The association between derived TyG index and the risk of heart failure in the elderly population: a prospective cohort study from 2017 to 2023.

Background: Diabetes and obesity are established risk factors for heart failure(HF). Although the TyG (triglyceride-glucose) index serves as a sensitive marker for identifying insulin resistance, there is a lack of comprehensive evidence regarding whether its integration with obesity indices can enhance the predictive capacity for HF. This prospective cohort study is designed to explore the correlation between TyG indices in conjunction with obesity indices (TyG-body mass index, or TyG-BMI; TyG-waist circumference, or TyG-WC; TyG-waist circumference-to-height ratio, or TyG-WHtR) and the risk of HF.

Methods: Between 2017 and 2023, the study employed a prospective cohort study design to investigate all older adults aged 60 years and above who completed at least twice periodical health examinations in the National Basic Public Health Service at the Hongguang Community Health Service Center. The association between TyG and its derived indices (TyG-BMI; TyG-WC; TyG-WHtR) and the risk of HF was assessed by Cox modelling, as well as their longitudinal trajectories fitted using a group-based trajectory model.

Results: A total of 7,335 people participated in the study. During an average follow-up period of 2.97 years, 229 participants were eventually diagnosed with HF. Findings showed that individuals with a TyG-BMI less than 142 or greater than or equal to 169, TyG-WC greater than or equal to 614, and TyG-WHtR greater than or equal to 3.85 had a higher risk of developing HF, with hazard ratios (HR) and 95% confidence intervals (CIs) of 1.17 (1.15, 2.55), 1.45 (1.06. 1.98), 1.54 (1.09, 2.18) and 1.33 (1.01, 1.75). In terms of trajectories, the three derived indexes exhibited relatively stable fluctuations. Specifically, among men, those with low-level fluctuations in the TyG-BMI trajectory had a hazard ratio of 2.37 for HF compared to those with a medium-level wave.Compared to individuals whose TyG-WHtR levels fluctuate around 3.71 over five years, those with TyG-WHtR levels approaching 3.29 and steadily decreasing face an 80% higher risk of developing HF. However, there was no such difference observed in women.

Conclusion: This study demonstrates a difference in the risk of HF among populations with varying levels of TyG combined with obesity indicators. In addition, persistently low and decreasing levels of TyG-WHtR also indicate an increased risk of developing HF. These biomarkers can be used as effective practical tools for identifying those at high risk of developing HF in the community's older population.