Association of cumulative triglyceride glucose–Chinese visceral adiposity index with incident heart disease in a Chinese cohort

Background The association of cumulative triglyceride glucose–Chinese visceral adiposity index (TyG-CVAI) exposure with subsequent heart disease remains incompletely characterized. Methods We included 4,924 middle-aged and older participants from the China Health and Retirement Longitudinal Study. TyG-CVAI measured at Waves 1 and 3 was used to characterize cumulative exposure through 2015, and incident heart disease was ascertained thereafter through 2020. Logistic regression, restricted cubic splines, subgroup analyses, K-means clustering, and discrimination analyses were performed. Results During the post-exposure outcome-assessment period, 941 participants (19.11%) developed incident heart disease. Higher cumulative TyG-CVAI was associated with progressively greater odds of incident heart disease; compared with the lowest quartile, the fully adjusted OR for the highest quartile was 1.80 (95% CI 1.44–2.25). Restricted cubic spline analysis showed a positive overall association, with no statistically significant evidence of nonlinearity within the observed exposure range. In contrast, absolute change in TyG-CVAI between the two assessments was not independently associated with incident heart disease. K-means analysis showed that patterns characterized by relatively high TyG-CVAI across both assessments were associated with higher odds of heart disease despite differing directions of change. Adding cumulative TyG-CVAI to conventional risk factors increased the AUC from 0.616 to 0.630 (ΔAUC = 0.014, P = 0.008), indicating modest incremental discrimination. Conclusions Higher cumulative TyG-CVAI was associated with greater odds of incident heart disease. Repeated TyG-CVAI assessment may provide complementary information on longitudinal metabolic-adiposity burden, although its incremental discriminatory value was modest and requires external validation before clinical application.