To determine the association between a high TyG index and the risk of stroke recurrence and mortality in patients with ischemic stroke or transient ischemic attack.

The triglyceride-glucose (TyG) index, a surrogate marker of insulin resistance, has recently emerged as a potential predictor of vascular outcomes. Its prognostic value for stroke recurrence and mortality still remains uncertain.

A systematic review and meta-analysis was performed which included cohort studies comparing high versus low TyG index groups from databases including PubMed , EMBASE, Cochrane and Scopus, through October 2025. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using a random-effects model in Review Manager (RevMan 5.4.1). Heterogeneity was assessed with the I² statistics.

Four studies (n≈27,000) were included for stroke recurrence. A high TyG index was associated with greater risk of recurrence (pooled HR = 1.60; 95% CI 1.23–2.07; p = 0.0004; I² = 34%), portraying moderate heterogeneity.

Three studies (n≈18,000) evaluated mortality, showing no significant association (pooled HR = 1.36; 95% CI 0.74–2.50; p = 0.33; I² = 83%)

A higher TyG index was associated with increased risk of stroke recurrence but not mortality. These findings suggest that the TyG index may serve as simple metabolic marker for identifying patients at higher risk of recurrent stroke. Furthermore, more prospective studies are needed to clarify its prognostic role for mortality outcomes.