Assessment of triglyceride‐glucose composite indices associated mortality risk in diabetes‐related heart failure

ABSTRACT Background Patients with diabetes are at an increased risk of heart failure. The triglyceride‐glucose index increases the risk of diabetes‐related heart failure (dHF). We aimed to validate a practical clinical risk score for dHF in a large diabetic cohort and assess whether this score can identify dHF patients with an elevated triglyceride‐glucose (TyG) index who have poor outcomes. Methods Participants were drawn from multiple NHANES cycles (1999–2018). A simplified TRS‐HF DM score (0–6 points) and TyG‐related parameters were calculated in 3,455 participants with dHF. Candidate variables were evaluated using multivariable Cox proportional hazards models, Kaplan–Meier curves, and restricted cubic splines (RCS); independent predictors with statistical significance were included. Sensitivity analyses tested robustness. Results Kaplan–Meier analysis revealed that higher levels of TRS‐HF DM were significantly associated with poor dHF participants survival. Multivariate‐adjusted Cox regression analysis revealed that high quartile levels of TyG‐related indices were significantly associated with mortality in participants with dHF TyG‐Age: HR = 6.94, 95% CI: 4.34–11.08, P < 0.001; TyG‐eGFR: HR = 3.78, 95% CI: 2.66–5.37, P < 0.001. The participants in the highest quartile of TyG‐Age had a six‐fold increased risk of mortality compared to those in the lowest quartile (95% CI: 3.93–10.24). Nonlinear trends were observed between TyG‐Age indices and mortality of dHF participants ( P for overall < 0.0001; P for nonlinear < 0.0001). The sensitivity analyses supported the positive correlations between TyG‐related indices and mortality of the TRS‐HF DM ‐determined dHF population. Conclusion TyG‐related indices, especially TyG‐Age, have strong prognostic value for mortality in adults with dHF. TyG‐Age and TRS‐HF DM may serve as surrogate biomarkers for clinical management of dHF.