The predictive significance of the triglyceride-glucose index in forecasting adverse cardiovascular events among type 2 diabetes mellitus patients with co-existing hyperuricemia: a retrospective cohort study

Background The triglyceride-glucose (TyG) index functions as a crucial parameter for assessing insulin resistance (IR) and cardiovascular vulnerability among type 2 diabetes mellitus (T2DM) patients. Concurrently, hyperuricemia (HUA) demonstrates robust correlations with unfavorable cardiovascular outcomes. Nevertheless, the prognostic capability of the TyG index particularly within populations exhibiting both conditions remains inadequately defined. This investigation examined the relationship between TyG index measurements and the incidence of major adverse cardiovascular events (MACEs) in subjects simultaneously diagnosed with T2DM and HUA. Methods This retrospective cohort analysis from a single institution incorporated 628 patients diagnosed with both T2DM and HUA at Chaohu Hospital (Anhui Medical University) between 2019–2024. Participants were stratified into tertiles according to their TyG index values. MACE probability was evaluated through Kaplan-Meier curves with log-rank comparisons, while hazard ratios were calculated using Cox regression analyses. The supplementary predictive contribution of the TyG index was quantified via C statistics, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) parameters. Results Throughout the 38.00 ± 8.78 month surveillance interval, 74 MACEs were documented. A distinct proportional association emerged between TyG index and cardiovascular incidents—subjects in the uppermost tertile experienced markedly elevated risk compared to those in the lowest category (HR = 2.45, 95%CI 1.23–4.95). A pivotal demarcation point was identified at TyG > 8.40, beyond which each standard deviation increment corresponded to 66% heightened MACE probability (HR = 1.66, 95%CI 1.36–2.36, P = 0.014). Incorporation of the TyG index into traditional risk frameworks considerably enhanced predictive efficacy across multiple statistical indicators (C statistic enhancement: 0.64→0.67, P = 0.029; NRI = 0.14, IDI = 0.02, both P < 0.05). Conclusion The TyG index constitutes an autonomous MACE predictor specifically within the distinctive cohort of patients manifesting both T2DM and HUA. Systematic evaluation of this biomarker could enhance risk classification and therapeutic approaches for these particularly susceptible individuals.