# Triglyceride–glucose index and atherogenic index of plasma as predictors of cardiovascular risk in rectal cancer survivors

## TL;DR

This study shows that the triglyceride-glucose index and atherogenic index of plasma are linked to cardiovascular risk in rectal cancer survivors, especially in older patients.

## Contribution

The study identifies TyG and AIP as novel metabolic predictors of cardiovascular disease in rectal cancer survivors.

## Key findings

- TyG and AIP were independently associated with increased cardiovascular disease risk in rectal cancer patients.
- The predictive value of TyG and AIP was stronger in patients aged 62 years or older.
- Proteomic analysis revealed 14 proteins linked to lipid metabolism and other pathways that may mediate the observed associations.

## Abstract

Rectal cancer survivors face elevated cardiovascular disease (CVD) risk, but simple metabolic indices for risk stratification remain underexplored. We investigated associations of triglyceride-glucose index (TyG) and atherogenic index of plasma (AIP) with secondary CVD in rectal cancer patients.

We analyzed rectal cancer patient data from the First Affiliated Hospital of Gannan Medical University (January 2010 to December 2023) to evaluate the associations between TyG, AIP and CVD. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed using UK Biobank proteomics data to identify mediating proteins.

This study included 1,431 cases, among which 1,240 had no CVD and 191 had CVD. Both TyG (OR 1.102, 95% CI: 1.030–1.179, p = 0.005) and AIP (OR 1.062, 95% CI: 1.010–1.116, p = 0.018) showed independent associations with CVD risk in multivariable models. Age significantly modified these associations (interaction p < 0.05), with stronger effects in patients ≥62 years. Combined TyG + AIP modestly improved prediction (IDI: 1.2%, p = 0.013) compared to clinical variables alone. Proteomic analysis identified 14 mediating proteins enriched in lipid metabolism, complement/coagulation, and tight junction pathways.

TyG and AIP indices were independently associated with secondary CVD risk in rectal cancer patients, with age-dependent effects. While the predictive improvement was modest, these easily obtainable indices may aid risk stratification when combined with traditional factors. Proteomic findings suggest potential mechanistic pathways warranting further investigation.