Associations of insulin resistance-related indices with incident carotid plaques by cardiovascular risk profiles: a prospective cohort study

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BACKGROUND: Evidence has linked insulin resistance (IR) with atherosclerotic disorders, but their relationship by different cardiovascular risk profiles remains indistinct. We sought to explore the associations of triglyceride-glucose (TyG) index and C-reactive protein-triglyceride glucose index (CTI), two reliable surrogates for IR, with incident carotid plaques in a rural Chinese population, while taking into account cardiovascular risk profiles. METHODS: A total of 929 participants who were aged ≥ 40 years and free of carotid plaques at baseline in 2017 were recruited from participants of the Rose Asymptomatic Intracranial Artery Stenosis (RICAS) cohort. The presence of incident carotid plaques was assessed using B-mode ultrasound at the follow-up in 2021. TyG index and CTI were calculated from triglycerides, fasting plasma glucose, and hypersensitive C-reactive protein. Logistic regression models were used to explore the association of IR surrogates with incident carotid plaques. RESULTS: Over a median follow-up period of 3.92 years, 190 (20.45%) participants were detected with incident carotid plaques. A higher TyG index and a higher CTI were significantly associated with an increased risk of incident carotid plaques in the total sample, and among participants with low-density lipoprotein cholesterol (LDL-C) < 2.6 mmol/L or those with low-to-intermediate atherosclerotic cardiovascular disease (ASCVD) risk. Furthermore, among participants with LDL-C < 2.6 mmol/L, TyG index and CTI were significantly associated with incident carotid plaques only in males (p for interactions < 0.05). CONCLUSIONS: Elevated TyG index and CTI, indicators of insulin resistance, are associated with incident carotid plaques even among individuals with low cardiovascular risk profiles. These findings have potential implications for primary prevention of atherosclerotic disorders among populations with low cardiovascular risks. TRIAL REGISTRATION: URL: https://www.chictr.org.cn ; Unique identifier: ChiCTR1800017197; Registration Date: July 17, 2018.

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