Association between triglyceride glucose-body mass index and incident risk of heart failure among patients with type 2 diabetes: a real-world study

Objective: The triglyceride glucose-body mass index (TyG-BMI) is recognized as a reliable indicator for assessing insulin resistance. The association between TyG-BMI and heart failure (HF) has been less studied, with inconsistent findings. We aimed to investigate the relationship between TyG-BMI and HF in among the Chinese populations with type 2 diabetes. Methods: This retrospective cohort study included 4116 patients with type 2 diabetes, comprising 2941 men and 1175 women. TyG-BMI levels were determined utilizing the equation. The primary outcome was the diagnosis of HF, confirmed by cardiologists utilizing ICD-10-CM code I50. Cox proportional hazards models were utilized to evaluate the relationship between TyG-BMI and HF. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the discriminative ability of TyG-BMI, BMI, and the TyG index. Shapley Additive Explanations (SHAP) analysis was applied to interpret the contribution of each variable within the prediction model. Additionally, the Sprague-Dawley rats were used to illustrate alterations in glucose and lipid metabolic parameters in the context of impaired cardiac function. Results: Over a median follow-up of 3.01 years, 904 new cases of HF were identified. After adjusting for multiple factors, the hazard ratios (HRs) [95% confidence interval (CI)] of HF based on quartiles of TyG-BMI levels at baseline [<175 (set as the reference), 175-208, 209-250, ≥ 250] were 1.00, 1.11(95% CI 0.89-1.45), 1.17 (95% CI 0.94-1.45), and 1.40 (95% CI 1.13-1.73), respectively. The TyG-BMI index exhibited robust predictive capability for incident HF, with an area under the curve (AUC) of 0.83, in contrast to 0.80 for BMI and 0.72 for the TyG index. Rats with impaired cardiac function exhibited elevated levels of blood glucose and lipids, as evidenced by animal research. Conclusion: In the overall population with type 2 diabetes, a higher TyG-BMI is associated with increased risk of HF. In comparison to TyG and BMI, the TyG-BMI index exhibits superior predictive value for incident HF.