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Serum calcium (Ca) and insulin resistance (IR) can have impact on each other and both are associated with the acute coronary syndrome (ACS). The triglyceride-glucose (TyG) index is a surrogate marker of IR that can be easily calculated from fasting glucose and fasting triglyceride. We aimed to investigate the temporal relationship between serum Ca and the TyG index and its impact on ACS development. We retrospectively collected 2856 eligible patients in this longitudinal observational study. Patients’ basal characteristics and laboratory values, including serum Ca and TyG index, were noted at baseline and after a median 4-year (3–6 years) follow-up period at two different times. Cross-lagged panel analysis was performed to demonstrate the temporal relationship between serum Ca and the TyG index. The incidence of ACS was noted, and mediation analysis was used to detect the mediation effect of variables on the ACS. Baseline serum Ca and TyG index were associated with follow-up serum Ca and TyG index. The path coefficient from baseline serum Ca to the follow-up TyG index was significantly different from the baseline TyG index to the follow-up serum Ca, which indicated a reciprocal temporal relationship. The TyG index had a mediation effect of 23.5% on the serum Ca-ACS association in the total population. There was a reciprocal temporal relationship between serum Ca and the TyG index, and both were associated with the risk of incident ACS. The TyG index mediation effect on the association of serum Ca with ACS was 23.5%.

acta cardiologica

Temporal relationship between serum calcium and triglyceride-glucose index and its impact on the incident of the acute coronary syndrome: a cross-lagged panel study