Association of the triglyceride-glucose index with dynamic bidirectional transitions of cardiovascular-kidney-metabolic syndrome: a multistate Markov model study based on CHARLS.

Authors

Xiunan Liu, Buyuan Tian, Hongwei Leng, Xumao Deng, Yun Sun, Xiang Xiao

Published in

Frontiers in medicine. Volume 13. Pages 1912039. Epub Sep 28, 2026.

Abstract

To characterize dynamic transitions across cardiovascular-kidney-metabolic (CKM) stages and examine the associations of the TyG index with bidirectional transitions between low- and high-risk CKM states among middle-aged and older adults.
Data were obtained from CHARLS. A continuous-time multistate Markov model was used to estimate transition intensities, predicted transition probabilities, and expected sojourn times across CKM stages 0-4. A two-state Markov model was further constructed by defining CKM stages 0-2 as the low-risk state and stages 3-4 as the high-risk state to evaluate the associations of the TyG index with CKM progression and reversal.
A total of 5,135 participants were included. CKM stages 0-3 exhibited clear bidirectional transitions, with more active transitions at earlier stages and longer expected sojourn times at higher stages. The predicted 4-year probabilities of transition to CKM stage 4 among participants initially in stages 0, 1, 2, and 3 were 8.3%, 8.8%, 12.0%, and 13.9%, respectively. The expected sojourn time increased from 1.97 years in stage 0 to 10.64 years in stage 3. In the multivariable-adjusted two-state model, compared with the lowest TyG tertile, the HRs for progression from the low-risk to the high-risk CKM state were 1.15 (95% CI: 0.96-1.37) for T2 and 1.35 (95% CI: 1.11-1.65) for T3. Restricted cubic spline analysis showed a significant linear positive association between the TyG index and CKM progression risk. No significant association was observed between the TyG index and reversal from the high-risk to the low-risk CKM state.
CKM exhibited a clear dynamic evolutionary pattern, with greater transition activity at earlier stages and increasing persistence at more advanced stages. Higher TyG levels were associated with progression from the low-risk to the high-risk CKM state but not with CKM reversal. The TyG index may provide complementary information for identifying individuals at increased risk of CKM progression.

PMID:
42865477
Bibliographic data and abstract were imported from PubMed on 13 Oct 2026.

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