TyG index simple and cost-effective marker for early detection of people at high risk of HF

The findings, published in Cardiovascular Diabetology, suggest that the TyG index could serve as a cost-effective and simple marker for risk stratification and early detection of individuals at higher risk for heart failure.

"Our findings support the TyG index as a valuable marker to evaluate the risk of heart failure incidence in different populations and as a prognostic marker in patients with HF," the researchers wrote.

Heart failure represents the end stage of most heart diseases. Enormous progress has been made in therapy and tool development in the last decade to predict the adverse outcomes and incidence, but still, there has been a dramatic increase in HF prevalence over time. Therefore, the identification of more specific predictors of future HF events represents one of the most significant achievements of the research in the field.

Several biomarkers have been identified, tested, and implemented in clinical practice along with prediction models for HF that primarily rely on traditional risk factors, including insulin resistance (IR) and type 2 diabetes mellitus (T2DM). Insulin resistance is a major metabolic disorder observed in HF and is tightly associated with poor prognosis in patients. The TyG index has been proposed as a surrogate marker of IR in HF. Yet, there is no clarity on whether TyG is a reliable clinical marker.

Therefore, Amir Hossein Behnoush, Tehran University of Medical Sciences, Tehran, Iran, and colleagues aimed to respond to this relevant question via a systematic review and meta-analysis of existing studies.

For this purpose, the researchers conducted a systematic search to find studies investigating the TyG index in heart failure patients or its association with HF incidence. Adjusted hazard ratios (HR) were pooled through random-effect meta-analysis. HRs were calculated using TyG as a continuous variable (1 unit increase) and by comparing the group with the highest TyG to the lowest TyG group. Thirty studies comprising 772,809 participants were included in the systematic review.

The research led to the following findings:

• Meta-analysis of seven studies comparing the highest-TyG to the lowest-TyG group showed a significantly increased risk of HF in the former group (HR 1.21).
• The same result was found when pooling the HRs for a one-unit increase in the TyG index (HR 1.17).
• A more elevated TyG index was associated with a higher incidence of HF in patients with type 2 diabetes or coronary artery disease.
• The incidence of adverse events (readmission and mortality) in patients with HF was associated with TyG.

"As our analysis shows, the TyG index is associated with heart failure incidence and outcomes in all groups of patients, and monitoring the TyG index might be beneficial in patients with established HF as it predicts adverse events," the researchers wrote.

"Further studies should be conducted to confirm these associations and investigate the clinical utility of the TyG index," they concluded.

Reference:

Khalaji, A., Behnoush, A.H., Khanmohammadi, S. et al. Triglyceride-glucose index and heart failure: a systematic review and meta-analysis. Cardiovasc Diabetol 22, 244 (2023). https://doi.org/10.1186/s12933-023-01973-7