Association of Triglyceride–Glucose Index and Atherogenic Index of Plasma with Coronary Artery Calcium in Fibromyalgia

Background/Aims: Fibromyalgia (FM) has increasingly been associated with adverse cardiovascular outcomes; however, objective data on structurally quantified subclinical coronary atherosclerosis in this population remain limited. Metabolic indices such as the triglyceride–glucose (TyG) index and the atherogenic index of plasma (AIP) are linked to cardiometabolic risk in the general population; yet, their relationship with coronary artery calcium (CAC)-defined atherosclerosis in FM has not been adequately characterized. Therefore, this study aimed to explore the association of the TyG index and AIP with CAC-defined subclinical atherosclerosis in patients with FM.

Materials and Methods: In this retrospective cross-sectional study, 146 patients with FM and 64 controls were evaluated. Subclinical coronary atherosclerosis was assessed using CAC scoring. Fibromyalgia patients were stratified according to CAC score (<100 and ≥100). Triglyceride–glucose and AIP were calculated from fasting laboratory parameters. Multivariable logistic regression analyses adjusted for age, sex, body mass index, diabetes mellitus, and hypertension were performed.

Results: Both TyG and AIP showed statistically significant but weak correlations with CAC. Triglyceride–glucose correlated with CAC (r = 0.208, P = .012) and homeostasis model assessment of insulin resistance (HOMA-IR), whereas AIP remained associated with CAC after adjustment for HOMA-IR in the analyzed models. In receiver operating characteristic analyses, TyG and AIP demonstrated limited discriminative performance for identifying CAC ≥100 (area under the curve 0.63 and 0.62, respectively), characterized by high specificity but low sensitivity. In multivariable models, patients in the highest tertile of TyG and AIP had significantly higher odds of CAC ≥100 compared with the lowest tertile. Neither index was associated with FM symptom severity.

Conclusion: Metabolic indices reflecting insulin resistance and atherogenic dyslipidemia were associated with subclinical coronary atherosclerosis in patients with FM, independent of symptom burden. These findings suggest an association between cardiometabolic alterations and subclinical coronary involvement in this population. However, given the observational design and modest effect sizes, the results should be interpreted with caution, treated as hypothesis-generating, and confirmed in prospective studies.

Cite this article as: Hira S, Çağlar SO, Çağlar H. Association of triglyceride– glucose index and atherogenic index of plasma with coronary artery calcium in fibromyalgia. ArchRheumatol. Published online July 9, 2026. doi: 10.5152/ArchRheumatol.2026.26368.