Insulin Resistance Indices and Cardiovascular Health

Insulin resistance—a state in which normal concentrations of insulin produce subnormal biological responses—lies at the heart of metabolic syndrome and substantially elevates the risk of cardiovascular disease. While the hyperinsulinaemic–euglycaemic clamp remains the reference standard for quantifying insulin sensitivity, its complexity and cost limit routine use. Over the past decade, simpler surrogate indices derived from fasting glucose, triglycerides and anthropometric measures have been developed to improve risk stratification. Chief among these is the triglyceride–glucose (TyG) index and its extensions, which combine TyG with body mass index (TyG-BMI), waist circumference (TyG-WC) or waist-to-height ratio (TyG-WHtR). These hybrid metrics capture the interplay between lipid metabolism, central adiposity and glycaemic control, all of which contribute to endothelial dysfunction, atherogenesis and adverse cardiac outcomes. Evidence from large population studies shows that TyG-based indices correlate closely with gold-standard measures of insulin sensitivity and independently predict coronary events, stroke and cardiovascular mortality. Their calculation from routine laboratory and anthropometric data makes them especially suitable for low-resource settings and for incorporation into electronic health records, where they can support early identification of high-risk individuals, guide lifestyle and pharmacological interventions, and inform public health policies aimed at reducing the global burden of cardiovascular disease.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Insulin Resistance Indices and Cardiovascular Health publication trend

The graph below shows the total number of articles in insulin resistance indices and cardiovascular health across all publications each year (not limited to Nature Index journals).

Technical terms

Insulin resistance: A metabolic condition in which target tissues (muscle, fat, liver) respond inadequately to normal insulin levels, leading to compensatory hyperinsulinaemia.

Homeostatic model assessment of insulin resistance (HOMA-IR): A calculated index based on fasting insulin and glucose levels used to estimate insulin sensitivity in epidemiological studies.

Triglyceride–glucose (TyG) index: A surrogate marker of insulin resistance calculated as the logarithm of the product of fasting plasma triglyceride and glucose concentrations.

TyG-BMI, TyG-WC, TyG-WHtR: Composite indices combining the TyG index with body mass index (BMI), waist circumference (WC) or waist-to-height ratio (WHtR) to integrate lipid–glucose dysregulation with measures of general or central adiposity.

Major adverse cardiac and cerebrovascular events (MACCEs): A composite clinical endpoint including events such as myocardial infarction, repeat revascularisation, stroke and all-cause mortality used in cardiovascular outcome studies.

References

1. The association between triglyceride-glucose index and its combination with obesity indicators and cardiovascular disease: NHANES 2003–2018. Cardiovascular Diabetology (2024).
2. Association between triglyceride glucose-body mass index and cardiovascular outcomes in patients undergoing percutaneous coronary intervention: a retrospective study. Cardiovascular Diabetology (2023).
3. Estimate of prevalent ischemic stroke from triglyceride glucose-body mass index in the general population. BMC Cardiovascular Disorders (2020).