Triglyceride–glucose index in the development of heart failure and left ventricular dysfunction: analysis of the ARIC study

Abstract

Aims We aimed to investigate whether the triglyceride–glucose (TyG) index, an easy-calculated and reliable surrogate of insulin resistance, was associated with the development of heart failure (HF) and left ventricular (LV) dysfunction. Methods and results A total of 12 374 participants (mean age: 54.1 ± 5.7 years, male: 44.7%) free of history of HF and coronary heart disease at baseline from the Atherosclerosis Risk in Communities study were included. The TyG index was calculated as ln[fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. The long-term TyG index was calculated as the updated cumulative average TyG index using all available TyG index from baseline to the events of HF or the end of follow-up. We evaluated the associations of both the baseline and the long-term TyG index with incident HF using Cox regression analysis. We also analysed the effect of the TyG index on LV structure and function among 4889 participants with echocardiographic data using multivariable linear regression analysis. There were 1958 incident HF cases over a median follow-up of 22.5 years. After adjusting for potential confounders, 1-SD (0.60) increase in the baseline TyG index was associated with a 15% higher risk of HF development [hazard ratio (HR): 1.15, 95% confidence interval (CI): 1.10–1.21]. Compared with participants in the lowest quartile of the baseline TyG index, those in the highest quartile had a greater risk of incident HF [HR (95% CI): 1.25 (1.08–1.45)]. In terms of LV structure and function, a greater baseline TyG index was associated with adverse LV remodelling and LV dysfunction. Similar results were found for the long-term TyG index. Conclusion In a community-based cohort, we found that a greater TyG index was significantly associated with a higher risk of incident HF and impaired LV structure and function.

Effect of PCSK9 inhibitors on remnant cholesterol and lipid residual risk: The LIPID‐REAL registry

“…Finally, the study was not designed or powered to assess the effect of cardiovascular events, but we believe that our results might represent a relevant issue in major cardiovascular event incidence. Since LDLc reductions and clinical features were similar to previous reports, 3,4,14,[21][22][23][24][25][26][27]32,34,35 this might make our results representative and useful for daily clinical practice.…”

“…11 More recently, an analysis of the Atherosclerosis Risk in Communities study involving 12,374 participants free of history of heart failure or coronary heart disease demonstrated that increase in the baseline TGGi index was associated with a 15% higher risk of heart failure. 32 Thereafter, many other lipid variables are actively involved in the atherosclerotic process that leads to clinically evident ischaemic events in our population. Thereafter, the global assessment of the lipid profile, beyond LDLc, might have a relevant role in the primary and secondary prevention of cardiovascular disease.…”

“…Similarly, a subanalysis of the PREDIMED trial demonstrated that cholesterol remnants >30 mg/dL were the leading risk factor for major cardiovascular events incidence 11 . More recently, an analysis of the Atherosclerosis Risk in Communities study involving 12,374 participants free of history of heart failure or coronary heart disease demonstrated that increase in the baseline TGGi index was associated with a 15% higher risk of heart failure 32 . Thereafter, many other lipid variables are actively involved in the atherosclerotic process that leads to clinically evident ischaemic events in our population.…”

Triglyceride-glucose index and the risk of heart failure: Evidence from two large cohorts and a mendelian randomization analysis

“…Previous studies have found independent associations between TyG index and risks of atherosclerotic cardiovascular diseases, including myocardial infarction and ischemic stroke [25,33]. In a recent analysis of data from the Atherosclerosis Risk in Communities (ARIC) study, Huang et al also reported an association between higher TyG index and higher risk of incident HF in an American population, with every standard deviation's increase in TyG index (corresponding to a TyG index of 0.6) associated with a 15% increase in risk [34]. Our study confirmed these findings in two larger cohorts from distinct geographical regions in China.…”

Triglyceride-glucose (TyG) index is a predictor of arterial stiffness, incidence of diabetes, cardiovascular disease, and all-cause and cardiovascular mortality: A longitudinal two-cohort analysis

“…One study explored relationship between TyG index as a marker for IR and heart failure, but these authors did not observe a significant association ( 31 ). However, a recent study from the Atherosclerosis Risk in Communities study (ARIC) showed a significant association between TyG index and incident HF ( 32 ).…”