Value of the triglyceride–glucose index and related parameters in heart failure patients

Figures

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  Figure 1. Role of the TyG index in cardiovascular outcomes. The TyG index, defined as ln [fasting triglyceride (mg/dl) × fasting glucose (mg/dl)]/2, is measured during admission or outpatient visits. It is associated with ischemic stroke, myocardial infarction, heart failure, cardiac arrest, peripheral artery disease, cardiovascular mortality, and all-cause mortality.

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  Figure 2. Obesity paradox in heart failure patients. In HF patients, first, fatty acid oxidation and glucose oxidation are suppressed, leading the bodies to switch to ketone fuel utilization in an energy-starved state. Second, HF patients with a deficiency of left ventricular function usually experience lower blood pressure. Third, HF patients generate tumor necrosis factor, which causes inflammation in the myocardium. Finally, muscle disuse, malnutrition, neurohumoral factor activation, and HF medications contribute to muscle wasting. The above-mentioned factors result in higher mortality rates. However, for higher-BMI (30.0–34.9 kg/m2) patients with HF, stored adipose tissue provides abundant energy to avoid malnutrition. In addition, obese patients present with elevated blood pressure and spare more space for drugs to target HF. Also, molecules and adipokines, provided by increased levels of cholesterol and serum lipids or hyperlipidemia, prevent the inflammatory response. Moreover, adipose tissue protects muscle. All these points counteract the damage caused by lower BMI in HF patients and result in higher mortality rates.