding from adiposity, diet, and untreated dysglycemia is plausible. There was no industry sponsorship signal and no implausibly large effect to flag. Can I use this with my patients? Not yet as a treatment target, but the TyG index is a reasonable, low-cost flag for residual cardiometabolic risk in a tightly controlled hypertensive patient who otherwise looks low risk. I would welcome a prospective study testing whether acting on a high TyG index changes outcomes.
References
Chen X, Wang L, Jiang Y, Tang W, Xiao J, Deng W, Ren X, Li C. Interplay between triglyceride-glucose index and cardiovascular events in hypertensive patients with controlled blood pressure (SBP<140 mmHg): insights from the SPRINT trial. Front Endocrinol (Lausanne). 2025;16:1508667. doi:10.3389/fendo.2025.1508667