Elevated TyG-BMI significantly increases the 1-year stroke recurrence risk in patients with acute ischemic stroke and hypertension.

Objectives: To investigate the association between triglyceride-glucose-body mass index (TyG-BMI) and the 1-year stroke recurrence risk in patients with acute ischemic stroke (AIS) and hypertension. Methods: In this retrospective, multicenter cohort study, multivariable Cox proportional hazards models were constructed, and curve fitting and subgroup analyses were performed to evaluate the aforementioned association. TyG-BMI was analyzed as a continuous variable and in quartiles (Q1-Q4). Sex-specific stratified analyses were performed to explore potential effect modifications. Results: Among 1,620 enrolled patients (39.6% women; mean age 65.2 ± 11.5 years), elevated TyG-BMI was significantly associated with increased 1-year stroke recurrence risk after adjusting for potential confounding factors (hazard ratio [HR]=1.06, 95% confidence interval [CI]: 1.01-1.11, P = 0.032). This association was particularly prominent in women (HR = 1.18, 95%CI: 1.07-1.29, P<0.001). Women in the Q3 and Q4 TyG-BMI groups had significantly higher 1-year stroke recurrence risks (Q3: HR=8.81 95%CI: 2.22-34.97, P = 0.002; Q4: HR=5.79 95%CI: 1.49-22.56, P = 0.011) compared with those in the Q1 group. No significant association was observed in men (HR = 1.01, 95%CI: 0.94-1.08, P = 0.830). Segmented linear regression and curve fitting revealed a significant sex-specific nonlinear relationship between TyG-BMI and 1-year stroke recurrence risk. For women when TyG-BMI was below 221.97, each unit increase was associated with a more pronounced increase in the risk of 1-year stroke recurrence compared to patients above this threshold (adjusted HR = 1.04, 95% CI 1.01-1.07, P = 0.005). Conclusion: Elevated TyG-BMI is independently associated with a higher risk of 1-year stroke recurrence in patients with AIS and hypertension. A significant association was identified only in women, specifically among those with a TyG-BMI below 221.97, below which each unit increase in TyG-BMI was associated with a significantly greater risk of 1-year stroke recurrence compared to those above this threshold.