SAT-640 Association Between Triglyceride-Glucose Index and Heart Failure Risk in Patients with Type 2 Diabetes: A Nationwide Cohort Study

Abstract Disclosure: M. Kim: None. K. Lee: None. S. Lee: None. H. Kwon: None. K. Han: None. E. Lee: None. Background: The triglyceride-glucose (TyG) index, a robust marker of insulin resistance, has been increasingly recognized for its role in metabolic dysfunction. Despite its relevance in cardiovascular risk stratification, the association between TyG index and heart failure (HF) risk in type 2 diabetes remains poorly understood. Given the intricate interplay between metabolic health and cardiac function, this study explores whether TyG index can serve as a predictive marker for HF across different durations of diabetes. Methods: We analyzed a nationwide cohort of 1,153,201 individuals with type 2 diabetes, stratified into quartiles (Q1-Q4) based on TyG index levels. HF incidence rates (IR) per 1,000 person-years were assessed for each quartile across various diabetes durations. Cox proportional hazards regression models were employed to calculate hazard ratios (HRs) for HF, adjusting for key confounders such as age, sex, BMI, lifestyle factors, comorbidities, and medication use. Results: The relationship between TyG index and HF risk exhibited a dose-dependent pattern (P for interaction <0.001). In newly diagnosed diabetes, the highest TyG quartile (Q4) was paradoxically associated with a lower unadjusted HF risk compared to Q1 (HR: 0.812; 95% CI: 0.785-0.841). However, after full adjustment, Q4 was linked to a significantly higher HF risk (HR: 1.054; 95% CI: 1.017-1.091). Notably, this risk amplification became more pronounced with longer diabetes duration. Among individuals with ≥10 years of diabetes, those in Q4 had a 28% increased HF risk in fully adjusted models (HR: 1.280; 95% CI: 1.238-1.323). Conclusions: Elevated TyG index is an independent predictor of heart failure risk in type 2 diabetes, particularly in those with longer disease duration. These findings highlight the crucial role of insulin resistance in cardiometabolic complications and suggest that metabolic profiling using TyG index could enhance early HF risk stratification. Presentation: Saturday, July 12, 2025