Metabolic and Nutritional Biomarkers for Cardiovascular Risk Stratification in Beninese Taxi-Motorbike Drivers: Interrelationships Between Homocysteine, Folate, Vitamin B12, TyG Index, and Framingham Risk Score
Background: Higher Framingham Risk Score (FRS) and elevated triglyceride-glucose (TyG) index are well-established markers of cardiovascular disease (CVD) risk. Given the high prevalence of insulin resistance (IR) and dyslipidemia among taxi-motorbike drivers (TMDs) in Cotonou, it is plausible that hyperhomocysteinemia (HHcy) or suboptimal folate and vitamin B12 status may further amplify their cardiovascular risk. However, the relationships between folate, vitamin B12, and homocysteine and established CVD risk markers like the TyG index and FRS have not been systematically investigated within this high-risk occupational group. Therefore, this study aimed to examine the associations of these key nutritional determinants with both the TyG index and FRS among TMDs. Methods: In this cross-sectional study of 137 TMDs (mean age 39.2 ± 7.7 years), we collected comprehensive demographic and lifestyle data alongside standardized anthropometric measurements, including BMI and blood pressure. Biochemical assessments encompassed glucose, lipid profiles, creatinine, vitamin B12, folate, and homocysteine levels. Cardiovascular risk was evaluated using risk stratification tools such as the FRS and TyG index. Participants were stratified by TyG cut-off (TyG ≤ 7.73 vs. TyG > 7.73) and by FRS category (<10% vs. ≥10%). HHcy was further classified into moderate and intermediate levels. Statistical analyses included univariate comparisons employing chi-square and Mann-Whitney tests, and multivariable logistic regression was used to examine associations among metabolic, nutritional, and clinical variables. Results: The cohort exhibited a high prevalence of hypertension (47.4%) and markedly elevated homocysteine levels (mean 30.5 ± 18.8 μmol/L), with 88.3% of participants showing HHcy. Plasma folate concentrations declined significantly with increasing homocysteine (p = 0.006), strongly linking low folate status to exacerbated HHcy. Participants with elevated FRS were older, hypertensive, and presented with significantly increased triglycerides, TyG index, and homocysteine. Conversely, high TyG index correlated with greater BMI (24.8 vs. 21.9 kg/m2, p < 0.001), elevated blood pressure, pronounced dyslipidemia, lower vitamin B12 levels (376.2 vs. 455.0 pmol/L, p = 0.002), and hypertension. Multivariable logistic regression identified BMI (OR = 1.28, p = 0.001) and FRS (OR = 1.33, p = 0.001) as independent predictors of elevated TyG index; conversely, higher vitamin B12 was protective (OR？ =
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