AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2692-9759/111
1 Kermanshah University of Medical Sciences, College in Kermanshah, Iran.
2 Sulaimani polytechnic university, Kurdistan Region, Iraq.
*Corresponding Author: Yahya Pasdar, Kermanshah University of Medical Sciences, College in Kermanshah, Iran.
Citation: Kamari N., Hawal L. Fateh, Darbandi M., Najafi F., Pasdar Y., et al., (2023), Association Between the Triglyceride-Glucose Index and The Risk of Cardiovascular Disease in Kurdish Adult: Result from RANCD Cohort Study, Cardiology Research and Reports. 5(5); DOI:10.31579/2692-9759/111
Copyright: © 2023, Yahya Pasdar. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 20 October 2023 | Accepted: 06 November 2023 | Published: 15 November 2023
Keywords: triglyceride glucose index; cardiovascular disease; persian cohort
Background: The triglyceride-glucose (TyG) index, a consistent content for insulin resistance, has been related to cardiovascular disease (CVD). We aimed to perused the relationship between the TyG index and development of CVD in Kurdish adults.
Materials and Methods: In this cross-sectional study, data was used from the Ravansar Noncommunicable Diseases (RaNCD) Cohort Study. Subjects with a history of stroke, myocardial infarction, or coronary artery disease, or who were currently receiving medications for these conditions, were classified as CVD patients.
Results: The research comprised 9723 individuals overall (51.76% of whom were female, mean age 47.3 ±8.26 year). We found that the TyG index in CVD patients (8.82±0.81) was substantially higher than that in non-CVD patients (P=0.001), and the top quartile of the TyG had significantly more BMI (28.73±4.20), TG (239.45±103.30), and FBS (117.85±50.36) values than the lowest quartiles (P=0.001). The TyG and CVD showed a positive association according to the cohort data. The chances of CVD were 2.54 (95% CI: 2.16-2.98) times higher in the fourth tertile of the TYG index than in the first tertile. After controlling for confounding factors, their association was still significant (OR: 1.58, 95%Ci: 1.35-1.95). The predictive value of the TYG score was 63% for females and 57% for males, according to ROC curve research.
Conclusion: According to the findings, risk of cardiovascular disease was linearly correlated with the triglyceride glucose index. Moreover, the TyG may be more accurate predictor of CVD in female.
Many variables, including diabetes and chronic renal disease, have an impact on the prevalence of cardiovascular disease (CVD), adding a significant financial bar on the national health system [1]. In order to minimize the occurrence of cardiovascular disease and comorbidities, it is necessary to identify the population at risk for the condition.
With the recent rise in living standards, the burst of type 2 diabetes mellitus (T2DM) and insulin resistance (IR) has significantly grown [2]. T2DM recognized as a risk factor that influences the development of CVD and treatment options [3]. The development of diabetic mellitus (DM) is mostly attributed to IR, which is also recognized as a risk factor for CVD [4]. Also, it has been shown that fasting glucose and TG levels within the high normal range may indicate a person's risk of developing a cardiovascular disease [5, 6]. Thus, it may be clinically necessary to assess the combined value of TG and fasting glucose in individuals who had stable coronary artery disease (CAD). The triglyceride glucose index (TyG) is a new measure with high sensitivity to detect metabolic syndrome [7]. Previous studies approved correlation between the TyG index and the onset coronary artery stenosis, coronary artery calcification, and carotid artery atherosclerosis, despite the attendance of diabetes [8]. An elevated TyG index is independently associated with a higher risk of myocardial infarction (MI), according to a large study conducted in China, highlighting the need to monitor TyG index to identify individuals at high risk of myocardial infarction [9]. Prospective cohort studies on the relationship between the TyG index and newly diagnosed cardiovascular disease are currently missing. Owing to the rise in CVD prevalence, thus aim of the current study was to explore the association between the TyG index and the risk of developing CVD in subjects of the Ravansar Non-Communicable Diseases (RaNCD) cohort study, in Kermanshah, Iran.
Study design and participants
This cross-sectional study was conducted in 2018 in western Iran using baseline data from the Ravansar Noncommunicable Disease (RaNCD) Cohort Study. A total of 10047 subjects were enrolled in the RaNCD as part of prospective epidemiological studies in various Iranian ethnic groups conducted in collaboration with the Ministry of Health and Medical Education. The sampling process was based on the capitation.
One of the cities in the province of Kermanshah is Ravansar. The largest and most significant Kurdish settlement in western Iran is located in the provincial capital of Kermanshah, which has a population of around a million people. Over 50,000 people live in the rural and urban regions of the Ravansar district, with 30% of them being between the ages of 35 and 65 and mostly being of Iranian Kurdish ethnicity.
Written and verbal informed permission was obtained from each participant who matched the inclusion criteria. The cohort study's eligibility requirements were being between the ages of 35 and 65, permanently residing in Ravansar area and be Iranian. Excluded are those who do not wish to participate in the study, stay in Ravansar less than nine months a year, have recently moved to Ravansar (less than one year), cannot come to the cohort center or cannot speak with the interviewers (physical. or physical disabilities due to stupidity, deafness, blindness, severe psychiatric illness due to mental disability). 324 participants in this research Excluded, including 83 persons with cancer, 44 with renal failure, and 138 women who were pregnant. This study also contains 59 missing data points. In the end, 9,723 participants were choosing to take part in the study. Alcohol use and be smoker or not, were evaluated by a self-completed questionnaire. Based on their smoking history, participants were divided into current and past smokers. For drinking alcohol, a question with two possible answers (yes or no) was used. The study's design and justification in its entirety have already been published [10].
Measurements
A bioimpedance analyzer (Inbody 770, Inbody Co, Seoul, Korea) was used to determine body weight to the nearest 0.5 kg. BSM 370 (Biospace Co, Seoul, Korea) was used to measure height. The formula for determining a person's body mass index (BMI) is to multiply their weight in kilograms by the square of their height (in meters). WC was measured to the nearest 0.5 cm using a flexible measuring tape at a point halfway between the lower edge of the ribs and the iliac crest. The WHR was decided by the BIA.
After each participant had rested for 10 minutes, blood pressure (BP) was measured in a seated position using a sphygmomanometer (Reister), cuff, and stethoscope (Reister), with a 5-minute shatter between each measurement. The average of the three measurements was then used to calculate blood pressure. In the cohort study, blood samples were taken from the antebrachial vein with sterile infusion tubing and syringes after 8–12 hours of fasting. Using commercially available kits and following the manufacturer's instructions, we tested serum's TG, TC, LDL, and HDL concentrations as well as the patient's fasting blood sugar levels. A standardized cohort study questionnaire based on met/hour per day was used to measure physical activity [11].
TyG index calculation and the study outcomes
TyG index was evaluated based on the TG and FBG concentration according to the equation: ln [TG (mg/ dl) ×FBG (mg/dl)/2] [12, 13]. People are considered to have a CVD, under the RaNCD cohort study protocol, if they have ever received treatment for one or more heart conditions such as stroke, heart attack or coronary artery disease, or if they are currently taking medication to treat them [14].
The investigation made use of STATA software version 14.2 (Stata Corp, College Station, TX, USA). The significance level was set at 0.05. Results for the quantitative and qualitative components were presented as mean SD and percentage (frequency), respectively.
Characteristics of subjects with cardiovascular disease were compared using Chi-square and T-tests. We used one-way ANOVA and Chi-square testing to examine variations in the TYG index.
Logistic regression analysis was used to compute odds ratios (OR) and 95% confidence intervals (CI) for the association between TyG index and CVD risk. Model 1 wasn’t adjusted. Model 2 was adjusted for age and gender. Model 3 was modified to account for Variants and behavioral factors from Model 2 (smoking, alcohol consumption, physical activity and SES). Model 4 also has modifications for traits including age, sex, behavioral factors and metabolic factors (systolic and diastolic blood pressure, body mass index), T2DM, Renal Failure and Energy.
When comparing predictive validity, use receiver operating characteristic (ROC) analysis to determine the best cutoffs. sensitivity (true positive rate) and specificity measurements were performed to generate ROC curves based on FBS, TG, and TyG cutoffs (False positive rate). The ROC curves demonstrated the diagnostic test's overall discriminating power over the whole range of test results. A test's diagnostic effectiveness is measured by the zone under the ROC curve (AUC). A test that works flawlessly has an AUC of 1.0, while a test that performs at least as well as chance has an AUC of 0.5. AUC 0.60 was thought to have subpar diagnostic performance [15]. The FBS, TG, and TyG with the highest Youden index [(sensitivity specificity)1] were approved to have the highest sensitivity and specificity for every risk factor [16].
Baseline characteristics
Of the 9723 studied, 5033 (51.76%) were female. The mean age of patients was 47.30 ± 8.26 years. Almost 47% of subject had moderate physical activity and 33.54% had high Socioeconomic status. 1135 (11.73%) of participants were smoker. A total of 1,632 participants were diagnosed with CVD. Compared with non-CVD participants, those with CVD tended to be older and female. The mean TyG index in CVD group was 8.82 ± 0.81 that significantly was higher than non-CVD group (8.60 ± 0.58) (p = < 0.001). Also, observed BMI (28.75 ± 4.64), SBP (119.39 ± 119.39), TG (150.19 ± 87.97), FBS (107.72 ± 40.12) and BUN (14.17 ± 4.41) were higher in CVD group than another group (p = < 0.001) (Table 1)
| Variables | Total (n = 9,723) | non-CVD (n = 8,091) | CVD (n= 1,632) | P value* |
| Mean ± S.D or Frequency (%) | ||||
| Age (year) | 47.30 ± 8.26 | 46.09 ± 7.82 | 53.29 ± 7.74 | < 0.001 |
| Gender, n (%) | ||||
| Male | 4690 (48.24) | 4115 (50.86) | 575 (35.23) | < 0.001 |
| Female | 5033 (51.76) | 3976 (49.14) | 1057 (64.77) | |
| Place ofresidence, n (%) | ||||
| Rural | 3905 (40.16) | 3206 (39.62) | 699 (42.38) | 0.016 |
| Urban | 5818 (59.84) | 4885 (60.38) | 933 (57.17) | |
| Socioeconomic status, n (%) | ||||
| Low | 3206 (32.99) | 2560 (31.66) | 646 (39.58) | < 0.001 |
| Moderate | 3253 (33.47) | 2701 (33.40) | 552 (33.82) | |
| High | 3260(33.54) | 2826 (34.94) | 434 (26.59) | |
| Physical Activity (met/hour per day), n (%) | ||||
| Light | 2935 (30.19) | 2342 (28.95) | 593 (36.34) | < 0.001 |
| Moderate | 4607 (47.38) | 3823 (47.25) | 784 (48.04) | |
| High | 2181 (22.43) | 1926 (23.80) | 255 (15.63) | |
| Smoking status,n (%) | ||||
| Current smoker | 1135 (11.73) | 998 (12.40) | 137 (8.45) | < 0.001 |
| Former smoker | 851 (8.80) | 650 (8.07) | 201 (12.39) | |
| Drinking, n (%) | 477 (4.91) | 417 (5.15) | 60 (3.68) | 0.012 |
| Body MassIndex (kg/m2) | 27.48 ± 0.04 | 27.23 ± 4.59 | 28.75 ± 4.64 | < 0.001 |
| Waist hip ratio | 0.94 ± 0.06 | 0.93 ± 0.06 | 0.95 ± 0.06 | < 0.001 |
| Percent Body Fat | 33.77 ± 9.48 | 33.02 ± 9.45 | 37.55 ± 8.73 | < 0.001 |
| Visceral Fat Area | 122.03 ± 51.56 | 118.06 ± 50.88 | 141.84 ± 50.39 | < 0.001 |
| SBP (mmHg) | 108.26 ± 16.97 | 106.01 ± 15.24 | 119.39 ± 119.39 | < 0.001 |
| DBP (mmHg) | 69.86 ± 9.90 | 68.86 ± 9.29 | 74.83 ± 11.25 | < 0.001 |
| BUN (mg/dl) | 13.57 ± 4.01 | 13.45 ± 3.91 | 14.17 ± 4.41 | < 0.001 |
| Creatinine (mg/dl) | 0.99 ± 0.18 | 0.98 ± 0.18 | 0.99 ± 0.19 | 0.041 |
| LDL (mg/dl) | 111.5 ± 31.27 | 111.63 ± 30.88 | 111.12 ± 33.11 | 0.546 |
| HDL (mg/dl) | 46.33 ± 11.31 | 46.35 ± 11.31 | 46.25 ± 11.32 | 0.739 |
| TG (mg/dl) | 137.49 ± 84.16 | 134.92 ± 83.14 | 150.19 ± 87.97 | < 0.001 |
| TC (mg/dl) | 185.30 ± 37.74 | 184.90 ± 37.28 | 187.27 ± 39.91 | 0.021 |
| FBS (mg/dl) | 97.06 ± 29.79 | 94.91 ± 26.73 | 107.72 ± 40.12 | < 0.001 |
| TYG | 8.63 ± 59.90 | 8.60 ± 0.58 | 8.82 ± 0.81 | < 0.001 |
Table 1: The baseline characteristics of participants classified by CVD.
Data are shown mean ± D for continuous variables and n (%) categorical variables. *P- value was obtained t-test and Chi square test
Abbreviation: TyG-index triglyceride and glucose index, WC waist circumference, BMI body mass index, SBP diastolic blood pressure, DBP diastolic blood pressure FBS fast blood sugar, TC total cholesterol, TG total three glyceride, LDL-C low-density lipoprotein cholesterol, HDL-C high-density lipoprotein cholesterol
About 54% of people that was in the highest quartile of TyG was men and, about F had moderate physical activity. Also, people with the highest TyG index significantly drink more alcohol (p = 0.008) than people in the lowest level. Compared to Q1 group, BMI (28.73 ± 4.20) in quartile 4 significantly was higher than quartile 1 group (p = < 0.001). It is noteworthy that in Q4 group TG (239.45 ± 103.30) and FBS (117.85 ± 50.36) were higher than Q1 group (p = < 0.001). Also observed that SBP (112.33 ± 17.56) and Creatinine (1.02 ± 0.17), were significantly high in Q4 group of TyG index (p = < 0.001) (Table 2).
| Variables | TYG index | P value | |||
| Q1 | Q2 | Q3 | Q4 | ||
| n (%) | 2431(25.00) | 2431(25.00) | 2431(25.00) | 2430(24.99) | |
| Mean ± SD | 7.92 ± 0.249 | 8.41 ± 0.105 | 8.78 ± 0.115 | 9.42 ± 00.389 | |
| Age (year) | 45.86 ± 8.18 | 47.03 ± 8.25 | 47.72 ± 8.25 | 48.60 ± 8.11 | < 0.001 |
| Gender, n (%) | |||||
| Male | 1049 (43.15) | 1108 (45.58) | 1210 (49.77) | 1323 (54.44) | < 0.001 |
| Female | 1382 (56.85) | 1323 (54.42) | 1221 (50.23) | 1107 (45.56) | |
| Place ofresidence, n (%) | |||||
| Rural | 1013 (41.67) | 966 (39.74) | 936(38.50) | 990 (40.74) | 0.132 |
| Urban | 1418 (58.33) | 1465 (60.26) | 1495 (61.50) | 1440 (59.26) | |
| Socioeconomic status, n (%) | |||||
| Low | 842 (34.64) | 833 (34.28) | 752 (30.95) | 779 (32.08) | 0.007 |
| Moderate | 838 (34.47) | 799 (32.88) | 818 (33.66) | 798 (32.87) | |
| High | 751 (30.89) | 798 (32.84) | 860 (35.39) | 851 (35.05) | |
| Physical Activity (met/hour per day),n (%) | |||||
| Light | 552 (22.71) | 739 (30.40) | 804 (33.07) | 840 (34.57) | < 0.001 |
| Moderate | 1213(49.90) | 1148 (47.22) | 1116(45.91) | 1,130 (46.50) | |
| High | 666 (27.40) | 544 (22.38) | 511 (21.02) | 460 (18.93) | |
| Smoking status,n (%) | |||||
| Current smoker | 246 (10.18) | 287 (11.88) | 292 (12.06) | 310 (12.82) | < 0.001 |
| Former smoker | 172 (7.12) | 179 (7.41) | 235 (9.71) | 265 (10.96) | |
| Drinking, n (%) | 107 (4.40) | 99 (4.07) | 124 (5.10) | 147 (6.05) | 0.008 |
| Body Mass Index (kg/m2) | 25.53 ± 4.46 | 27.32 ± 4.74 | 28.36 ± 4.44 | 28.73 ± 4.20 | < 0> |
| Waist hip ratio | 0.91 ± 0.06 | 0.93 ± 0.06 | 0.95 ± 0.06 | 0.95 ± 0.05 | < 0> |
| Percent Body Fat | 31.26 ± 10.19 | 33.99 ± 9.66 | 35.06 ± 9.01 | 34.79 ± 8.50 | < 0> |
| Visceral Fat Area | 104.39 ± 51.28 | 121.57 ± 52.55 | 131.28 ± 50.26 | 130.91 ± 47.38 | < 0> |
| SBP (mmHg) | 103.62 ± 16.20 | 106.90 ± 16.02 | 110.17 ± 16.78 | 112.33 ± 17.56 | < 0> |
| DBP (mmHg) | 67.55 ± 9.25 | 69.15 ± 9.58 | 70.75 ± 9.85 | 71.98 ± 10.32 | < 0> |
| BUN (mg/dl) | 13.92 ± 4.21 | 13.47 ± 4.00 | 13.38 ± 3.89 | 13.51 ± 3.90 | < 0> |
| Creatinine (mg/dl) | 0.96 ± 0.15 | 0.97 ± 0.23 | 0.99 ± 0.17 | 1.02 ± 0.17 | < 0> |
| LDL (mg/dl) | 100.08 ± 27.25 | 112.92 ± 29.10 | 119.08 ± 30.02 | 114.09 ± 30.00 | < 0> |
| HDL (mg/dl) | 51.56 ± 11.64 | 47.87 ± 10.92 | 44.62 ± 10.20 | 41.28 ± 9.72 | < 0> |
| TG (mg/dl) | 66.71 ± 15.06 | 101.91 ± 14.81 | 141.92 ± 23.01 | 239.45 ± 103.30 | < 0> |
| TC (mg/dl) | 164.97 ± 31.28 | 181.16 ± 32.97 | 192.09 ± 34.28 | 202.99 ± 40.86 | < 0> |
| FBS (mg/dl) | 85.94 ± 8.44 | 90.12 ± 10.52 | 94.34 ± 4.91 | 117.85 ± 50.36 | < 0> |
Table 2: Comparison of the demographic characteristics, behavioral factors and biochemical indices between quartiles of TYG subgroups.
*P- value was obtained one-way ANOVA and Chi square test
Abbreviation: TyG-index triglyceride and glucose index, WC waist circumference, BMI body mass index, SBP diastolic blood pressure, DBP diastolic blood pressure FBS fast blood sugar, TC total cholesterol, TG total three glyceride, LDL-C low-density lipoprotein cholesterol, HDL-C high-density lipoprotein cholesterol
Association between TyG index groups and CVD
The results of logistic regression analysis are presented in Table 3. Univariate logistic regression analysis showed a statistically significant correlation between TyG index and CVD. Data from Model 4 showed that the risk of cardiovascular disease increased with increasing TyG index. Compared to Q1 group as reference, those on Q2 group had an odd of 1.16 (95% CI: 0.96–1.41) times more to CVD. In the following Q3 group 1.31 (95% CI :1.09–1.58) and Q4 group 1.58 (1.35–1.95) times had more odds of CVD than Q1 group (p = < 0.001).
| TYG | Model 1 | Model 2 | Model 3 | Model 4 |
| OR (95%CI) | OR (95%CI) | OR (95%CI) | OR (95%CI) | |
| Q1 | Ref | Ref | Ref | Ref |
| Q2 | 1.43 (1.20–1.69) | 1.31 (1.09–1.57) | 1.28 (1.07–1.53) | 1.11 (0.92–1.34) |
| Q3 | 1.89 (1.60–2.22) | 1.69 (1.42–2.02) | 1.63 (1.37–1.94) | 1.27 (1.06–1.53) |
| Q4 | 2.54 (2.16–2.98) | 2.23 (1.88–2.64) | 2.14 (1.80–2.54) | 1.58 (1.35–1.95) |
| P valuetrend | < 0.001 | < 0.001 | < 0.001 | < 0.001 |
Table 3: The association between TyG index groups and CVD.
Model 1: Unadjusted.
Model 2: Adjusted for age and sex.
Model 3: Adjusted for age, sex and behavioral factors (smoking status, alcohol intake, physical activity and SES)
Model 4: Adjusted for age, sex, behavioral factors and metabolic factors (systolic and diastolic blood pressure, body mass index), T2DM, Renal Failure and Energy.
ROC Curve of the Risk CVD According to FBS, TG and TyG Index
To determine the predictive value of FBS, TG and TyG index for CVD, analysis of the area under the ROC curve was performed, the predictive power of TYG index was 57% in male and 63% in female. While the predictive power of FBS in male 61% and 63% in female. Also, predictive power for TG was performed, in male was about 53% and in female was about 59%, respectively. (Figures 1 and 2).
Figure 1: Receiver-operating characteristic (ROC) analysis of TyG as indicators to predict CVD in Male.
Figure 2: Receiver-operating characteristic (ROC) analysis of TyG as indicators to predict CVD in female.
TyG index has reportedly been linked to CVD risk in those who seem to be in good health [17]. The TyG index's predictive usefulness in individuals with stable CAD is yet unknown, however.
Therefore, the aim of this study was to investigate the relationship between TyG index and cardiovascular disease in Iranians. Our study is the first to examine this link in the sizable Kurdish population, as far as we are aware.
In our investigation, we found a substantial correlation between the prevalence of CVD and the TyG index. Compared with the lowest tertile of the TyG group, the highest tertile (Q4 group) was associated with a 1.58-fold increased CVD risk (Q1 group).
The exact mechanism of the association between TyG index and CVD is not yet fully understood. A trustworthy indicator of IR has been suggested as the TyG index [18]. The major cause of these correlations may thus be IR. First, IR is crucial for endothelial dysfunction, [19] chronic inflammation, [20] as well as platelet activation, adhesion, and aggregation [21]. Second, IR was linked to the onset of atherosclerosis, the growth of plaque, and plaque rupture [22, 23]. Finally, IR may be a process that causes diabetes and hypertension [24], A high level of TyG index can act as a surrogate biomarker of IR and cause lip toxicity in the cardiovascular system in addition to the harmful vascular remodeling caused by oxygenation and systemic inflammation. Together, these elements—along with dyslipidemia and hypertension increase the risk of CVD [25]. This provides strong support for the hypothesis that a high TyG index can be a reliable biomarker for the development of cardiovascular disease. A previous clinical study also showed that the TyG index is a reliable indicator of the development of coronary artery calcification [26] It was a more significant CVD predictive factor in diabetic patients than hemoglobin A1 [27].
Cross-sectional data provide further evidence that the TyG index and CVD are related [28] as well as a case-control study [29]. Retrospective cohort research conducted recently by Li et al [30] studied how the TyG-index affected older citizens' incident CVD. In our study, a multivariate adjusted model showed that the upper quartile was related with a higher risk of cardiovascular disease than the lower quartile. Moreover, Park et al [31] showed that the TyG index is an accurate predictor of coronary artery calcification progression. Inigo Sanchez et al, [17] showed that the TyG index was significantly associated with a higher risk of cardiovascular disease. Between the fourth and fifth quintiles, The European population had a 1.52 and 2.32 higher risk of cardiovascular disease. In our data analysis, multivariate analyzes showed a 1.62 higher CVD risk in the fourth quintile of TyG index. In addition, we found that the TyG index is a better predictor of cardiovascular disease in women. Meanwhile, Salazar et al, [32] conducted a study among Argentines aged 15–80 years and found that the continuous variable TyG index was associated with a 46% increased risk of cardiovascular disease in a multivariate analysis. However, this measurement risk did not materialize when the TyG index was treated as a categorical variable.
According to several studies, the TyG index strongly mediates the relationship between BMI and DM and CVD onset. As a result of obesity, increased production of free fatty acids leads to IR. In addition, it reduces insulin signaling and at the same time increases the transport of glucose in the liver [33, 34]. furthermore, obesity-induced inflammation promotes triglyceride synthesis, lipolysis, and fatty acid esterification in the liver, which increases the development of hyperlipidemia [35]. Acting as a reasonable mediator between BMI and future CVD risk, the TyG index, which is constructed using TG and FBG concentrations, helps explain the J-shaped association between the TyG index and future CVD incidence [36].
A limitation of this study was its cross-sectional design, which prevented the establishment of appropriate causal relationships. One of the main strengths of the study is the use of prospective research data (RaNCD), which ensured excellent quality of anthropometric and laboratory data. Another important advantage is its sample size. The prediction values determined in this study apply to all Kurdish regions.
The TyG index was associated with the possibility of CVD. Cardiovascular disease risk was positively associated with TyG index in the population with high TyG index values. Moreover, the TyG index may be a more accurate predictor of CVD in women than in men.
Ethics approval and consent to participate
The study was approved by the ethics committee of Kermanshah University of Medical Sciences (KUMS.REC.1394.318). All methods were carried out in accordance with relevant guidelines and regulations. All the participants were provided oral and written informed consent. All methods were carried out by relevant guidelines and regulations. This study was conducted by the Declaration of Helsinki.
Consent for publication
Not applicable.
Competing interests
The authors declare no conflicts of interest.
Funding Sources
This research was supported by Kermanshah University of Medical Sciences (grant number: 92472).
Authors’ contribution
YP and FN designed the study. MD analyzed the data. HL and NK prepared the draft of the manuscript. ES, YP and FN and MB reviewed and approved the final manuscript.
Acknowledgements
The authors thank the PERSIAN cohort Study collaborators and of Kermanshah University of Medical Sciences. The Iranian Ministry of Health and Medical Education has also contributed to the funding used in the PERSIAN Cohort through Grant no 700/534.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
