The triglyceride-glucose index trajectories are associated with cardiovascular diseases in people living with HIV: evidence from a prospective cohort study in China, 2005–2022

Abstract Background The triglyceride-glucose (TyG) index has been validated as a novel biomarker for cardiovascular disease (CVD) risk. However, the prospective relationship between baseline and long-term trajectories of the TyG index and CVD risk in people living with HIV (PLWH) remains unexplored. Methods This cohort study included 16,122 treatment-naive PLWH who initiated antiretroviral therapy (ART) at the Third People's Hospital of Shenzhen from 2005 to 2022. The TyG index was calculated as Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Group-based trajectory modeling was used to identify distinct TyG index trajectories over the follow-up period. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using multivariate Cox proportional hazards models to assess the association between TyG index trajectories and CVD risk. Nonlinear relationships were investigated using a restricted cubic spline plot. Results During a median follow-up of 70 months, 214 PLWH developed CVD. Each 1-standard deviation (SD) increase in the baseline TyG index was associated with a 39% higher risk of CVD (HR 1.39, 95% CI 1.22, 1.59) after adjusting for covariates. Participants were categorized into four distinct TyG trajectory groups: low-stable, low-moderate-stable, high-moderate-stable, and high-increasing. After multivariate adjustment, the high-increasing trajectory group had a 2.92-fold (95% CI 1.68, 5.05) increased risk of CVD compared to the low-stable group. The restricted cubic spline plot showed an upward trend between the baseline TyG index and the CVD occurrence (P