Association between triglyceride glucose index and heart failure with preserved ejection fraction in patients with coronary heart disease — a RCSCD-TCM study in China

Background The triglyceride glucose (TyG) index serves as a surrogate indicator of insulin resistance. However, there is limited evidence on the association between the TyG index and heart failure with preserved ejection fraction (HFpEF) in patients with coronary heart disease (CHD). Methods The 62,794 CHD patients were included used to analyze the relationship between the TyG index and heart failure (HF) in CHD patients. Of these, 8,606 patients who underwent echocardiography were included to identify different types of HF, including HF with reduced ejection fraction (HFrEF), HF with intermediate-range ejection fraction (HFmrEF), and HFpEF. Logistic regression was used to analyze the relationship between the TyG index and HFpEF in CHD patients. The relationship between the TyG index and HFpEF according to sex, age, blood lipids and blood pressure states were also assessed. Results A baseline analysis of CHD patients divided into four groups according to the tertile level of the TyG index showed that there were significant differences in related parameters between the groups. In the multi-adjusted modles, the TyG index was significantly associated with the risk of HFpEF (OR: 1.56; 95% CI: 1.08–1.23). In addition, the TyG index of CHD patients was significantly associated with HFpEF in elderly (> 60 years old) patients (OR:1.19; 95% CI: 1.10-1.48), hypertension (OR:1.17; 95% CI: 1.10-1.25) and dyslipidemia (OR:1.16; 95% CI: 1.08-1.23). The association between the TyG index and HFpEF was not affected by sex. And the association between the TyG index of female and HFpEF was (OR:1.21; 95% CI: 1.10-1.34), which was higher than that of male (OR:1.11; 95% CI: 1.02-1.21). Conclusions This study demonstrated a significant association of the TyG index and HFpEF in CHD patients. In this study, the results show that the TyG index was independently associated with HFpEF in hypertension, dyslipidemia, and elder patients (> 60 years old). In addition, the association between the TyG index and HFpEF in CHD patients was higher in female. ![Figure][1] Graphical abstract ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by the National Natural Science Foundation of China (82074140). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved by the ethics committee of Tianjin University of Traditional Chinese Medicine (TJUTCM-EC20190008) and registered in the Chinese Clinical Trial Registry (ChiCTR-1900024535) and in Clinical Trials.gov ([NCT04026724][2]). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The datasets used and/or analyzed in the current study are available from the corresponding author upon reasonable request. * TyG : Triglyceride glucose HF : Heart failure HFrEF : Heart failure with reduced ejection fraction HFmrEF : Heart failure with mid-range ejection fraction HFpEF : Heart failure with preserved ejection fraction LVEF : Left ventricle ejection fraction CHD : Coronary heart disease DM : Diabetes mellitus NCD : Non-communicable diseases T2DM : Type 2 diabetes CAD : Coronary artery disease Pre-DM : Prediabetes AS : Atherosclerosis SBP : Systolic blood pressure DBP : Diastolic blood pressure FPG : Fasting plasma glucose TC : Total cholesterol HDL-C : High-density lipoprotein cholesterol TG : Triglycerides LDL-C : Low-density lipoprotein cholesterol CRP : C-reactionprotein HbA1c : Glycated haemoglobin OR : Odds ratios CIs : Confidence intervals HOMA-IR : Homeostasis model assessment of insulin resistance SA : Subclinical atherosclerosis [1]: pending:yes [2]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04026724&atom=%2Fmedrxiv%2Fearly%2F2023%2F11%2F01%2F2023.10.31.23297884.atom