The triglyceride-glucose index as a measure of insulin resistance and risk of obesity-related cancers

Abstract Background The role of insulin resistance as a mediator in the association of body mass index (BMI) with site-specific cancer risk has, to our knowledge, never been systematically quantified. Methods Altogether 510 471 individuals from six European cohorts, with a mean age of 43.1 years, were included. We used the triglyceride glucose product (TyG index) as a surrogate measure for insulin resistance. We fitted Cox models, adjusted for relevant confounders, to investigate associations of TyG index with 10 common obesity-related cancers, and quantified the proportion of the effect of BMI mediated through TyG index on the log-transformed hazard ratio (HR) scale. Results During a median follow-up of 17.2 years, 16 052 individuals developed obesity-related cancers. TyG index was associated with the risk of cancers of the kidney HR per one standard deviation increase 1.13, 95% confidence interval: 1.07 to 1.20], liver (1.13, 1.04 to 1.23), pancreas (1.12, 1.06 to 1.19), colon (1.07, 1.03 to 1.10) and rectum (1.09, 1.04 to 1.14). Substantial proportions of the effect of BMI were mediated by TyG index for cancers of the pancreas (42%), rectum (34%) and colon (20%); smaller proportions for kidney (15%) and liver (11%). Little or no mediation was observed for breast (postmenopausal), endometrial and ovarian cancer. Results were similar for males and females, except for pancreatic cancer where the proportions mediated were 20% and 91%, respectively. Conclusions The TyG index was associated with increased risk of cancers of the digestive system and substantially mediated the effect of BMI, suggesting that insulin resistance plays a promoting role in the pathogenesis of gastrointestinal cancers.

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Insulin resistance measured by the triglyceride-glucose index and risk of obesity-related cancers: An epidemiological investigation in more than 500,000 individuals.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.1552 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 1552-1552

Author(s):

Josef Fritz ◽

Tone Bjorge ◽

Gabriele Nagel ◽

Hans Concin ◽

Jonas Manjer ◽

...

Keyword(s):

Insulin Resistance ◽

Reproductive Organs ◽

Overweight And Obesity ◽

Excess Body Weight ◽

Standard Deviation Increase ◽

Cox Models ◽

Tyg Index ◽

Triglyceride Glucose Index ◽

Colon And Rectum

1552 Background: The role of insulin resistance as a mediator in the association of body mass index (BMI) with site-specific cancer risk has, to our knowledge, never been systematically quantified. We aimed to determine to what extent insulin resistance measured as the logarithmized triglyceride glucose product (TyG index) mediates the effect of BMI on risk of obesity-related cancers. Methods: A total of 510,471 individuals from six European cohorts with a mean age of 43.1 years were included in the study. We fitted Cox models, adjusted for relevant confounders, to investigate associations of TyG index with ten common obesity-related cancer sites, and quantified the proportion of the effect of BMI mediated through TyG index. Results: During a median follow-up of 17.2 years, 16 052 individuals developed obesity-related cancers. TyG index was associated with the risk of cancers of the kidney (hazard ratio (HR) per one standard deviation increase 1.13, 95% confidence interval: 1.07-1.20), liver (1.13, 1.04-1.23), pancreas (1.12, 1.06-1.19), colon (1.07, 1.03-1.10), and rectum (1.09, 1.04-1.14). Substantial proportions of the effect of BMI were mediated by TyG index for cancers of the pancreas (42%), rectum (34%), and colon (20%); smaller proportions for kidney (15%) and liver (11%); none for endometrium, ovary and breast (postmenopausal). Conclusions: In this pooled cohort study including more than 500,000 individuals, insulin resistance measured as the logarithmized triglyceride glucose product significantly mediated the effect of overweight and obesity on risk of cancers of the kidney, liver, pancreas, colon, and rectum. In contrast, insulin resistance did not mediate the risk for cancers of the endometrium, ovary and breast. Our results confirm a promoting role of insulin resistance in the pathogenesis of gastrointestinal cancers. Although often claimed, insulin resistance does not appear to connect excess body weight with cancers of the female reproductive organs.

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Triglyceride-Glucose Index and HOMA-IR in Young Adulthood and Risk of Incident Congestive Heart Failure: The CARDIA Study

10.21203/rs.3.rs-960362/v1 ◽

2021 ◽

Author(s):

Xianghui Zeng ◽

Haobin Zhou ◽

Yuting Xue ◽

Xiao Wang ◽

Qiong Zhan ◽

...

Keyword(s):

Heart Failure ◽

Insulin Resistance ◽

Congestive Heart Failure ◽

Young Adults ◽

Young Adulthood ◽

Surrogate Marker ◽

Model Assessment ◽

Tyg Index ◽

Triglyceride Glucose Index ◽

Increased Risk

Abstract Background: Triglyceride-glucose (TyG) index and homeostasis model assessment-insulin resistance (HOMA-IR) are related to insulin resistance (IR). The aim of this study was to assess the association between triglyceride-glucose index / HOMA-IR within young adults and congestive heart failure (CHF), and to explore whether triglyceride-glucose index can replace HOMA-IR as a surrogate marker for insulin resistance in predicting the risk of CHF.Methods：A total of 4992 participants between the ages of 18 and 30 were enrolled from the Coronary Artery Risk Development in Young Adults (CARDIA) investigation (from 1985 to 1986 [year 0]). Cox proportional hazard regression analysis was conducted for assessing correlations between baseline TyG index / HOMA-IR and congestive heart failure events, together with Receiver Operating Characteristic (ROC) Curve employed for scrutinizing TyG index / HOMA-IR and he risk of CHF.Results: During the 31-year follow-up period, 64 (1.3%) out of the 4992 participants developed congestive heart failure. In multivariable Cox proportional hazards models, adjusted for confounding factors for CHF, increased risk of CHF was associated with per-unit increase in TyG index (hazard ratio [HR] 2.8; 95% confidence interval [CI], 1.7-4.7) and HOMA-IR (HR 1.2; 95%CI, 1.1-1.3). Kaplan-Meier curve analysis showed that participants in the TyG index and HOMA-IR index Q4 group had a higher risk of congestive heart failure than those in the Q1 group. The area under curve (AUC) for TyG index and HOMA-IR consisted of 0.67 (95% CI, 0.6-0.742) and 0.675 (95%CI, 0.604-0.746), respectively. There were no significant differences between TyG index and HOMA-IR for AUC (P = 0.986).Conclusions: TyG index and HOMA-IR are independent risk factors for CHF. The TyG index can replace HOMA-IR in young adulthood as a surrogate marker for IR to predict the risk of CHF.

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Abstract 13714: Clinical Utility of the Triglyceride-glucose Index Which is a Novel Marker of Insulin Resistance for Predicting the Neointimal Vulnerability After Everolimus-eluting Stent Implantation

Circulation ◽

10.1161/circ.142.suppl_3.13714 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Naotaka Akutsu ◽

Riku Arai ◽

Daisuke Fukamachi ◽

Yasuo Okumura

Keyword(s):

Insulin Resistance ◽

Stent Implantation ◽

Tyg Index ◽

Index Group ◽

Triglyceride Glucose Index ◽

Coronary Angioscopy ◽

High Insulin ◽

Grade 3 ◽

The Relationship

Introduction: Insulin resistance has been recognized as the cause of cardiovascular disease, but little is known about the influence of insulin resistance to neointimal characteristics after stent implantation. Hypothesis: The high triglyceride-glucose index (TyG index) has been reported to indirectly represent a high insulin resistance. It was hypothesized that in-stent neointimal characteristics in the high TyG index patients may be unstable more than the low TyG index patients. Methods: In 100 patients, we investigated the relationship between the neointimal characteristics and the TyG index using coronary angioscopy (CAS) and optical coherence tomography (OCT) during follow-up angiography after stent implantation. We divided into 2 groups according to the median value of TyG index (8.8). Results: The high TyG index group (n=48) had the higher yellow grade and the higher prevalence of yellow grade 3 by CAS than the low TyG index group (n=52). The prevalence of heterogeneous and layered patterns were more often observed by OCT in the high TyG index group than in the low TyG index group (Figure). Conclusions: The high TyG index strongly associated with neointimal vulnerability evaluating by CAS and OCT. The TyG index can be a useful predictor for the neointimal vulnerability after stent implantation.

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The impact of triglyceride-glucose index on incident cardiovascular events during 16 years of follow-up: Tehran Lipid and Glucose Study

Cardiovascular Diabetology ◽

10.1186/s12933-020-01121-5 ◽

2020 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Niloofar Barzegar ◽

Maryam Tohidi ◽

Mitra Hasheminia ◽

Fereidoun Azizi ◽

Farzad Hadaegh

Keyword(s):

Multivariate Analysis ◽

Risk Score ◽

Framingham Risk Score ◽

Significant Trend ◽

Lipid Lowering ◽

Tyg Index ◽

Framingham Risk ◽

Triglyceride Glucose Index ◽

Increased Risk

Abstract Background To investigate whether the Triglyceride-Glucose index (TyG-index) is associated with increased risk of cardiovascular diseases (CVD)/coronary heart disease (CHD). Methods A total of 7521 Iranians aged ≥ 30 years (male = 3367) were included in the study. Multivariate Cox regression analyses (adjusted for age, gender, waist circumference, body mass index, educational level, smoking status, physical activity, family history of CVD, type 2 diabetes, hypertension, low and high density lipoprotein cholesterol, and lipid lowering drugs) were used to assess the risk of incident CVD/CHD across quintiles and for 1-standard deviation (SD) increase in the TyG-index. The cut off point for TyG-index was assessed by the minimum value of $$\sqrt {\left( {1 - sensitivity} \right)^{2} + \left( {1 - specificity} \right)^{2} }$$ 1 - s e n s i t i v i t y 2 + 1 - s p e c i f i c i t y 2 . We also examined the added value of the TyG-index in addition to the Framingham risk score when predicting CVD. Results During follow-up, 1084 cases of CVD (male = 634) were recorded. We found a significant trend of TyG-index for incident CVD/CHD in multivariate analysis (both Ps for tend ≤ 0.002). Moreover, a 1-SD increase in TyG-index was associated with significant risk of CVD/CHD in multivariate analysis [1.16 (1.07–1.25) and 1.19 (1.10–1.29), respectively]. The cut-off value of TyG-index for incident CVD was 9.03 (59.2% sensitivity and 63.2% specificity); the corresponding value of TyG-index for incident CHD was 9.03 (60.0% sensitivity and 62.8% specificity), respectively. Although no interaction was found between gender and TyG-index for CVD/CHD in multivariate analysis (both Ps for interaction > 0.085), the significant trend of TyG-index was observed only among females for incident CVD (P = 0.035). A significant interaction was found between age groups (i.e. ≥ 60 vs < 60 years) and TyG-index for CVD outcomes in the multivariate model (P-value for interaction = 0.046). Accordingly, a significant association between the TyG-index and outcomes was found only among the younger age group. Among the population aged < 60 the addition of TyG-index to the Framingham risk score (FRS) did not show improvement in the predictive ability of the FRS, using integrated discrimination improvement. Conclusion The TyG-index is significantly associated with increased risk of CVD/CHD incidence; this issue was more prominent among the younger population. However, adding TyG-index to FRS does not provide better risk prediction for CVD.

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High triglyceride–glucose index is associated with poor prognosis in patients with acute ST-elevation myocardial infarction after percutaneous coronary intervention

Cardiovascular Diabetology ◽

10.1186/s12933-019-0957-3 ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 12

Author(s):

Erfei Luo ◽

Dong Wang ◽

Gaoliang Yan ◽

Yong Qiao ◽

Bo Liu ◽

...

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

St Elevation Myocardial Infarction ◽

Tyg Index ◽

Triglyceride Glucose Index ◽

Increased Risk ◽

Percutaneous Coronary ◽

St Elevation

Abstract Background Insulin resistance (IR) is considered a pivotal risk factor for cardiometabolic diseases, and the triglyceride–glucose index (TyG index) has emerged as a reliable surrogate marker of IR. Although several recent studies have shown the association of the TyG index with vascular disease, no studies have further investigated the role of the TyG index in acute ST-elevation myocardial infarction (STEMI). The objective of the present study was to evaluate the potential role of the TyG index as a predictor of prognosis in STEMI patients after percutaneous coronary intervention (PCI). Methods The study included 1092 STEMI patients who underwent PCI. The patients were divided into 4 quartiles according to TyG index levels. Clinical characteristics, fasting plasma glucose (FPG), triglycerides (TGs), other biochemical parameters, and the incidence of major adverse cardiovascular and cerebral events (MACCEs) during the follow-up period were recorded. The TyG index was calculated using the following formula: ln[fasting TGs (mg/dL) × FPG (mg/dL)/2]. Results The incidence of MACCEs and all-cause mortality within 30 days, 6 months and 1 year after PCI were higher among STEMI patients with TyG index levels in the highest quartile. The TyG index was significantly associated with an increased risk of MACCEs in STEMI patients within 1 year after PCI, independent of confounding factors, with a value of 1.529 (95% CI 1.001–2.061; P = 0.003) for those in the highest quartile. The area under the curve (AUC) of the TyG index predicting the occurrence of MACCEs in STEMI patients after PCI was 0.685 (95% CI 0.610–0.761; P = 0.001). The results also revealed that Killip class > 1, anaemia, albumin, uric acid, number of stents and left ventricular ejection fraction (LVEF) were independent predictors of MACCEs in STEMI patients after PCI (all P < 0.05). Conclusions This study indicated an association between higher TyG index levels and increased risk of MACCEs in STEMI patients for the first time, and the TyG index might be a valid predictor of clinical outcomes in STEMI patients undergoing PCI. Trial Registration ChiCTR1900024577.

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Triglyceride-Glucose Index Mediates the Effect of General and Central Obesity on Cardiovascular Disease: A Prospective Cohort Study

10.21203/rs.3.rs-636654/v1 ◽

2021 ◽

Author(s):

Anxin Wang ◽

Xue Tian ◽

Yingting Zuo ◽

Shuohua Chen ◽

Xia Meng ◽

...

Keyword(s):

Insulin Resistance ◽

Cardiovascular Disease ◽

Survival Data ◽

Central Obesity ◽

Normal Weight ◽

Mediating Effects ◽

Mediation Analyses ◽

Tyg Index ◽

Triglyceride Glucose Index

Abstract Background: The mechanisms linking obesity to cardiovascular disease (CVD) are still not clearly defined. Individuals who are overweight or obese often develop insulin resistance, mediation of the association between obesity and CVD through the triglyceride-glucose (TyG) index (a simple surrogate of insulin resistance) seems plausible and has not been investigated. This study aimed to evaluate whether and to what extend the effect of general and central obesity is mediated by the TyG index.Methods: A total of 94,136 participants without CVD at baseline were recruited from the Kailuan study. The TyG index was calculated as ln [fasting triglyceride (mg/dL)×fasting glucose (mg/dL)/2]. Mediation analysis using a newly proposed 2-stage regression method for survival data was to explore the mediating effects of the TyG index on the association between obesity and CVD.Results: During a median follow-up of 13.01 years, we identified 7,327 cases of CVD. Mediation analyses showed that 45.60% of the total association (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.18-1.31) between overweight and CVD was mediated through the TyG index (HR [indirect association], 1.10; 95% CI, 1.08-1.11), and the proportion mediated was 38.30% for general obesity. For central obesity, analysis by waist circumference, waist/hip, and waist/height categories yielded an attenuated proportion mediated of 33.76%, 37.10%, and 33.10% for obesity, taken normal weight as reference. Similar results were observed for stroke and myocardial infarction.Conclusions: This study found that the association between obesity and CVD was mediated by the TyG index, suggesting proper control of insulin resistance can be effective to significantly reduce the effects of general and central obesity on CVD.

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Triglyceride–glucose index is associated with the risk of myocardial infarction: an 11-year prospective study in the Kailuan cohort

Cardiovascular Diabetology ◽

10.1186/s12933-020-01210-5 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Xue Tian ◽

Yingting Zuo ◽

Shuohua Chen ◽

Qian Liu ◽

Boni Tao ◽

...

Keyword(s):

Myocardial Infarction ◽

Surrogate Marker ◽

Tyg Index ◽

Triglyceride Glucose Index ◽

Increased Risk ◽

The Mean ◽

Adjusted Model ◽

Multivariable Adjusted Model

Abstract Background The triglyceride–glucose (TyG) index, which is a simple surrogate marker of insulin resistance, has been suggested as a contributor of cardiovascular disease. However, evidence on the effect of long-term elevation of the TyG index exposure on myocardial infarction (MI) is limited. The current study aimed to evaluate the association of baseline and long-term elevation of the TyG index exposure with the risk of MI. Methods A total of 98,849 participants without MI at baseline (2006) were enrolled from the Kailuan study. The baseline TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. The long-term TyG index was characterized in two ways as follows. The updated mean TyG index was calculated as the mean of TyG index at all previous visits before MI occurred or the end of follow-up; alternatively, the TyG index was calculated as the number of visits with a high TyG index in 2006, 2008, and 2010, ranging from 0 (no exposure) to 3 (had high TyG index at all three study visits). Hazard ratio (HR) and 95% confidence interval (CI) was estimated using multivariable Cox proportion hazard models. Results During a median follow-up of 11.03 years, 1555 incident MI occurred. In the multivariable-adjusted model, the risk of MI increased with quartiles of the baseline and updated mean TyG index, the HR in quartile 4 versus quartile 1 was 2.08 (95% CI,1.77–2.45) and 1.58 (1.18–2.12), respectively. Individuals with a high TyG index at all three visits had a 2.04-fold higher risk (95% CI, 1.63–2.56) of MI compared with no exposure. Subgroup analyses showed that the associations were more pronounced in women than in men (Pinteraction = 0.0411). Conclusions Elevated levels of the baseline and long-term TyG index are associated with an increased risk of MI. This finding indicates that the TyG index might be useful in identifying people at high risk of developing MI.

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Are patients with rheumatoid arthritis still at an increased risk of tuberculosis and what is the role of biological treatments?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2013-204960 ◽

2014 ◽

Vol 74 (6) ◽

pp. 1212-1217 ◽

Cited By ~ 46

Author(s):

Elizabeth V Arkema ◽

Jerker Jonsson ◽

Eva Baecklund ◽

Judith Bruchfeld ◽

Nils Feltelius ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

General Population ◽

Population Based ◽

Calendar Time ◽

Cox Models ◽

Increased Risk ◽

National Cohort ◽

Biologics Register

ObjectiveTo estimate the risk of tuberculosis (TB) in patients with rheumatoid arthritis (RA) both with and without exposure to biological therapy and to directly compare the risks between therapies.MethodsData from the Swedish National Population Registers, Tuberculosis Register and the Swedish Biologics Register were used to conduct a prospective population-based national cohort study (2002–2011). We estimated the rate of incident TB in the general population and in a cohort of biological-naïve and biological-exposed patients diagnosed with RA. Cox models were used to estimate HRs with particular attention to risks by calendar and follow-up time and individual biologics.ResultsCompared to the general population, RA patients not exposed to biologicals had a fourfold increased risk of TB (HR 4.2; 95% CI 2.7 to 6.7), which did not decline over calendar time. In contrast, the risk of TB in the biological-exposed RA population decreased since 2002 compared with biological-naïve; from HR=7.9 (95% CI 3.3 to 18.9) in 2002–2006 to HR=2.4 (95% CI 0.9 to 6.1) in 2007–2011. The HRs for most recent exposure to adalimumab and infliximab compared with etanercept were 3.1 (95% CI 0.8 to 12.5) and 2.7 (95% CI 0.7 to 10.9), respectively, and the HR for etanercept compared with biological-naïve RA was 1.7 (95% CI 0.6 to 4.6).ConclusionsIn the past decade, the risk of TB has decreased among biological-exposed RA patients but remains higher than in biological-naïve RA patients. Most cases of TB in RA occur in biological-naïve RA patients, underscoring the elevated risk also in these patients.

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Prognostic role of neoplastic markers in Takotsubo syndrome

Scientific Reports ◽

10.1038/s41598-021-95990-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Francesco Santoro ◽

Tecla Zimotti ◽

Adriana Mallardi ◽

Alessandra Leopizzi ◽

Enrica Vitale ◽

...

Keyword(s):

Serum Levels ◽

Takotsubo Syndrome ◽

Ca 15.3 ◽

Risk Of Death ◽

Increased Risk ◽

Ca 19.9 ◽

Long Term Follow Up

AbstractTakotsubo syndrome (TTS) is an acute heart failure syndrome with significant rates of in and out-of-hospital mayor cardiac adverse events (MACE). To evaluate the possible role of neoplastic biomarkers [CA-15.3, CA-19.9 and Carcinoembryonic Antigen (CEA)] as prognostic marker at short- and long-term follow-up in subjects with TTS. Ninety consecutive subjects with TTS were enrolled and followed for a median of 3 years. Circulating levels of CA-15.3, CA-19.9 and CEA were evaluated at admission, after 72 h and at discharge. Incidence of MACE during hospitalization and follow-up were recorded. Forty-three (46%) patients experienced MACE during hospitalization. These patients had increased admission levels of CEA (4.3 ± 6.2 vs. 2.2 ± 1.5 ng/mL, p = 0.03). CEA levels were higher in subjects with in-hospital MACE. At long term follow-up, CEA and CA-19.9 levels were associated with increased risk of death (log rank p < 0.01, HR = 5.3, 95% CI 1.9–14.8, HR = 7.8 95% CI 2.4–25.1, respectively, p < 0.01). At multivariable analysis levels higher than median of CEA, CA-19.9 or both were independent predictors of death at long term (Log-Rank p < 0.01). Having both CEA and CA-19.9 levels above median (> 2 ng/mL, > 8 UI/mL respectively) was associated with an increased risk of mortality of 11.8 (95% CI 2.6–52.5, p = 0.001) at follow up. Increased CEA and CA-19.9 serum levels are associated with higher risk of death at long-term follow up in patients with TTS. CEA serum levels are correlated with in-hospital MACE.

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P1818Descending aortic thoracic diameter: a risk marker for major adverse cardiovascular outcomes in women

European Heart Journal ◽

10.1093/eurheartj/ehz748.0570 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

O L Rueda Ochoa ◽

L R Bons ◽

S Rohde ◽

K E L Ghoud ◽

R Budde ◽

...

Keyword(s):

Heart Failure ◽

Cardiovascular Risk ◽

Cardiovascular Mortality ◽

Total Mortality ◽

Population Based ◽

Cardiovascular Outcomes ◽

Increased Risk ◽

Almost All

Abstract Background Thoracic aortic diameters have been associated with cardiovascular risk factors and atherosclerosis. However, limited evidence regarding the role of thoracic aortic diameters as risk markers for major cardiovascular outcomes among women and men exist. Purpose To evaluate the independent associations between crude and indexed ascending and descending aortic (AA and DA) diameters with major cardiovascular outcomes among women and men and to provide optimal cutoff values associated with increased cardiovascular risk. Methods and results 2178 women and men ≥55 years from the prospective population-based Rotterdam Study underwent multi-detector CT scan of thorax. Crude diameters of the AA and DA were measured and indexed by height, weight, body surface area (BSA) and body mass index (BMI). Incidence of stroke, coronary heart disease (CHD), heart failure (HF), cardiovascular and all-cause mortality were evaluated during 13 years of follow-up. Weight-, BSA-, or BMI-indexed AA diameters showed significant associations with total or cardiovascular mortality in both sexes and height-indexed values showed association with HF in women. Crude AA diameters were associated with stroke in men and HF in women. For DA, crude and almost all indexed diameters showed significant associations with either stroke, HF, cardiovascular or total mortality in women. Only weight-, BSA- and BMI-indexed values were associated with total mortality in men. For crude DA diameter, the risk for stroke increased significantly at the 75th percentile among men while the risks for HF and cardiovascular mortality increased at the 75th and 85th percentiles respectively in women. Conclusions Our study suggests a role for descending thoracic aortic diameter as a marker for increased cardiovascular risk, in particular for stroke, heart failure and cardiovascular mortality among women. The cut points for increased risk for several of cardiovascular outcomes were below the 95th percentile of the distribution of aortic diameters.

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