Lupus Sci Med. 2026 Sep 12;13(2):e002141. doi: 10.1136/lupus-2026-002141.
ABSTRACT
BACKGROUND: SLE is a chronic autoimmune disease associated with heightened cardiovascular risk. However, the relationship between the triglyceride-glucose (TyG) index and cardiovascular involvement remains unclear. This study aimed to evaluate the association between the TyG index and cardiovascular involvement in SLE.
METHODS: We conducted a retrospective cohort study of 991 patients with SLE admitted between 2000 and 2021, spanning 21 years with extended follow-up. Kaplan-Meier curves were used to compare event-free survival across TyG quartiles, and differences between curves were assessed using the log-rank test. Time-to-event analyses were performed using Cox proportional hazards regression models. The proportional hazards assumption was assessed using scaled Schoenfeld residuals. Restricted cubic spline analyses based on Cox models were performed to evaluate the dose-response association between TyG and cardiovascular outcomes.
RESULTS: Cardiovascular involvement occurred in 251 patients (25.3%), consisting of 210 inflammatory or lupus-related manifestations and 41 major adverse cardiovascular events (MACE). Elevated TyG correlated with progressively lower event-free survival. An approximately linear association was observed between TyG and both overall cardiovascular involvement and inflammatory/lupus-related cardiovascular manifestations. Each one-unit increase in TyG remained associated with higher risk after multivariable adjustment (adjusted HR 1.36 for both outcomes, both p<0.05). These associations were materially unchanged after accounting for non-proportional covariate effects (overall cardiovascular involvement: HR 1.37, 95% CI 1.10 to 1.71; inflammatory/lupus-related manifestations: HR 1.35, 95% CI 1.06 to 1.74). For the original MACE composite, higher TyG was associated with increased risk in the adjusted analysis; however, this finding was less robust in a post hoc sensitivity analysis excluding heart failure and should be interpreted cautiously because of the limited number of events.
CONCLUSION: These findings support the potential value of the TyG index as an accessible marker of cardiometabolic risk in SLE.
PMID:42731885 | DOI:10.1136/lupus-2026-002141