The Correlation Between Triglyceride-Glucose Index and Its Associated Indices With All-Cause and Cardiovascular Mortality in Patients With Advanced-Stage Cardiovascular-Kidney-Metabolic Syndrome

Sep 12, 2025Heart, lung & circulation

Link Between Triglyceride-Glucose Index and Death from Any Cause or Heart Disease in Patients with Advanced Heart, Kidney, and Metabolic Problems

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Abstract

5,826 patients with advanced cardiovascular-kidney-metabolic syndrome were analyzed for mortality outcomes over a median follow-up of 8.21 years.

The TyG-waist-to-height ratio (TyG-WHtR) and TyG-weight-waist index (TyG-WWI) are significantly associated with all-cause mortality in advanced CKM patients.
In the highest tertile, TyG-WHtR was linked to an increased risk of all-cause mortality (hazard ratio 1.33) and cardiovascular mortality (1.47).
TyG-WWI also showed significant associations with all-cause (1.40) and cardiovascular mortality (1.71) in the highest tertile.
A J-shaped relationship was observed, indicating higher mortality risk at specific thresholds for both TyG-WHtR (≥5.43) and TyG-WWI (≥99.03).
Cardiovascular mortality risk increased significantly at a TyG-WWI threshold of ≥98.87.

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AIM: The American Heart Association (AHA) introduced the Cardiovascular-Kidney-Metabolic (CKM) syndrome in 2023, emphasising low survival rates in advanced CKM patients. This study explores the predictive value of the triglyceride-glucose (TyG) index and its associated indices for all-cause and cardiovascular mortality in these patients.

METHODS: Data from 5,858 patients with advanced CKM (defined as stage 3/4 CKM per AHA criteria) were extracted from the National Health and Nutrition Examination Survey (NHANES), USA. The median follow-up duration for mortality outcomes was 8.21 years. Patients were categorised into tertiles (T) based on the TyG index and its associated indices (TyG-waist-to-height ratio [TyG-WHtR] and TyG-weight-waist index [TyG-WWI]; T1, T2, T3). Cox proportional hazards regression was used to analyse the prognostic value of these indices, adjusting for various covariates, and the results were presented as hazard ratio (HR) and 95% confidence interval (CI). Restricted cubic splines (RCS) assessed linear or nonlinear relationships between these indices and advanced CKM risk, with subgroup analyses for stratified examination.

RESULTS: A total of 5,826 and 5,150 patients were included for the analysis of all-cause mortality and cardiovascular mortality, respectively. Multivariable Cox regression demonstrated that in the T3 group, both TyG-WHtR (HR 1.33, 95% CI 1.04-1.70) and TyG-WWI (1.40, 1.01-1.95) were significantly associated with all-cause mortality. Similar associations were observed for cardiovascular mortality, with TyG-WHtR (1.47, 1.06-1.88) and TyG-WWI (1.71, 1.06-2.78) showing comparable effects. Both indices exhibited a J-shaped association with mortality, with significant increases in HRs for all-cause mortality observed at TyG-WHtR ≥5.43 and TyG-WWI ≥99.03, while cardiovascular mortality HRs showed a significant rise at TyG-WWI ≥98.87.

CONCLUSION: This study is the first known to link TyG-WHtR and TyG-WWI with all-cause and cardiovascular mortality in advanced CKM patients, indicating their significant predictive value for this population.

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The Correlation Between Triglyceride-Glucose Index and Its Associated Indices With All-Cause and Cardiovascular Mortality in Patients With Advanced-Stage Cardiovascular-Kidney-Metabolic Syndrome

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