Cumulative Triglyceride–Glucose‐Related Metabolic Burden and Incident Cardiovascular Disease Among Middle‐Aged and Older Adults With Low Handgrip Strength

Aim To examine associations of cumulative triglyceride–glucose index (TyG) and obesity‐related derivatives, and their two‐point change patterns, with incident cardiovascular disease (CVD) among middle‐aged and older adults with low handgrip strength. Methods This study included 607 China Health and Retirement Longitudinal Study participants with low handgrip strength at least once during 2011–2015, defined by the 2019 Asian Working Group for Sarcopenia criteria. Cumulative TyG and five derivatives were calculated from Waves 1 and 3. Change patterns were classified by values below or above the population median at both waves. Incident CVD was identified at Waves 4 and 5. Cox proportional hazards models, restricted cubic splines, and subgroup and sensitivity analyses were performed for incident CVD, with additional component‐specific analyses conducted separately for heart disease and stroke. Incremental predictive performance was evaluated using changes in the C‐index, continuous NRI, and IDI. Results During follow‐up, 130 participants developed CVD. Each 1‐standard deviation increase in cumulative TyG and its derivatives was associated with a 22%–40% higher CVD hazard. Compared with the lowest quartile, the highest quartiles of all indicators except TyG‐a body shape index were associated with higher risk (hazard ratios 1.62–2.71). High–high patterns of several indicators were associated with increased risk; high–low patterns of TyG‐WC and TyG‐body roundness index were also associated with higher risk. Restricted cubic splines suggested linear associations for five indicators, without evidence of nonlinearity. Associations were significant in several female and older‐age strata, although interaction tests were not significant. Adding cumulative TyG‐related indices to traditional CVD risk factors modestly improved apparent model discrimination (C‐index: 0.623–0.646 vs. 0.606). Sensitivity analyses yielded generally consistent findings, and component‐specific analyses showed broadly similar positive associations for heart disease and stroke. Conclusions Higher cumulative TyG‐related metabolic burden was associated with incident CVD. Adding cumulative TyG‐related indices to traditional risk factor models modestly improved apparent predictive performance. Repeated assessment may aid cardiovascular risk stratification, but validation in larger, diverse cohorts is needed.