Cardiovascular disease (CVD) remains a major health challenge globally, particularly in aging populations. Using data from the China Health and Retirement Longitudinal Study (CHARLS), this study examines the Triglyceride-glucose (TyG) index dynamics, a marker for insulin resistance, and its relationship with CVD in Chinese adults aged 45 and older.

This reanalysis utilized five waves of CHARLS data with multistage sampling. From 17,705 participants, 5,625 with TyG index and subsequent CVD data were included, excluding those lacking 2011 and 2015 TyG data. TyG derived from glucose and triglyceride levels, CVD outcomes via self-reports and records. Participants divided into four groups based on TyG changes (2011–2015): low-low, low-high, high-low, high-high TyG groups.

Adjusting for covariates, stable high group showed a significantly higher risk of incident CVD compared to stable low group, with an HR of 1.18 (95% CI: 1.03–1.36). Similarly, for stroke risk, stable high group had a HR of 1.45 (95% CI: 1.11–1.89). Survival curves indicated that individuals with stable high TyG levels had a significantly increased CVD risk compared to controls. The dynamic TyG change showed a greater risk for CVD than abnormal glucose metabolism, notably for stroke. However, there was no statistical difference in single incidence risk of heart disease between stable low and stable high group. Subgroup analyses underscored demographic disparities, with stable high group consistently showing elevated risks, particularly among < 65 years individuals, females, and those with higher education, lower BMI, or higher depression scores. Machine learning models, including random forest, XGBoost, CoxBoost, Deepsurv and GBM, underscored the predictive superiority of dynamic TyG over abnormal glucose metabolism for CVD.

Dynamic TyG change correlate with CVD risks. Monitoring these changes could predict and manage cardiovascular health in middle-aged and older adults. Targeted interventions based on TyG index trends are crucial for reducing CVD risks in this population.

The validation of various risk scores in elderly patients with comorbid atrial fibrillation (AF) and acute coronary syndrome (ACS) has not been reported. The present study compared the predictive performance of existing risk scores in these patients.

A total of 1252 elderly patients with AF and ACS comorbidities (≥ 65 years old) were consecutively enrolled from January 2015 to December 2019. All patients were followed up for one year. The predictive performance of risk scores in predicting bleeding and thromboembolic events was calculated and compared.

During the 1-year follow-up, 183 (14.6%) patients had thromboembolic events, 198 (15.8%) patients had BARC class ≥ 2 bleeding events, and 61 (4.9%) patients had BARC class ≥ 3 bleeding events. For the BARC class ≥ 3 bleeding events, discrimination of the existing risk scores was low to moderate, PRECISE-DAPT (C-statistic: 0.638, 95% CI: 0.611-0.665), ATRIA (C-statistic: 0.615, 95% CI: 0.587-0.642), PARIS-MB (C-statistic: 0.612, 95% CI: 0.584-0.639), HAS-BLED (C-statistic: 0.597, 95% CI: 0.569-0.624) and CRUSADE (C-statistic: 0.595, 95% CI: 0.567-0.622). However, the calibration was good. PRECISE-DAPT showed a higher integrated discrimination improvement (IDI) than PARIS-MB, HAS-BLED, ATRIA, and CRUSADE (P < 0.05) and the best decision curve analysis (DCA). For thromboembolic events, the discrimination of GRACE (C-statistic: 0.636, 95% CI: 0.608-0.662) was higher than CHA2DS2-VASc (C-statistic: 0.612, 95% CI: 0.584-0.639), OPT-CAD (C-statistic: 0.602, 95% CI: 0.574-0.629) and PARIS-CTE (C-statistic: 0.595, 95% CI: 0.567-0.622). The calibration was good. Compared to OPT-CAD and PARIS-CTE, the IDI of the GRACE score slightly improved (P < 0.05). However, NRI analysis showed no significant difference. DCA showed that the clinical practicability of thromboembolic risk scores was similar.

The discrimination and calibration of existing risk scores in predicting 1-year thromboembolic and bleeding events were unsatisfactory in elderly patients with comorbid AF and ACS. PRECISE-DAPT showed higher IDI and DCA than other risk scores in predicting BARC class ≥ 3 bleeding events. The GRACE score showed a slight advantage in predicting thrombotic events.