Predictive value of the C-reactive protein-triglyceride-glucose index for new-onset heart failure in patients with type 2 diabetes mellitus and hypertension: An ambidirectional cohort study

Background: Type 2 diabetes mellitus (T2DM) and hypertension frequently coexist and substantially increase the risk of heart failure (HF), particularly HF with preserved ejection fraction (HFpEF). Aims: This study evaluated the association of the C-reactive protein–triglyceride-glucose index (CTI) with new-onset HF in patients with T2DM and hypertension. Methods: A total of 1278 patients with T2DM and hypertension were enrolled in this ambidirectional cohort study. Patients with coronary artery disease, pre-existing HF, moderate-to-severe valvular heart disease, or other major structural heart disease were excluded. Participants were stratified into tertiles according to baseline CTI. The primary endpoint was new-onset HF, with HFpEF and HF with reduced ejection fraction (HFrEF) as secondary endpoints. Median follow-up was 8.8 years. Results: During a median follow-up of 8.8 years, the cumulative incidence of new-onset HF differed significantly across CTI tertiles (overall log-rank P = 0.03), with a higher incidence in the highest CTI tertile than in the lowest tertile ( P = 0.01). This association was primarily driven by HFpEF (overall log-rank P = 0.01), whereas no significant association was observed for HFrEF ( P = 0.72). In multivariable Cox regression analyses, high CTI was independently associated with new-onset HF and HFpEF. Sodium–glucose cotransporter 2 inhibitor use was associated with a lower risk of new-onset HF. Restricted cubic spline analysis demonstrated a significant association between CTI and HFpEF risk ( P = 0.02). Conclusions: Higher CTI levels were independently associated with increased risk of new-onset HF, particularly HFpEF, in patients with T2DM and hypertension.