Yang Zou

The triglyceride-glucose (TyG) and its obesity‑derived indices are important composite parameters of insulin resistance coupled with obesity, and have been associated with cardiometabolic diseases. However, their associations with cardiovascular‑liver‑metabolic multimorbidity (CLMM) remain unclear. This study aims to systematically compare TyG and its obesity-derived indices to identify the optimal surrogate marker for CLMM, and to explore the potential impact of CLMM status on mortality. Based on a multi-stage sampling design of a national cohort, weighted logistic and Cox regression models were applied to evaluate the associations of each index with CLMM and long-term mortality. Discriminatory performance was compared using the area under the receiver operating characteristic curve (AUROC), net reclassification improvement, and integrated discrimination improvement. Additionally, weighted quantile sum regression, and mediation analysis were employed to explore the underlying disease mechanisms. The study included 20,235 adults. Weighted logistic regression analyses for the individual indices revealed that the TyG and its obesity‑derived indices were all positively associated with CLMM, with TyG‑WHtR, TyG‑WWI, and TyG‑CVAI showing the strongest associations. Further longitudinal weighted interaction analyses revealed that CLMM status significantly amplified the mortality risk associated with the TyG and its obesity-derived indices. For CLMM identification, all indices showed favorable diagnostic performance (AUROC > 0.76), with TyG‑WWI and TyG‑CVAI achieving the best performance (AUROC > 0.83) and exhibiting the largest net reclassification improvement and integrated discrimination improvement. Joint XGBoost-SHAP analyses further indicated that TyG-CVAI and TyG-WWI were the major contributing variables for discriminating CLMM status. Exploratory mechanistic analyses suggested glucose metabolism as a core driver underlying CLMM development, with inflammatory factors partially mediating these associations. The TyG and its obesity-derived indices, particularly TyG-WWI and TyG-CVAI, exhibited significant incremental value for identifying CLMM, with CLMM status also conferring elevated subsequent mortality risk. Incorporating these indices into primary prevention monitoring systems for chronic diseases could facilitate the identification of individuals at high risk for CLMM and mortality.

Obesity is a well-recognized risk factor for stroke, and this study aims to explore the association between a novel obesity parameter, the metabolic score

The obesity and Atherogenic Index of Plasma (AIP) have been identified as independent predictors of abnormal glucose metabolism. The objective of this stud

The triglyceride-glucose (TyG) index is an important determinant influencing the incidence of cardiometabolic multimorbidity (CMM). However, it remains unc

Introduction: Acute decompensated heart failure (ADHF), a critical cardiovascular emergency, is driven by a metabolic and inflammatory imbalance that serves as the central mechanism of disease progression. This study aims to analyze the heterogeneity of mortality risk in patients with comorbid diabetes mellitus (DM) and HF using the C-reactive protein-triglyceride-glucose index (CTI). Methods: This study evaluated 1,051 ADHF patients from the Jiangxi-ADHF II cohort. The Boruta algorithm, a fully automated feature selection method, was applied to identify key predictive variables and rank their importance. Cox proportional hazard models were constructed to assess the association between the CTI and 30-day mortality risk in ADHF patients, stratified by DM status. To further elucidate the nonlinear characteristics of risk associations, restricted cubic splines were employed to construct dose-response relationship curves. Additionally, heatmaps were used to assess the joint association of CTI components with mortality risk. Results: The 30-day follow-up revealed a mortality rate of 8.3%. Through the Boruta algorithm and multivariate Cox regression analysis, we identified CTI as a key prognostic factor for short-term mortality risk in ADHF patients, especially in those with comorbid DM. The restricted cubic splines model further confirmed the linear and non-linear associations between CTI and mortality in ADHF patients with and without DM. Additionally, heatmaps visualized the association between CTI components and mortality: to summarize, the mortality risk is relatively low when the triglyceride-glucose index remains within specific ranges (8.25-9.0 for patients with DM; 7.0-9.0 for non-DM patients) and the C-reactive protein level is maintained below 50 mg/L. Further subgroup analyses highlighted distinct risk modulation patterns: non-DM ADHF patients exhibited mortality risk heterogeneity across gender, hypertension, and stroke subgroups; however, the DM comorbid group demonstrated uniform risk profiles with no statistically significant differences. Discussion: This study demonstrates the clinical utility of the novel inflammatory-metabolic index CTI in mortality risk assessment for ADHF patients, with superior risk stratification efficacy observed in those with DM comorbidity.

Background The atherogenic index of plasma (AIP) and obesity indices have been introduced as cost-effective indicators for cardiovascular disease (CVD) risk. We aimed to investigate the association between cumulative changes in AIP and its obesity-related derivatives (AIP, AIP-BMI, AIP-WC, AIP-WHtR, AIP-BRI, and AIP-CVAI) and CVD using a nationally representative cohort. Methods A total of 4,519 CVD-free participants from the China Health and Retirement Longitudinal Study were included. Based on repeated measurement data from Waves 1 and 3, we classified the control levels of AIP and its obesity-related derivatives using k-means clustering and evaluated their cumulative exposure. A multi-model joint analysis strategy was adopted to systematically assess the associations of cumulative changes in AIP and its obesity-related derivatives with CVD, the component contributions, and the mediating role of glycometabolic factors. Results Over 8 years' median follow-up, the study found that both AIP and its obesity-related derivatives (including baseline levels and cumulative changes) exhibited linear positive associations with CVD events. Compared to baseline assessments, evaluating the cumulative changes in AIP and its obesity-related derivatives further enhanced the assessment of CVD risk. Compared to individuals with better control level or lowest cumulative exposure, those with poor control level or highest cumulative exposure of AIP, AIP-BMI, AIP-WC, AIP-WHtR, AIP-BRI, and AIP-CVAI exhibited odds ratios of 1.37/1.34, 1.48/1.43, 1.44/1.42, 1.36/1.42, 1.43/1.42, and 1.51/1.42, respectively. Notably, diabetic status further amplified the impact of cumulative changes in AIP and its obesity-related derivatives on CVD risk. Further weighted quantile sum analysis revealed that cumulative triglycerides and cumulative obesity indices exhibited the highest relative contribution weights to CVD events. Finally, mediation analysis demonstrated that cumulative haemoglobin A1c partially mediated the CVD risk associated with cumulative AIP and its obesity-related derivatives. Conclusions AIP and its obesity-related derivatives (particularly AIP-CVAI) exhibited significant positive associations with incident CVD risk. The strength of these associations dynamically influenced with cumulative changes in these metrics and significantly modified by diabetic status. Comprehensive analysis using weighted quantile sum and mediation models revealed that cumulative glucose effect partially mediated these associations, while sustained exposure to triglycerides and obesity emerged as primary drivers. Graphic Abstract

Background The triglyceride glucose (TyG) index and various obesity indices have been proven to be cost-effective indicators of cardiovascular disease (CVD) risk. This study aims to systematically investigate and compare the associations between longitudinal trajectories of TyG index combined with classical and novel obesity indices (TyG-BMI, TyG-WC, TyG-WHtR, TyG-WWI, TyG-ABSI, TyG-BRI, TyG-CVAI) and CVD. Methods The study sample comprised 3505 non-CVD participants from the CHARLS national cohort. Longitudinal data from Waves 1 and 3 of the national surveys were used to quantify cumulative exposure and trajectories of TyG and its obesity derivatives. A multi-model analytical framework (including logistic regression, spline regression, and weighted quantile sum regression models) was constructed to systematically examine the strength of associations between trajectories of TyG and its obesity derivatives and CVD, and the contribution of each component. Results During 8-year median follow-up, 411 CVD cases occurred. The study demonstrated that compared to static baseline values, longitudinal assessment of cumulative exposure and trajectory of TyG and its obesity derivatives enhanced predictive capacity for CVD. Notably, combinations of TyG with classical obesity index WC and novel obesity index CVAI (TyG-WC and TyG-CVAI) exhibited superior performance for CVD risk assessment. Compared to participants with well-controlled trajectories and low exposure levels, those with poorly controlled or highest cumulative exposure to TyG index, TyG-BMI, TyG-WC, TyG-WHtR, TyG-WWI, TyG-ABSI, TyG-BRI, and TyG-CVAI had odds ratios of 1.61/1.40, 2.13/1.70, 2.00/1.78, 1.77/1.59, 1.31/1.36, 1.37/1.30, 1.76/1.56, and 2.00/1.72, respectively. Finally, weighted quantile sum regression results indicated that cumulative exposure to obesity and triglycerides contributed most to CVD risk among all metabolic indices, suggesting that simultaneous regulation of triglycerides and obesity may be critical for reducing CVD risk. Conclusion In this cohort study, the longitudinal trajectories of TyG and its obesity derivatives were closely associated with CVD. Comparatively, the combinations of TyG with classical obesity index WC and novel obesity index CVAI (TyG-WC and TyG-CVAI) exhibited superior performance for CVD risk assessment, with this risk primarily driven by obesity and triglycerides. Graphical abstract

Introduction: Metabolic disorders characterized by dysregulation of glucose and lipid homeostasis are significant drivers of heart failure progression. This study proposes using high-density lipoprotein cholesterol (HDL-C) to modify fasting plasma glucose (FPG), and thereby constructing the FPG/HDL-C ratio (FHR) as a novel comprehensive metabolic indicator, and further investigates the synergistic effects of the FHR and its components on mortality in patients with acute decompensated heart failure (ADHF). Methods: This cohort study included 2,328 ADHF patients recruited from the Jiangxi-ADHF II cohort. Multivariable Cox regression and restricted cubic spline models were used to analyze the association between the FHR and 30-day mortality in ADHF patients. To visualize the joint effects of FPG and HDL-C on 30-day mortality risk, we generated two-dimensional heatmaps and three-dimensional surface plots. Finally, mediation models were employed to perform exploratory analysis of the potential mediating roles of inflammatory factor white blood cells, oxidative stress marker gamma-glutamyl transferase, and nutritional factor albumin in the association between FHR and mortality risk. Results: During the 30-day follow-up, 150 deaths (6.44%) occurred in the Jiangxi-ADHF II cohort. Multivariable Cox regression analysis revealed a positive association between FHR and 30-day mortality. Restricted cubic spline analysis showed a U-shaped association instead of a linear pattern, with the lowest mortality risk at FHR values ranging from 4 to 6. Notably, the joint association analysis based on two-dimensional heatmaps and three-dimensional surface plots, demonstrated a concave-shaped association of FPG and HDL-C with 30-day mortality: when both FPG (3–7 mmol/L) and HDL-C (1.05–1.65 mmol/L) were maintained within specific ranges, short-term mortality risk was minimized. Finally, mediation analysis suggested that inflammatory factor white blood cells and the nutritional factor albumin play significant mediating roles in the short-term mortality risk of ADHF patients associated with FHR. Discussion: This cohort study of the Jiangxi population in China is the first to reveal a U-shaped association between FHR and 30-day mortality in ADHF patients, establishing a synergistic effect of FPG and HDL-C on mortality risk. Based on these findings, we propose implementing a “metabolic synergistic management” strategy for ADHF patients in clinical practice.

Objective: Acute decompensated heart failure (ADHF) is the most common and severe type of HF. The aim of this study is to evaluate the impact and predictive value of a novel inflammatory marker, the inflammatory burden index (IBI), on the 30-day mortality and adverse prognosis in patients with ADHF.Methods: This retrospective cohort study included 1,241 ADHF patients from Jiangxi Provincial People's Hospital between 2018 and 2024. The IBI was calculated as C-reactive protein × (neutrophil count/lymphocyte count). In the event analysis, the study outcome was defined as the 30-day mortality rate after hospital admission in ADHF patients. Multivariable Cox regression and receiver operating characteristic curve analysis were used to assess the impact and predictive value of the IBI on 30-day mortality. Additionally, subgroup analyses were performed to determine the risk dependency of the IBI within specific populations.Results: During the 30-day observation period, a total of 108 death events (8.70%) were recorded. When the study population was stratified into tertiles based on the IBI, the 30-day mortality rates were 1.93%, 4.60%, and 19.57%, respectively. Multivariable Cox regression analysis revealed a significant positive association between the IBI and 30-day mortality in ADHF patients (HR per SD increase: 1.29, 95% CI: 1.15–1.46). Compared to ADHF patients with a low IBI (T1), those with a high IBI (T3) showed a 368% higher risk of 30-day mortality (HR: 4.68, 95% CI: 1.06–13.73). Subgroup analysis revealed a significant interaction between the IBI and 30-day mortality in ADHF patients across sex subgroups (P-interaction < 0.05). In particular, compared to male patients, female ADHF patients exhibited a significantly higher risk of IBI-related in-hospital all-cause mortality (HR: 1.52 vs. 1.33). Receiver operating characteristic analysis further demonstrated that the novel inflammatory marker IBI had the highest AUC value (0.80) compared to conventional inflammatory markers, including C-reactive protein, white blood cell count, neutrophil count, lymphocyte count, and monocyte count.Conclusion: The cohort study conducted in Jiangxi, China, revealed that the novel inflammatory marker IBI is significantly positively associated with 30-day mortality in ADHF patients and demonstrated strong predictive value. Incorporating IBI into the clinical management of ADHF patients may hold significant potential for preventing further disease deterioration.

Introduction: Remnant cholesterol (RC), a highly atherogenic lipid component, has been strongly implicated in the pathogenesis and adverse clinical outcomes of numerous cardiovascular and cerebrovascular diseases. However, its impact on short-term prognosis in patients with acute decompensated heart failure (ADHF) remains to be elucidated.Methods: This study enrolled 2,365 patients with acute decompensated heart failure (ADHF) admitted to Jiangxi Provincial People’s Hospital from 2018 to 2024. Participants were stratified into quartiles based on RC. The primary outcome was 30-day all-cause mortality. Multivariable-adjusted Cox regression and restricted cubic spline regression were employed to analyze the association between RC and 30-day mortality in ADHF patients. Additionally, exploratory mediation analyses were performed to assess potential mediating roles of inflammation, oxidative stress, and nutritional factors in this relationship.Results: During the 30-day follow-up period, 151 deaths were recorded. Mortality was significantly higher in the highest RC quartile compared to the other three groups (Q1:4.41% vs Q2:5.85% vs Q3:5.93% vs Q4:9.18%). After full adjustment for potential confounders, RC demonstrated a significant linear positive association with 30-day mortality in ADHF patients [Hazard ratio: 1.16 (1.05, 1.28)]. Compared with those in the lowest quartile, patients in the highest RC quartile had a 76% increased risk of 30-day mortality. Further subgroup analyses demonstrated that ADHF patients with comorbid hypertension, coronary heart disease, and reduced ejection fraction had a significantly higher 30-day mortality risk than those without these conditions. Discussion: This Chinese cohort study reveals a dose-dependent relationship between RC and 30-day mortality in ADHF patients, particularly exacerbated in those with hypertension, coronary heart disease, or reduced ejection fraction.