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Background <p>Arterial stiffness and insulin resistance are established risk factors for chronic heart failure (CHF), yet their interaction in CHF remains unclear.</p> Methods <p>We analyzed 1,162 hospitalized CHF patients at Nanjing Drum Tower Hospital. Estimated pulse wave velocity (ePWV) was calculated using a nonlinear function of age and mean blood pressure, and the triglyceride-glucose index (TyG) was calculated based on fasting triglyceride and plasma glucose levels. Participants were stratified into four groups by the medians of ePWV and TyG. Restricted cubic spline (RCS) analysis examined nonlinear associations, while Cox proportional hazards regression assessed cardiovascular mortality risk; additive and multiplicative interactions between ePWV and TyG were further evaluated.</p> Results <p>During a median follow-up of 921&#xa0;days, 121 cardiovascular deaths occurred. RCS revealed a nonlinear J-shaped association between ePWV and cardiovascular mortality risk (inflection point: 11.36&#xa0;m/s; 95% CI 11.35–11.38, <i>P</i> for nonlinearity = 0.013).&#xa0;In the combined analysis comparing with the dual-low group, cardiovascular mortality risk was significantly elevated when both markers were above the median (HR = 2.99, 95% CI 1.73–5.17). Controlling for one of the two factors below the median, the isolated elevation of the other marker did not lead to a significant increase in risk. Additive interaction analysis indicated a synergistic effect (RERI = 1.52, 95% CI 0.28–2.99; AP = 0.52, 95% CI 0.08–0.81), whereas multiplicative interaction was nonsignificant (<i>P</i> = 0.065). Findings were consistent across subgroups and robust to sensitivity analyses.</p> Conclusion <p>In CHF, concomitant elevation of ePWV and TyG conferred a 2.99-fold increased risk, with 52% attributable to their interaction.</p> Graphical Abstract <p></p>

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A retrospective cohort study on the interaction between arterial stiffness and insulin resistance in chronic heart failure

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月6日

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  • Lingyu Ma,
  • Wei Guo,
  • Jinhua Bi,
  • Xiaoli Liu,
  • Xue Bao,
  • Guo Song,
  • Rong Gu

摘要

Background

Arterial stiffness and insulin resistance are established risk factors for chronic heart failure (CHF), yet their interaction in CHF remains unclear.

Methods

We analyzed 1,162 hospitalized CHF patients at Nanjing Drum Tower Hospital. Estimated pulse wave velocity (ePWV) was calculated using a nonlinear function of age and mean blood pressure, and the triglyceride-glucose index (TyG) was calculated based on fasting triglyceride and plasma glucose levels. Participants were stratified into four groups by the medians of ePWV and TyG. Restricted cubic spline (RCS) analysis examined nonlinear associations, while Cox proportional hazards regression assessed cardiovascular mortality risk; additive and multiplicative interactions between ePWV and TyG were further evaluated.

Results

During a median follow-up of 921 days, 121 cardiovascular deaths occurred. RCS revealed a nonlinear J-shaped association between ePWV and cardiovascular mortality risk (inflection point: 11.36 m/s; 95% CI 11.35–11.38, P for nonlinearity = 0.013). In the combined analysis comparing with the dual-low group, cardiovascular mortality risk was significantly elevated when both markers were above the median (HR = 2.99, 95% CI 1.73–5.17). Controlling for one of the two factors below the median, the isolated elevation of the other marker did not lead to a significant increase in risk. Additive interaction analysis indicated a synergistic effect (RERI = 1.52, 95% CI 0.28–2.99; AP = 0.52, 95% CI 0.08–0.81), whereas multiplicative interaction was nonsignificant (P = 0.065). Findings were consistent across subgroups and robust to sensitivity analyses.

Conclusion

In CHF, concomitant elevation of ePWV and TyG conferred a 2.99-fold increased risk, with 52% attributable to their interaction.

Graphical Abstract