• Xiaoyan Wang and Shuchuan Miao.
• Department of Clinical Nutrition, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China.
• Am J Prev Med. 2025 Feb 4.

IntroductionInsulin resistance (IR) is a well-establsihed risk factor for stroke. However, the relationship between triglyceride-glucose (TyG) index, its modified indices‒TyG-waist circumference (TyG-WC), TyG-waist-to-height ratio (TyG-WHtR), and TyG-BMI‒and the risk of stroke in populations without diabetes remains underexplored.MethodsData from the CHARLS on 4,029 participants without diabetes aged 45+ at baseline (2011‒2012) were analyzed, with follow-ups through 2020. Statistical analysis and modeling were performed in 2024. Incident strokes occurring between 2015 and 2020 were examined. TyG and its modified indices were categorized into tertiles and analyzed based on baseline levels, changes over time, and cumulative measures. Changes in TyG and its modified indices were identified using K-means clustering, while cumulative indices were calculated using a formula: (TyG2012+TyG2015)/2 × time (2015-2012).ResultsBetween 2015 and 2020, 225 participants (5.6%) experienced a stroke. After full adjustment, for cofounders only TyG-WC remained significantly associated at each level across its baseline levels, changes, and cumulative measures (p < 0.05), outperforming TyG, TyG-WHtR and TyG-BMI. Compared to Tertile 1, AORs for stroke associated with TyG-WC were 1.64 (1.10‒2.47) in Tertile 2 and 1.79 (1.15‒2.82) in Tertile 3. For changes in TyG-WC, ORs were 1.70 (1.14‒2.60) in Class 2 and 1.80 (1.11‒2.97) in Class 3. Regarding cumulative TyG-WC: the ORs were: 1.61 (1.08‒2.41) for Tertile 2 and 1.70 (1.10‒2.66) for Tertile 3. Additionally, TyG-WC demonstrated superior predictive performance for stroke compared to other indices.ConclusionsTyG-WC is strongly associated with stroke risk in populations without diabetes, offering superior risk stratification compared to other TyG indices.Copyright © 2025. Published by Elsevier Inc.

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