Elevated TyG Index Predicts Progression of Coronary Artery Calcification. Park Kahui,Ahn Chul Woo,Lee Sang Bae,Kang Shinae,Nam Ji Sun,Lee Byoung Kwon,Kim Jung Hye,Park Jong Suk Diabetes care OBJECTIVE:To investigate the triglyceride-glucose (TyG) index association with coronary artery calcification (CAC) progression in adult Koreans. RESEARCH DESIGN AND METHODS:Various cardiovascular risk factors and anthropometric profiles were assessed in 1,175 subjects who previously had a CAC evaluation at least twice by multidetector computed tomography in a health care center. The TyG index was determined using ln(fasting triglycerides [mg/dL] × fasting glucose [mg/dL]/2). The CAC progression was defined as either incident CAC in a CAC-free population at baseline or an increase of ≥2.5 units between the square roots of the baseline and follow-up coronary artery calcium scores (CACSs) of subjects with detectable CAC at baseline. RESULTS:CAC progression was seen in 312 subjects (27%) during 4.2 years follow-up. On the basis of the TyG index, subjects were stratified into three groups. Follow-up CACS and incidence of CAC progression were markedly elevated with rising TyG index tertile. Logistic regression analysis adjusted for various risk factors revealed an odds ratio for CAC progression of 1.82 (95% CI 1.20-2.77; ≤ 0.01) when the highest and lowest TyG index tertiles were compared. CONCLUSIONS:The TyG index is an independent predictor of CAC progression. 10.2337/dc18-1920

Incorporating Coronary Calcification Into Pre-Test Assessment of the Likelihood of Coronary Artery Disease. Winther Simon,Schmidt Samuel Emil,Mayrhofer Thomas,Bøtker Hans Erik,Hoffmann Udo,Douglas Pamela S,Wijns William,Bax Jeroen,Nissen Louise,Lynggaard Vibeke,Christiansen Jens Juel,Saraste Antti,Bøttcher Morten,Knuuti Juhani Journal of the American College of Cardiology BACKGROUND:The prevalence of obstructive coronary artery disease (CAD) in symptomatic patients referred for diagnostic testing has declined, warranting optimization of individualized diagnostic strategies. OBJECTIVES:This study sought to present a simple, clinically applicable tool enabling estimation of the likelihood of obstructive CAD by combining a pre-test probability (PTP) model (Diamond-Forrester approach using sex, age, and symptoms) with clinical risk factors and coronary artery calcium score (CACS). METHODS:The new tool was developed in a cohort of symptomatic patients (n = 41,177) referred for diagnostic testing. The risk factor-weighted clinical likelihood (RF-CL) was calculated through PTP and risk factors, while the CACS-weighted clinical likelihood (CACS-CL) added CACS. The 2 calculation models were validated in European and North American cohorts (n = 15,411) and compared with a recently updated PTP table. RESULTS:The RF-CL and CACS-CL models predicted the prevalence of obstructive CAD more accurately in the validation cohorts than the PTP model, and markedly increased the area under the receiver-operating characteristic curves of obstructive CAD: for the PTP model, 72 (95% confidence intervals [CI]: 71 to 74); for the RF-CL model, 75 (95% CI: 74 to 76); and for the CACS-CL model, 85 (95% CI: 84 to 86). In total, 38% of the patients in the RF-CL group and 54% in the CACS-CL group were categorized as having a low clinical likelihood of CAD, as compared with 11% with the PTP model. CONCLUSIONS:A simple risk factor and CACS-CL tool enables improved prediction and discrimination of patients with suspected obstructive CAD. The tool empowers reclassification of patients to low likelihood of CAD, who need no further testing. 10.1016/j.jacc.2020.09.585