High triglyceride-glucose scores tracked with up to 45% higher heart risk

Cardio-kidney-metabolic syndrome is a staged framework that groups together heart, kidney and metabolic problems, with stages 0 to 3 covering people who have not yet developed full cardiovascular disease. Spotting which of those people are heading for heart trouble is exactly the window where prevention can still work. The triglyceride-glucose index and its variants are cheap scores built from routine blood tests, sometimes combined with BMI, waist circumference or waist-to-height ratio. This review asked whether these scores predict new cardiovascular disease in that early-stage group, and whether any version of the score does the job better than the rest.

The authors searched four major research databases from their beginnings to May 2026 for studies linking triglyceride-glucose indices with new cardiovascular disease in people at stages 0 to 3 of cardio-kidney-metabolic syndrome. Two reviewers independently screened the studies, extracted the data and rated study quality. Nine prospective cohort studies, all judged high quality, made the cut. The team then pooled the risk estimates comparing people in the highest band of each index against the lowest, and ran subgroup analyses, exploratory meta-regression, leave-one-out checks and tests for publication bias to probe how sturdy the findings were.

Every index showed a significant association with new cardiovascular disease. Compared with the lowest band, people in the highest band had 1.24 times the risk on the basic triglyceride-glucose index, rising to 1.44 for the BMI version, 1.42 for the waist version and 1.45 for the waist-to-height version. The composite versions looked numerically stronger, but their intervals overlapped and no direct statistical comparison was possible, so no winner can be declared. The included studies disagreed with each other substantially, with follow-up length and age explaining some of that disagreement, and no sign of publication bias emerged, though fewer than 10 studies per index limited the power of that check.

These results strengthen the case that triglyceride-glucose indices carry genuine information about heart risk before cardiovascular disease is established, extending earlier work into the cardio-kidney-metabolic framework. They stop short of showing the indices cause anything, since all nine studies simply followed people over time. The populations studied were not diverse, the studies disagreed considerably, and whether adding waist or BMI genuinely improves prediction remains unresolved. The authors call for large multi-ethnic prospective studies before these scores can claim a formal place in clinical risk assessment.

Triglycerides and fasting glucose appear on many routine blood panels, and this analysis suggests that, taken together and especially alongside waist size, they track future heart risk in people without established cardiovascular disease. That makes them a potential early flag worth understanding rather than a diagnosis. A high score here is an association, not a sentence, and the authors position these indices as possible auxiliary markers rather than replacements for standard risk assessment. It is a reason to see ordinary metabolic numbers as connected to heart health rather than as separate silos.