Arterial stiffness and insulin resistance are recognized contributors to adverse outcomes in patients with chronic heart failure (CHF). However, the combined impact of these factors on cardiovascular mortality has not been well characterized. A hospital-based cohort study published in the European Journal of Medical Research assessed the relationship and interaction between estimated pulse wave velocity (ePWV), a marker of arterial stiffness, and the triglyceride–glucose (TyG) index, an indicator of insulin resistance.
The study included 1,162 hospitalized patients with CHF treated at Nanjing Drum Tower Hospital. ePWV was calculated using a nonlinear function based on age and mean blood pressure, while the TyG index was derived from fasting triglyceride and plasma glucose levels. Participants were stratified into four groups according to the median values of ePWV and TyG. Restricted cubic spline analysis evaluated nonlinear associations between ePWV and cardiovascular mortality. Cox proportional hazards models assessed mortality risk. Additive and multiplicative interaction analyses examined the combined effects of ePWV and TyG.
During a median follow-up of 921 days, 121 cardiovascular deaths occurred. Restricted cubic spline analysis showed a nonlinear J-shaped relationship between ePWV and cardiovascular mortality risk, with an inflection point at 11.36 m/s (95% CI 11.35–11.38; P for nonlinearity = 0.013). Compared with patients with both markers below the median, those with elevated ePWV and TyG had higher cardiovascular mortality risk (HR 2.99; 95% CI 1.73–5.17). Isolated elevation of either marker was not associated with a significant increase in risk. Additive interaction analysis indicated interaction between the two markers, with 52% of the increased risk attributable to their combined effect.
Concurrent elevation of arterial stiffness and insulin resistance markers was associated with higher cardiovascular mortality risk in CHF. These findings indicate that combined assessment of ePWV and TyG was associated with cardiovascular mortality risk in patients with CHF.
