---
title: "Triglyceride–glucose (TyG) index correlates with coronary artery disease severity by Gensini score"
id: "plos-one-6-triglyceride-glucose-index-is-associated-with-the-severity-of-coronary-artery"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-6-triglyceride-glucose-index-is-associated-with-the-severity-of-coronary-artery"
content_type: "clinical_feed_article"
specialty: "Cardiology"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426"
published_at: "2026-08-17T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Triglyceride–glucose (TyG) index correlates with coronary artery disease severity by Gensini score
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-6-triglyceride-glucose-index-is-associated-with-the-severity-of-coronary-artery
- **Specialty:** [Cardiology](https://medichelpline.com/clinical-feed/cardiology.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426)
- **Published At:** 2026-08-17T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- The study evaluated the association between the **triglyceride–glucose (TyG) index** and the severity of coronary artery disease (CAD) as measured by the **Gensini Score (GS)** in patients undergoing coronary angiography. - This single-center, cross-sectional analysis included 861 adult patients with coronary heart disease (CHD) who underwent coronary angiography at the Fourth Affiliated Hospital of Harbin Medical University between June 2022 and June 2024. - Patients were stratified into three groups (low, moderate, high stenosis) according to Gensini scores calculated from coronary angiography findings. - TyG index values differed significantly between the mild and severe stenosis groups (p = 0.0021) and between the moderate and severe groups (p = 0.0173), indicating higher TyG levels with more severe stenosis. - When analyzed as a continuous variable, the TyG index was significantly associated with coronary stenosis (odds ratio [OR] = 1.591; 95% confidence interval [CI]: 1.237–1.866). - After adjustment for confounders including age, sex, diabetes, and hypertension, higher TyG quartiles showed increased odds for severe coronary stenosis relative to the reference quartile; reported adjusted ORs for quartiles were provided though confidence intervals included 1 for some quartiles (reported ORs: 0.932, 1.045, 1.101 with corresponding 95% CIs reported in the source). - The authors conclude that the **TyG index** is positively associated with the extent of coronary artery stenosis and may serve as an indicator of atherosclerosis severity and a surrogate of **insulin resistance** in CHD patients. - The study reports that TyG may complement serum biomarkers for diagnostic assessment, but details on which biomarkers or diagnostic performance metrics were used were not reported in the source extract. - The analysis used multivariate logistic regression; specific model covariates beyond age, sex, diabetes, and hypertension were not fully enumerated in the provided source text. - The paper is an open-access research article published in PLoS ONE (2026); funding sources and ethical compliance statements were reported in the manuscript.
## Clinical Analysis & Structured Key Points
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Triglyceride-glucose index is associated with the severity of coronary artery disease * Di Wang , Contributed equally to this work with: Di Wang, Ying Wang, Fangfang Li Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Writing – original draft, Writing – review & editing Affiliations The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China, Pathology Laboratory, Harbin Medical University, Harbin, Heilongjiang, China, Laboratory of the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China ⨯ * Ying Wang , Contributed equally to this work with: Di Wang, Ying Wang, Fangfang Li Roles Data curation, Formal analysis Affiliation The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China ⨯ * Fangfang Li , Contributed equally to this work with: Di Wang, Ying Wang, Fangfang Li Roles Data curation, Formal analysis Affiliation The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China ⨯ * Zhenyu Wang, Roles Conceptualization, Investigation, Methodology, Resources Affiliation The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China ⨯ * Kangde Zeng, Roles Methodology, Software Affiliation The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China ⨯ * Shujun Yan, Roles Formal analysis, Investigation Affiliation The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China ⨯ * Danyang Liu, Roles Formal analysis, Investigation Affiliation The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China ⨯ * Degen Pei, Roles Formal analysis, Investigation Affiliation The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China ⨯ * Ling Weng, Roles Supervision, Validation Affiliation The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China ⨯ * Enze Jin Roles Funding acquisition, Supervision, Validation, Writing – review & editing * E-mail: enzejin@163.com Affiliation The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0003-2127-2083 ](https://orcid.org/0000-0003-2127-2083 "ORCID Registry") ⨯ # Triglyceride-glucose index is associated with the severity of coronary artery disease * Di Wang, * Ying Wang, * Fangfang Li, * Zhenyu Wang, * Kangde Zeng, * Shujun Yan, * Danyang Liu, * Degen Pei, * Ling Weng, * Enze Jin ![PLOS](https://journals.plos.org/resource/img/logo-plos-full-color.svg) x * Published: August 17, 2026 * * [Article](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426) * [Authors](https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0356426) * [Metrics](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356426) * [Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0356426) * [Media Coverage](http://plos.altmetric.com/details/doi/10.1371/journal.pone.0356426) * [Abstract](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#abstract0) * [Background](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#sec001) * [Methods](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#sec002) * [Results](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#sec008) * [Discussion](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#sec012) * [Conclusion](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#sec013) * [Supporting information](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#sec014) * [Acknowledgments](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#ack) * [References](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#references) * [Reader Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0356426) * [Figures](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426) ## Abstract Cardiovascular disease(CVD) remains a leading cause of mortality worldwide. Among CVDs, coronary heart disease (CHD) is the most prevalent and represents the primary contributor to chronic disease-related deaths globally. The triglyceride-glucose (TyG) index has been shown to correlate significantly with both mortality and cardiovascular events, indicating its potential as an independent prognostic marker for cardiovascular outcomes. This study aimed to investigate variations in the TyG index among patients stratified by disease severity using Gensini scores and to evaluate the association between the TyG index and disease severity, as well as its diagnostic efficacy in combination with serum biomarkers. A total of 861 patients diagnosed with CHD who underwent coronary angiography were included. All participants were admitted to the Fifth Ward, Department of Cardiovascular Medicine, at the Fourth Affiliated Hospital of Harbin Medical University between June 2022 and June 2024. Comprehensive data, including demographics, laboratory findings, and medical history, were collected from medical records. Based on the Gensini scores derived from coronary angiography, patients were categorized into three groups—low, moderate, and high stenosis—representing the severity of coronary artery occlusion. Multivariate logistic regression analysis was performed to assess the relationship between the TyG index and coronary artery disease severity. TyG levels differed significantly between the mild and severe stenosis groups (p = 0.0021), and between the moderate and severe groups (p = 0.0173). The TyG index, treated as a continuous variable, was significantly associated with coronary stenosis (odds ratio [OR] = 1.591; 95% confidence interval [CI]: 1.237–1.866). After adjusting for confounding factors including age, sex, diabetes, and hypertension, individuals in the second, third, and fourth TyG quartiles exhibited higher odds ratios for severe coronary stenosis compared to the reference group (OR = 0.932; 95% CI: 0.642–1.351; OR = 1.045; 95% CI: 0.691–1.581; OR = 1.101; 95% CI: 0.605–2.004). These findings indicate that the TyG index is positively associated with the extent of coronary artery stenosis and may serve as an indicator of atherosclerosis severity. ## Figures ![Fig 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356426.g001) ![Table 4](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356426.t004) ![Fig 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356426.g002) ![Table 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356426.t001) ![Table 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356426.t002) ![Table 3](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356426.t003) ![Fig 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356426.g001) ![Table 4](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356426.t004) ![Fig 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356426.g002) ![Table 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356426.t001) ![Table 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356426.t002) ![Table 3](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356426.t003) **Citation:** Wang D, Wang Y, Li F, Wang Z, Zeng K, Yan S, et al. (2026) Triglyceride-glucose index is associated with the severity of coronary artery disease. PLoS One 21(8): e0356426. https://doi.org/10.1371/journal.pone.0356426 **Editor:** Paolo Magni, Università degli Studi di Milano, ITALY **Received:** December 4, 2024; **Accepted:** August 3, 2026; **Published:** August 17, 2026 **Copyright:** © 2026 Wang et al. This is an open access article distributed under the terms of the [Creative Commons Attribution License](http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. **Data Availability:** All relevant data are within the manuscript and its [Supporting information](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#sec014) files. ([Supporting information](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#sec014)-Original data). **Funding:** This research was supported by the National Natural Science Foundation of China (Grant #82072030). The participant for this project was Di Wang, who was responsible for the experimental design and manuscript preparation. This study also received funding from the Excellent Youth Project of the Fourth Affiliated Hospital of Harbin Medical University (Grant #HYDSYYXQN2023012), led by Di Wang. Additional support was provided by the Key Project Fund of the Institute of the Fourth Affiliated Hospital of Harbin Medical University (Grant #HYDSYYZ201602), overseen by the corresponding author, Enze Jin, who was responsible for conducting the CAG procedures. The three aforementioned grants supported the preparation of the manuscript, covering the costs associated with professional English editing and the final typesetting of the article. **Competing interests:** The authors have declared that no competing interests exist. ## Background Cardiovascular disease (CVD) remains the leading global cause of death, exerting immense pressure on public health systems and individual well-being [[1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#pone.0356426.ref001),[2](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#pone.0356426.ref002)]. In the early 20th century, CVD accounted for less than 10% of global deaths. By the early 21st century, this figure had risen to nearly 50% in developed countries and approximately 25% in developing nations. By 2020, it was projected to cause around 2.5 million deaths annually, further consolidating its status as the foremost cause of mortality worldwide [[3](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#pone.0356426.ref003)–[5](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#pone.0356426.ref005)]. Over the past three decades, the global burden of CVD has steadily increased. In China, it is one of the leading causes of death, accounting for approximately 40% of total fatalities [[6](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#pone.0356426.ref006),[7](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#pone.0356426.ref007)]. Coronary heart disease (CHD), the most common form of CVD, is the primary cause of death from chronic diseases on a global scale [[8](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#pone.0356426.ref008)]. The pathophysiological basis of CHD is atherosclerosis, which is widely recognized as a chronic inflammatory condition associated with dysregulation in glucose and lipid metabolism [[9](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#pone.0356426.ref009)]. Metabolic disturbances—such as elevated glucose levels, increased insulin resistance, and elevated free fatty acid concentrations—contribute to the progression of atherosclerosis by promoting oxidative stress in vascular endothelial cells and the formation of advanced glycation end products [[10](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#pone.0356426.ref010)]. Studies have shown that high levels of triglyceride-rich lipoproteins lead to the production of oxidized fatty acids, which trigger the release of cytokines, interleukins, and pro-atherogenic adhesion molecules. This cascade induces localized vascular inflammation and accelerates atherosclerotic plaque formation [[11](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#pone.0356426.ref011)]. The TyG index, which combines fasting triglyceride and glucose levels, has emerged as a surrogate marker for insulin resistance and shows a stronger association with cardiovascular events than traditional indicators. Insulin resistance is implicated in endothelial dysfunction [[12](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#pone.0356426.ref012),[13](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#pone.0356426.ref013)] and contributes to the formation of unstable atherosclerotic plaques [[14](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#pone.0356426.ref014)]. It is also a key factor in the development of both type 2 diabetes and CVD. The TyG index is increasingly recognized as a reliable marker for assessing insulin resistance [[15](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#pone.0356426.ref015)]. A large prospective cohort study involving 141,243 individuals from five continents demonstrated that the TyG index significantly correlates with cardiovascular mortality and event risk [[16](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#pone.0356426.ref016)]. Elevated TyG levels are associated with an increased likelihood of major cardiovascular events in patients with diabetes and acute coronary syndrome (ACS), underscoring its potential as an independent prognostic biomarker for CHD outcomes [[17](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#pone.0356426.ref017),[18](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#pone.0356426.ref018)]. Given these findings, identifying risk factors associated with CHD is essential for disease prevention and management. While current therapies primarily focus on lowering low-density lipoprotein cholesterol (LDL-C), even with the advent of PCSK9 inhibitors, a plateau may have been reached in reducing CVD risk among patients with type 2 diabetes and dyslipidemia [[19](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#pone.0356426.ref019)]. In the present study, we focus on a composite index derived from serum triglyceride and glucose levels—the TyG index—to comprehensively evaluate CHD risk factors. This approach enables a more integrated assessment and enhances early detection capabilities. In patients with established CHD, the TyG index provides valuable insight into disease severity. Elevated TyG levels may reflect more complex coronary lesions and a higher risk of adverse cardiovascular outcomes, thereby offering critical reference data for clinical decision-making and prognostic evaluation. Coronary angiography is considered the gold standard for diagnosing CHD. The Gensini Score (GS) is a widely accepted scoring system used in coronary angiography to assess the severity of coronary artery stenosis [[20](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#pone.0356426.ref020)]. Originally developed by Goffredo G. Gensini in 1975, this scoring method evaluates the complexity of CHD by incorporating three key elements related to coronary artery lesions: the degree of luminal narrowing, a regional weighting factor, and an adjustment for collateral circulation [[21](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#pone.0356426.ref021)]. Stenosis severity is classified in percentage intervals, with a score of 1 assigned to 1–25% stenosis, and the score doubling with each additional 25% increment. Additionally, the GS integrates weighting coefficients based on the myocardial territory supplied by each coronary artery or its branches. Each lesion score is multiplied by an anatomically determined factor reflecting the functional significance of the affected vascular region. The final Gensini Score is calculated by summing all individual lesion scores, thereby providing a comprehensive evaluation of the overall burden of coronary artery disease in a given patient [[22](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356426#pone.0356426.ref022)]. However, the association between the severity of coronary artery stenosis and the triglyceride-glucose (TyG) index remains inadequately explored. Therefore, the present study aimed to evaluate the correlation between the TyG index and the degree of coronary artery stenosis, as quantified by the Gensini Score, in patients diagnosed with CHD. Specifically, we sought to investigate variations in the TyG index across different levels of stenosis severity based on Gensini scores and to assess the diagnostic efficacy of the TyG index, particularly in combination with serum biomarkers. ## Methods ### Study population and design This study was designed as a cross-sectional observational analysis conducted in accordance with the Declaration of Helsinki. No data related to patient identity or personal privacy were collected. The study enrolled patients admitted to the Fifth Ward, Department of Cardiovascular Medicine, at the Fourth Affiliated Hospital of Harbin Medical University, who underwent coronary angiography between June 2022 and June 2024. Inclusion criteria were as follows: (1) adults aged 18 years or older; (2) a diagno
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