Triglyceride Glucose Index, and Its Modified Indices as Reliable Alternative Markers for Insulin Resistance in Men with Acute Coronary Syndrome

Introduction: Acute coronary syndrome (ACS) is a major cardiovascular event exacerbated by factors such as obesity and insulin resistance (IR). Triglyceride-Glucose (TyG) index and its modified indices have recently been suggested as useful stand-in indicators for IR. This study investigates the efficiency of TyG index {and modified indices: with body mass index (TyG-BMI), with waist circumference (TyG-WC), with waist-height ratio (TyG-WHtR), triglyceride to HDL-Cholesterol (TG/HDL) index and combination of TyG+TG/HDL index} in predicting IR in ACS patients in South India. Methods: This prospective cross-sectional study included 139 participants-69 diagnosed with ACS and 70 age-matched healthy controls-conducted at JIPMER, Puducherry, India. Demographic, clinical and biochemical parameters were recorded. IR was assessed using the Homeostasis Model Assessment of IR (HOMA-IR) and TyG index (and its modified indices). Statistical analyses were performed to evaluate differences between groups and correlations using SPSS statistical software. Results: Both HOMA-IR and HOMA-β showed significant differences between cases and controls, indicating increased IR and β-cell dysfunction in ACS patients (p < 0.001). The TyG index and its modified indices were significantly higher in cases than in controls. A significant positive correlation was seen between HOMA-IR and TyG and modified indices. ROC curve analysis demonstrated that the TyG index had the highest predictive value for IR (AUC: 82.0), with high specificity (94.3%) at a cut-off of >3.90. Other indices, such as TyG-WC (waist circumference) and TyG-WHtR (waist height ratio), also showed significant predictive potential. Conclusions: TyG and its modified indices, mainly TyG-WC and TyG-WHtR, may serve as alternative markers (either individually or in combination) for assessing IR in clinical settings especially in remote areas with inadequate medical facilities, providing valuable insights for targeted interventions in this high-risk population.