Jing Ning

Aims: This study investigated and compared the abilities of seven insulin resistance (IR) indices, including the triglyceride-glucose index (TyG), TyG-waist circumference (TyG-WC), TyG-waist-to-hip ratio (TyG-WHtR), lipid accumulation product (LAP), visceral adiposity index (VAI), Chinese visceral adiposity index (CVAI), and metabolic score for insulin resistance (METS-IR) to predict cardiovascular disease (CVD) among participants without a history of CVD. Methods: The population was recruited from the prospective Asymptomatic Polyvascular Abnormalities Community (APAC) Study in Hebei. This prospective study included 5,194 individuals without history of CVD who were stratified into CVD group and non-CVD group. The seven IR indices (TyG, TyG-WC, TyG-WHtR, LAP, VAI, CVAI, and METS-IR) were calculated. The primary endpoint was CVD. Results: Over a 12-year follow-up period, 373(7.2%) CVD were documented. The seven IR indices were strongly positively associated with CVD risk. Compare to other IR indices, CVAI was the strongest predictor for CVD (HR:1.84 95% CI: 1.45–2.35; p < 0.001) and showed the highest diagnostic value for CVD (AUC: 0.654 95% CI: 0.640–0.666; p < 0.001). Adding CVAI to the based model exhibited the maximum increased on incremental risk stratification for CVD (NRI: 0.355; IDI: 0.010; all p < 0.001). Moreover, there was a non-linear association between CVAI and CVD, with a threshold point of 96.21. The association between CVAI and CVD risk was more prominent among individuals aged<65 years, female, and non-hypertension (all P interaction<0.001). Conclusion: Compared to the other six tested IR indices, CVAI might be the most valuable index to predict and stratify CVD risk, with enhanced prediction in women under 65 years of age. This suggests that strategies aimed at improving risk stratification should incorporate CVAI into risk algorithms.

This study investigated and compared the abilities of the triglyceride glucose index (TyG) and its correlated factors involving TyG-body mass index (TyG-BMI), TyG-waist-to-height ratio (TyG-WHtR), and TyG-waist circumference (TyG-WC) to predict cardiovascular disease (CVD) among Chinese postmenopausal women. This topic has not been adequately explored in the existing literature. This prospective study included 1110 Chinese postmenopausal women, stratified into the CVD group and the non-CVD group. The TyG index and its correlated components (TyG, TyG-BMI, TyG-WHtR, and TyG-WC) were calculated. The primary endpoint was CVD. Across a 12-year follow-up period, 76 (6.84%) CVDs were documented. The TyG index, in collaboration with various indicators of obesity, demonstrated a robust positive correlation with the risk of CVD. In comparison to other TyG indices, TyG-WC was the strongest predictor for CVD (HR: 2.61, 95%CI:1.64–4.14; P < 0.001), and the TyG-WHtR index exhibited the strongest diagnostic value in identifying CVD (AUC: 0.632, 95%CI: 0.603–0.660; P < 0.001). Incorporating TyG-WHtR into the base model significantly enhanced incremental risk stratification for CVD (NRI: 0.115, 95%CI: 0.040–0.190, P < 0.05; AIC: 996; BIC: 1041; Harrell’s C-index: 0.73). Decision curve analysis (DCA) suggested that TyG, TyG-WHtR, and TyG-WC can provide significant clinical benefits for Chinese postmenopausal women. The sensitivity analyses have demonstrated the robustness of these results. The TyG index and its correlated factors can effectively predict CVD in Chinese postmenopausal women. TyG-WHtR has the most potent ability to predict CVD among postmenopausal women.

Rationale: Uterine artery spontaneous rupture is a rare but potentially life-threatening complication during pregnancy and puerperium. The lack of typical symptoms makes it difficult to diagnose, which can result in serious consequences for both the mother and fetus. Patient concerns: Case 1 presented with fainting and lower abdominal discomfort, while Case 2 developed hypotension after delivery and remained in poor condition even after rehydration. Diagnoses: Both cases were diagnosed with uterine artery spontaneous rupture, with intraoperative findings revealing ruptures in different branches of the uterine artery. Interventions: Both cases underwent surgical interventions, with laparoscopic surgery performed in Case 1 and repair of the ruptured artery in Case 2. Outcomes: Both cases had successful outcomes, with the ruptured arteries repaired and the patients discharged from the hospital within a week after surgery. Lessons: Uterine artery spontaneous rupture is a rare but potentially life-threatening complication that may present with atypical symptoms. Early diagnosis and prompt surgical intervention are crucial in preventing serious complications for both the mother and fetus. Clinicians should maintain a high level of suspicion for this condition when evaluating patients presenting with unexplained symptoms or signs of peritoneal irritation during pregnancy and puerperium.