Associations of triglyceride-glucose index and hs-CRP with incident aortic valve calcification and mortality in Kailuan study population: a nationwide prospective cohort study

Aims: Both insulin resistance (IR) and inflammation participated in the pathogenesis of aortic valve calcification (AVC). Triglyceride glucose (TyG) index is recently proposed as an alternative indicator of IR. But the associations of TyG index with incident AVC and mortality have not been established in population study. Moreover, whether high-sensitivity C-reactive protein (hs-CRP) mediates these associations is unknown. Methods and results: We prospectively followed 40,344 adults without AVC at baseline from the Kailuan cohort (2006-2018). Cox proportional hazards models were used to estimate the hazard ratios (HRs) of incident AVC and mortality according to TyG subgroups. During a median follow-up period of 14.1 to 14.4 years, 5,970 AVC cases and 6820 deaths were documented. Compared with participants in the lowest TyG quartile, those in the highest quartile had increased risks of incident AVC [HR 1.40, confidence interval (CI): 1.29-1.52], and mortality (HR 1.16, 95% CI: 1.08-1.25), and the corresponding proportions mediated by hs-CRP reached 12.65% and 15.81%, respectively. Conclusions: Higher TyG index is significantly associated with incident AVC and mortality, partly mediated by inflammation. Thus, IR and inflammation can be accessed by TyG-hs-CRP pathway in general population, and more stringent glucose and lipid control will benefit the individuals at higher risk of AVC.