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The following is a summary of “Association of triglyceride-glucose index trajectories with the risk of worsening heart failure in elderly patients with chronic heart failure and type 2 diabetes: a competing risk analysis,” published in the March 2025 issue of Cardiovascular Diabetology by Lai et al.

The triglyceride-glucose (TyG) index has emerged as a reliable biomarker for assessing insulin resistance, a key factor contributing to cardiovascular disease. This study aimed to evaluate the association between longitudinal changes in the TyG index and the risk of worsening HF and all-cause mortality in patients aged 60 years and older with chronic HF and type 2 diabetes mellitus. A total of 466 patients with at least three documented medical examinations were included in the analysis. The TyG index was calculated using the formula ln (fasting triglycerides [mg/dL] × fasting blood glucose [mg/dL] / 2). Longitudinal trends in the TyG index were assessed through linear mixed models, while competing Cox regression and mixed-effects Cox regression models were employed to investigate the relationship between TyG index trajectories and clinical outcomes. 

After adjusting for relevant confounders, patients in the highest quartile of the baseline TyG index exhibited a significantly increased risk of adverse outcomes compared to those in the lowest quartile. Specifically, the adjusted HRs for worsening HF in the top quartile were 2.40 (95% CI: 1.35–3.28) over a 10-year follow-up and 2.09 (95% CI: 1.22–3.58) for the entire follow-up duration. Similarly, the HRs for all-cause mortality in this group were 1.99 (95% CI: 1.56–3.14) over 10 years and 1.87 (95% CI: 1.22–2.88) over the full study period. Furthermore, patients with a high decreasing TyG index trajectory, compared to those with a low decreasing trajectory, also demonstrated an elevated risk of adverse outcomes. The adjusted HRs for worsening HF in the high decreasing trajectory group were 1.37 (95% CI: 1.10–1.71) over 5 years, 1.78 (95% CI: 1.10–2.88) over 10 years, and 1.67 (95% CI: 1.04–2.68) over the full follow-up period. 

Likewise, the HRs for overall mortality in this group were 2.16 (95% CI: 1.39–3.35) over 10 years and 2.23 (95% CI: 1.46–3.40) over the full follow-up duration. These findings suggest that both a higher baseline TyG index and a rapid decline in its trajectory are independently associated with an increased risk of long-term HF progression and all-cause mortality. The observed relationship between the TyG index trajectory and adverse outcomes underscores the importance of closely monitoring metabolic parameters in elderly patients with chronic HF and T2DM. Further studies are warranted to explore whether targeted metabolic interventions aimed at stabilizing the TyG index could mitigate HF progression and improve survival in this high-risk population.

Source: cardiab.biomedcentral.com/articles/10.1186/s12933-025-02687-8