Association of the Triglyceride-Glucose Index With Established Cardiovascular Disease in Adults With Metabolic Dysfunction-Associated Steatotic Liver Disease: A Cross-Sectional Study

Background Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognised as a multisystem disorder in which cardiovascular disease represents the leading cause of morbidity and mortality. The triglyceride-glucose (TyG) index is a simple surrogate marker of insulin resistance, but its association with established cardiovascular disease in individuals with MASLD has not been well characterised. Methods In this cross-sectional study, consecutive adults attending a general medicine outpatient clinic at a tertiary care teaching hospital between May 2023 and October 2025 underwent comprehensive metabolic, hepatic, and cardiovascular evaluation. MASLD was defined using contemporary consensus criteria. Established cardiovascular disease was defined a priori using objective diagnostic criteria, including electrocardiography, transthoracic echocardiography, and ankle-brachial index assessment. Multivariable logistic regression was performed to evaluate the association between the TyG index and established cardiovascular disease after adjustment for demographic and cardiometabolic risk factors. Model discrimination and dose-response relationships across TyG quartiles were assessed. Results Among 456 participants, 140 (30.7%) had established cardiovascular disease and 415 (91.0%) met criteria for MASLD. Each one-standard deviation increase in the TyG index was independently associated with established cardiovascular disease after multivariable adjustment, with an adjusted odds ratio of 3.05 (95% confidence interval 2.34-3.98). A graded increase in cardiovascular disease prevalence was observed across increasing TyG quartiles, demonstrating a strong dose-response relationship. The TyG-augmented model showed good discrimination, with an area under the receiver operating characteristic curve of 0.82. Conclusions In adults with MASLD, the TyG index is independently associated with established cardiovascular disease, demonstrates a clear dose-response relationship, and improves model discrimination beyond conventional risk factors. These findings support the role of the TyG index as a marker of cardiometabolic burden and highlight the importance of insulin resistance-focused cardiovascular risk assessment in MASLD.