# Association Between Triglyceride-Glucose Index, Blood Pressure Status, and Coronary Heart Disease Risk Among Chinese Adults With Disabilities: 10-Year Disability Health Survey Cohort Study

## TL;DR

This study finds that high triglyceride-glucose index and blood pressure increase heart disease risk in Chinese adults with disabilities, with stronger effects in those with physical or mild disabilities.

## Contribution

The study is novel in examining combined effects of TyG index and blood pressure on CHD risk specifically in individuals with disabilities.

## Key findings

- The TyG index and blood pressure status independently increase CHD risk in disabled individuals.
- TyG mediates about 20-22% of the BP-CHD association, especially in those with physical disabilities.
- Combined high TyG and hypertension show the highest CHD risk (HR 1.92), with even higher risk in those with intellectual or mental disabilities (HR 3.51).

## Abstract

The triglyceride-glucose (TyG) index and blood pressure (BP) status are key indicators associated with coronary heart disease (CHD). However, limited research has focused on individuals with disabilities.

This study explores the potential combined effects of the TyG index and BP status on CHD risk in groups with varying disability characteristics.

This study analyzed data from the Shanghai Disability Health Survey, conducted between January 2012 and December 2022. Participants were then categorized into 3 BP status groups: nonelevated BP, elevated BP, and hypertension. Cox proportional hazards regression models were used to assess the associations between BP status, the TyG index, and CHD incidence. Additionally, the mediating, interaction, and combined effects of these factors on CHD risk were examined. A stratified analysis was performed based on participants’ disability characteristics, including disability type and severity, to explore potential variations in the associations.

Among the 21,628 participants, the mean age was 53.30 (SD 10.57) years, and 50.89% (11007/21628) were male. In a follow-up of 77.45 months, CHD events occurred in 2312 participants (10.69%). The TyG index and BP status were independently associated with an increased risk of CHD. Mediation analysis showed that TyG explained 20.5% (95% CI 13.6%‐22.0%) of the BP and CHD association. Significant multiplicative interactions were identified (hazard ratio [HR] 1.41, 95% CI 1.02‐1.94), and joint analysis indicated the highest CHD risk in those with both hypertension and elevated TyG (HR 1.92, 95% CI 1.52‐2.42). Stratified analyses revealed stronger mediation in participants with physical disabilities (22.6%, 95% CI 9.0%‐60%) or visual disabilities (16.6%, 95% CI 4.8%‐51%), while this was not significant in those with hearing or speech (P=.07) or intellectual or mental disabilities (P=.13). By disability grading, the mediated proportion was 22.3% (95% CI 9.2%‐59.4%) in mild or moderate and 18.8% (95% CI 15.7%‐29%) in severe or very severe groups. Joint associations showed consistently higher CHD risk across most disability classifications, with particularly elevated risk in people with intellectual or mental disabilities (HR 3.51, 95% CI 1.89‐6.50).

BP and the TyG index were significantly associated with CHD risk in individuals with disabilities, with TyG mediating a part of this association and showing stronger effects in physical and mild to moderate disabilities. Significant interactions between BP and TyG further highlight their combined impact, underscoring the need for integrated interventions targeting both factors.