ABSTRACT NUMBER: ESOC2026A651 THE TRIGLYCERIDE-GLUCOSE INDEX (TYG) AS AN EMERGING BIOMARKER OF INSULIN RESISTANCE IN ATHEROTHROMBOTIC ISCHEMIC STROKE

Abstract Background and aims The triglyceride-glucose (TyG) index has been proposed as a surrogate marker of insulin resistance in ischemic heart disease. Emerging evidence suggests a role in ischemic stroke risk stratification. We aimed to evaluate the TyG index as a marker of insulin resistance in atherothrombotic ischemic stroke. Methods We retrospectively analyzed electronic health records of patients with atherothrombotic ischemic stroke admitted from January 2023 to September 2025. The TyG index was calculated as “ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL) / 2]”, using the laboratory values closest to the stroke event. Patients were categorized as TyG < 4.68 (no insulin resistance) or TyG ≥ 4.68 (insulin resistance). Results Among 205 patients, TyG index was available in 173, and 53.76% had TyG ≥ 4.68. The TyG ≥ 4.68 group had more men (73.1% vs 53.8%), dyslipidemia (88.2% vs 62.5%), diabetes (58.1% vs 32.5%), and smokers (71% vs 20%) rate than the TyG < 4.68 group. No significant differences were observed in NIHSS at discharge, 90-day mRS, mortality, or early recurrence. In patients without prior diabetes or prediabetes, TyG identified insulin resistance in 48.6%, whereas HbA1c identified it in 27.6%. Conclusions Over half of atherothrombotic stroke patients exhibited insulin resistance by the TyG index, even without hyperglycemia. In non-diabetic patients, the TyG index identified insulin resistance more frequently than HbA1c. These findings support the TyG index as a valuable tool for vascular risk stratification in this type of patients. Conflict of interest Óscar Camejo: Nothing to disclose