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To investigate this, we conducted a prospective cohort study in a Beijing community\u2010based population in China, enrolling participants without a history of stroke or myocardial infarction (MI). The primary outcome was major adverse cardiovascular events (MACEs), defined as a composite of MI, stroke, and cardiovascular death. We employed Cox proportional hazards models with landmark analysis to evaluate the association. Among 3466 individuals followed for a median of 7.52 years since 2014, 270 MACE events occurred. Our analysis suggested a potential threshold effect, with CVD risk increasing more markedly when the TyG\u2013WHtR increase exceeded approximately 0.400. Using this cutoff, individuals with a higher two\u2010year increase in TyG\u2013WHtR had a 30% higher risk of MACE (hazard ratio [HR] 1.30, 95% confidence interval [CI] 1.00\u20131.69) compared to those with lower increase. Landmark analysis revealed no significant association during the first 2 years; however, beyond this period, the association emerged, with an HR of 1.41 (95% CI 1.06\u20131.89). Further mediation analysis revealed that concurrent changes in mean arterial pressure (MAP) explained 30.4% of the association between changes in TyG\u2013WHtR and MACEs. In conclusion, an increase in TyG\u2013WHtR reflecting short\u2010term metabolic worsening, is associated with an increased MACE risk, and this relationship appears to be partly mediated by changes in MAP.<\/jats:p>","DOI":"10.1111\/jch.70269","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T05:57:21Z","timestamp":1778738241000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Dynamic Changes in Triglyceride Glucose\u2012Waist\u2012to\u2012Height Ratio and the Risk of Major Adverse Cardiovascular Events: Role of Concurrent Mean Arterial Pressure Change"],"prefix":"10.1111","volume":"28","author":[{"given":"Xingyu","family":"Luo","sequence":"first","affiliation":[{"name":"Department of Cardiology Peking University First Hospital  Beijing 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