Figure 1 depicts the procedure followed during the database search. The initial search yielded 2,728 literature citations (PubMed = 1,068; Cochrane Library = 28; Embase = 1,632), which were reduced to 1,795 after removing duplicates and irrelevant studies. From these, 1,701 articles were excluded because of irrelevance after screening their titles and abstracts. Subsequently, 94 papers were subjected to full-text review, resulting in the exclusion of 44 articles for the following reasons: (a) cross-sectional, case–control studies, or review articles (n = 9); (b) not focused on cardiovascular events (n = 13); (c) not specifically focused on patients with or without diabetes (n = 5); (d) no extractable data (n = 9); and (e) duplicated studies (n = 8). Ultimately, 50 cohort studies were included in the meta-analysis [6, 14, 16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46, 48,49,50, 56,57,58,59,60,61,62,63,64,65,66,67,68,69]. The excluded studies (n = 44) are shown in Online Table S4.

Flow chart of the study selection process in the meta-analysis of TyG index and risk of cardiovascular events and mortality in patients with or without diabetes

Table 1 presents an overview of the characteristics of the included studies. Thirty-two studies included participants with diabetes [6, 14, 25, 32,33,34,35,36,37,38, 40, 43,44,45,46, 48,49,50, 56,57,58,59,60,61,62,63,64,65,66,67,68,69], whereas 31 studies involved individuals without diabetes [16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46]. The participants had a mean age of 31.46 years (diabetes mellitus [DM]: 65.18; non-DM: 31.23), and 40.66% of participants were female (DM: 36.07%; non-DM: 40.70%). Among these studies, 26 were prospective cohort studies [16,17,18,19,20, 22,23,24,25,26,27, 31, 32, 35, 36, 40, 41, 43, 45, 56, 59, 62, 63, 65, 67, 69], and the others were retrospective [6, 14, 21, 28,29,30, 33, 34, 37,38,39, 42, 44,