Triglyceride-glucose index and all-cause mortality in patients with chronic severe heart failure

doi:10.4330/wjc.123414

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World Journal of Cardiology

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1949-8462

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Cardiol. Sep 26, 2026; 18(9): 123414
Published online Sep 26, 2026. doi: 10.4330/wjc.123414

Table 1 Baseline clinical characteristics according to triglyceride-glucose index, n (%)

Variable	Low TyG index (n = 130)	High TyG index (n = 131)	P value
Age, years	67.5 ± 11.8	68.1 ± 11.4	0.675
Age ≥ 65 years	74 (56.9)	77 (58.8)	0.761
Male sex	83 (63.8)	82 (62.6)	0.834
Smokin	73 (56.2)	68 (51.9)	0.580
Alcohol consumption	29 (22.3)	32 (24.4)	0.475
Hypertension	85 (65.4)	97 (74.0)	0.115
Diabetes mellitus	50 (38.5)	69 (52.7)	0.021
Hyperlipidemia	63 (48.5)	81 (61.8)	0.030
Cerebral infarction	16 (12.3)	24 (18.3)	0.178
Prior PCI	24 (18.5)	27 (20.6)	0.662
Prior CABG	15 (11.5)	14 (10.7)	0.827
BMI, kg/m²	24.2 ± 3.9	25.6 ± 5.2	0.012
Heart rate, bpm	80.0 (70.0-98.2)	81.0 (67.0-95.0)	0.326
SBP, mmHg	130.0 (118.7-150.0)	130.0 (120.0-150.0)	0.162
DBP, mmHg	80.0 (70.0-90.0)	80.0 (70.0-90.0)	0.100
White blood cell count, 10⁹/L	6.41 (5.22-7.75)	7.02 (5.74-8.45)	0.127
Hemoglobin, g/L	119.5 ± 22.2	125.1 ± 21.7	0.041
NEUT%, %	66.0 ± 10.6	67.2 ± 10.6	0.399
hs-CRP, mg/L	6.45 (2.05-12.33)	8.13 (3.01-13.41)	0.593
AST, U/L	23 (19-32)	22 (17-31)	0.365
ALT, U/L	21 (17-31)	21 (17-27)	0.326
Uric acid, μmol/L	382.8 (296.8-484.4)	388.7 (305.7-481.7)	0.877
eGFR, mL/minute/1.73 m²	56.8 (35.2-75.0)	61.8 (38.3-83.5)	0.148
TC, mmol/L	3.5 (3.1-4.0)	4.1 (3.6-4.9)	< 0.001
LDL-C, mmol/L	1.88 (1.48-2.33)	2.36 (1.89-2.88)	< 0.001
HDL-C, mmol/L	1.1 (0.9-1.3)	1.0 (0.9-1.2)	0.313
HbA1c, %	6.3 (5.8-7.0)	6.7 (6.2-7.8)	< 0.001
NT-proBNP, pg/mL	6014.0 (2883.2-12896.7)	5319.5 (3277.0-12287.2)	0.695
LVEF, %	43.0 (35.0-60.0)	45.0 (32.0-63.0)	0.653
ACEI/ARB	72 (55.4)	81 (61.8)	0.290
Beta-blocker	79 (60.8)	76 (58.0)	0.651
Digoxin	75 (57.6)	65 (49.6)	0.191

Values are presented as mean ± SD, median (interquartile range).

TyG: Triglyceride-glucose; PCI: Percutaneous coronary intervention; CABG: Coronary artery bypass grafting; BMI: Body mass index; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; NEUT%: Neutrophil percentage; hs-CRP: High-sensitivity C-reactive protein; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; eGFR: Estimated glomerular filtration rate; TC: Total cholesterol; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol; HbA1c: Glycated hemoglobin; NT-proBNP: N-terminal pro-brain natriuretic peptide; LVEF: Left ventricular ejection fraction; ACEI: Angiotensin-converting enzyme inhibitor; ARB: Angiotensin receptor blocker.

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Table 2 Clinical outcomes according to triglyceride-glucose index, n (%)

Outcome	Low TyG index (n = 130)	High TyG index (n = 131)	P value
1-year all-cause mortality	15 (11.5)	32 (24.4)	0.007
5-year all-cause mortality	57 (43.8)	78 (59.5)	0.011
5-year cardiac mortality	47 (36.2)	69 (52.7)	0.007

TyG: Triglyceride-glucose.

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Table 3 Univariable Cox regression analysis for 5-year all-cause mortality

Variable	HR	95%CI	P value
Age ≥ 65 years	1.92	1.35-2.73	< 0.001
Male sex	0.96	0.68-1.36	0.818
BMI, per 1 kg/m²	0.91	0.87-0.95	< 0.001
Hypertension	1.42	1.00-2.01	0.048
Diabetes mellitus	1.78	1.27-2.50	0.001
Hyperlipidemia	1.24	0.88-1.75	0.214
Prior PCI	1.48	1.00-2.19	0.049
Prior CABG	1.76	1.08-2.87	0.023
DBP, per 1 mmHg	0.985	0.972-0.998	0.024
Hemoglobin, per 10 g/L	0.83	0.76-0.91	< 0.001
NEUT%, per 1%	1.035	1.018-1.052	< 0.001
hs-CRP, per 1 mg/L	1.018	1.002-1.034	0.029
eGFR, per 10 mL/minute/1.73 m²	0.84	0.78-0.91	< 0.001
HbA1c, per 1%	1.15	1.02-1.30	0.026
LVEF, per 5%	0.96	0.89-1.03	0.245
NT-proBNP, per SD increase	1.71	1.33-2.21	< 0.001
ACEI/ARB use	0.67	0.47-0.95	0.026
Beta-blocker use	0.64	0.45-0.91	0.013
TyG index, per 1-unit increase	1.46	1.14-1.87	0.003
High TyG group	1.52	1.08-2.13	0.016

PCI: Percutaneous coronary intervention; CABG: Coronary artery bypass grafting; BMI: Body mass index; DBP: Diastolic blood pressure; NEUT%: Neutrophil percentage; hs-CRP: High-sensitivity C-reactive protein; eGFR: Estimated glomerular filtration rate; HbA1c: Glycated hemoglobin; NT-proBNP: N-terminal pro-brain natriuretic peptide; LVEF: Left ventricular ejection fraction; ACEI: Angiotensin-converting enzyme inhibitor; ARB: Angiotensin receptor blocker; HR: Hazard ratio; CI: Confidence interval; TyG: Triglyceride-glucose.

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Table 4 Multivariable Cox regression models for the association between triglyceride-glucose index and 5-year all-cause mortality

Model	Adjustment	n	Events	HR	95%CI	P value
Model 1	Unadjusted	261	135	1.46	1.14-1.87	0.003
Model 2	Age, sex, BMI	261	135	1.41	1.09-1.83	0.009
Model 3	Model 2 + diabetes mellitus, hypertension, eGFR, LVEF	261	135	1.36	1.04-1.78	0.025
Model 4	Model 3 + NT-proBNP, ACEI/ARB use, beta-blocker use	261	135	1.33	1.01-1.76	0.041

Hazard ratio refer to each 1-unit increase in triglyceride-glucose index. In models including N-terminal pro-brain natriuretic peptide (NT-proBNP), NT-proBNP was entered as a standardized continuous variable. HR: Hazard ratio; CI: Confidence interval; BMI: Body mass index; eGFR: Estimated glomerular filtration rate; LVEF: Left ventricular ejection fraction; NT-proBNP: N-terminal pro-brain natriuretic peptide; ACEI: Angiotensin-converting enzyme inhibitor; ARB: Angiotensin receptor blocker.

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Table 5 Exploratory subgroup analyses for the association between triglyceride-glucose index and 5-year all-cause mortality

Subgroup	n	Events	Adjusted HR	95%CI	P value	P for interaction
Diabetes mellitus	119	77	1.28	0.91-1.80	0.156	0.684
No diabetes mellitus	142	58	1.31	0.89-1.94	0.172
Age < 65 years	110	39	1.24	0.78-1.97	0.361	0.522
Age ≥ 65 years	151	96	1.39	1.01-1.92	0.044
Male	165	84	1.36	0.98-1.89	0.067	0.744
Female	96	51	1.29	0.82-2.04	0.269
eGFR < 60 mL/minute/1.73 m²	137	86	1.42	1.01-2.01	0.046	0.438
eGFR ≥ 60 mL/minute/1.73 m²	124	49	1.21	0.79-1.86	0.382

Subgroup analyses were exploratory and were not adjusted for multiple comparisons. Adjusted hazard ratio refer to each 1-unit increase in triglyceride-glucose index. HR: Hazard ratio; CI: Confidence interval; eGFR: Estimated glomerular filtration rate.

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Table 6 Receiver operating characteristic analysis for prediction of 5-year all-cause mortality

Model	AUC	95%CI	Sensitivity (%)	Specificity (%)	Youden index	P vs 0.5	*DeLong P vs* NT-proBNP**
TyG index	0.577	0.507-0.646	58.5	56.3	0.148	0.033	-
NT-proBNP	0.713	0.651-0.775	68.9	70.2	0.391	< 0.001	Reference
TyG index + NT-proBNP	0.722	0.661-0.783	66.7	76.2	0.429	< 0.001	0.318

AUC: Area under the curve; CI: Confidence interval; TyG: Triglyceride-glucose; NT-proBNP: N-terminal pro-brain natriuretic peptide.

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Citation: Li XF, Wang X, Zhang Y, Liu J, Liu JM, Chen ML, Zhao L, Shi LY. Triglyceride-glucose index and all-cause mortality in patients with chronic severe heart failure. World J Cardiol 2026; 18(9): 123414
URL: https://www.wjgnet.com/1949-8462/full/v18/i9/123414.htm
DOI: https://dx.doi.org/10.4330/wjc.123414

Li XF, Wang X, Zhang Y, Liu J, Liu JM, Chen ML, Zhao L, Shi LY. Triglyceride-glucose index and all-cause mortality in patients with chronic severe heart failure. World J Cardiol 2026; 18(9): 123414 [DOI: 10.4330/wjc.123414]

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