Triglyceride-Glucose Index as a Potential Marker for the Development of Heart Failure in Healthy Adults

Purpose Heart failure (HF) poses a major health burden worldwide, and early detection of at-risk populations is of clinical importance. The triglyceride-glucose index (TGI), a surrogate marker of insulin resistance, is thought to be associated with a higher risk of developing cardiovascular disease. Nonetheless, its predictive value for the future development of HF in healthy populations is unknown. We thus investigated the utility of TGI for the prediction of HF development in healthy adults. Methods The study population comprised 19,829 self-referred adults, evaluated annually in a screening program, who were free of baseline diabetes and cardiovascular disease. The TGI was calculated as: ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. The primary end-point was the development of any HF. An HF specialist classified all HF events in accordance with guidelines. Results The mean age was 50±8 years for the cohort, 14,039 (71%) were men, and 2,709 (14%) were obese. Baseline TGI was 8.53±0.54. During a median follow-up of 14 years (IQR 8-18), 193 (1%) subjects developed HF. Univariate Cox regression showed that each 1 unit increase in TGI was associated with a significant 67% increased risk of developing any HF during follow-up (95% CI 1.30-2.16, p<.001). A multivariate model, adjusted for age, sex, baseline hypertension, LDL, obesity, and fitness level consistently showed that each 1 unit increase in TGI was associated with a 39% increased risk of developing HF (95% CI 1.05-1.84, p=.020). The association between the baseline TGI and the development of HF was obesity dependent, such that for obese patients each 1 unit increase in TGI was associated with a significant 61% increase in the risk of HF (95% CI 1.18-2.20, p=.003), while for non-obese subjects the association was non-significant (p NS; p for interaction .018). Conclusion High TGI in the healthy adult population is associated with an increased risk of HF and is a promising potential marker for the later development of HF. The impact of interventions aiming to decrease TGI on HF outcomes should be assessed. Heart failure (HF) poses a major health burden worldwide, and early detection of at-risk populations is of clinical importance. The triglyceride-glucose index (TGI), a surrogate marker of insulin resistance, is thought to be associated with a higher risk of developing cardiovascular disease. Nonetheless, its predictive value for the future development of HF in healthy populations is unknown. We thus investigated the utility of TGI for the prediction of HF development in healthy adults. The study population comprised 19,829 self-referred adults, evaluated annually in a screening program, who were free of baseline diabetes and cardiovascular disease. The TGI was calculated as: ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. The primary end-point was the development of any HF. An HF specialist classified all HF events in accordance with guidelines. The mean age was 50±8 years for the cohort, 14,039 (71%) were men, and 2,709 (14%) were obese. Baseline TGI was 8.53±0.54. During a median follow-up of 14 years (IQR 8-18), 193 (1%) subjects developed HF. Univariate Cox regression showed that each 1 unit increase in TGI was associated with a significant 67% increased risk of developing any HF during follow-up (95% CI 1.30-2.16, p<.001). A multivariate model, adjusted for age, sex, baseline hypertension, LDL, obesity, and fitness level consistently showed that each 1 unit increase in TGI was associated with a 39% increased risk of developing HF (95% CI 1.05-1.84, p=.020). The association between the baseline TGI and the development of HF was obesity dependent, such that for obese patients each 1 unit increase in TGI was associated with a significant 61% increase in the risk of HF (95% CI 1.18-2.20, p=.003), while for non-obese subjects the association was non-significant (p NS; p for interaction .018). High TGI in the healthy adult population is associated with an increased risk of HF and is a promising potential marker for the later development of HF. The impact of interventions aiming to decrease TGI on HF outcomes should be assessed.