The novel triglyceride‒glucose-weighted adjusted waist index as a supplementary diagnostic tool for heart failure: evidence of improved reclassification beyond traditional TyG-related indices from a cross-sectional study.

Background: Heart failure (HF) remains a major public health burden, necessitating reliable biomarkers for early risk stratification. The triglyceride glucose weight-adjusted waist index (TyG-WWI), a novel metabolic indicator, has emerged as a potential predictor, but its association with HF in the general population remains underexplored.

Methods: This retrospective cross-sectional study included 22,575 participants from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2018, 704 of whom had HF. The TyG-WWI was calculated, and its association with HF risk was analyzed via multivariable logistic regression (adjusted for demographics, lifestyle factors, disease history, and medication use), restricted cubic splines (with 4 knots), and subgroup analyses. Additionally, interaction tests by different survey cycles were performed to account for temporal effects. ROC analysis with DeLong's test and net reclassification improvement (NRI) were used to compare the diagnostic performance of the TyG-WWI with that of conventional TyG-related parameters (TyG, TyG-WC, TyG-WHtR) and traditional HF prognostic factors. Sensitivity analyses with multiple imputation for missing data were performed to assess the robustness of the results.

Results: The study population had a mean age of 49.5 years, with 48.34% males. Baseline characteristics differed significantly between the HF and non-HF groups in terms of demographics, lifestyle, disease history, and medication use. After full adjustment for demographic, clinical, and lifestyle factors, each standard deviation increase in the TyG-WWI was associated with a 52% greater HF risk (OR 1.52, 95% CI 1.27-1.81). Restricted cubic spline analysis revealed a linear positive correlation between the TyG-WWI and HF risk. ROC analysis demonstrated that compared with conventional TyG-WWI (AUC = 0.697, 95% CI 0.678-0.715), TyG-WWI exhibited superior discriminative performance for HF diagnosis (TyG: AUC = 0.616; TyG-WC: AUC = 0.665; TyG-WHtR: AUC = 0.673) and traditional prognostic factors (BMI: 0.592; waist circumference: 0.654; fasting blood glucose: 0.524, all DeLong-P < 0.001 after Bonferroni correction). NRI analysis revealed that TyG-WWI provided an 11.41% NRI compared with TyG, 4.20% compared with TyG-WC, and 2.99% compared with TyG-WHtR. Further subgroup analyses revealed that this association was more pronounced in men, patients not using β-blockers, and nondiabetic individuals. Sensitivity analyses reinforced the robustness of the findings.

Conclusion: In the general population, the TyG-WWI is strongly, independently, and dose-dependently associated with heart failure (HF) risk. Notably, its diagnostic performance for HFs surpasses that of traditional TyG-related indices, and it has incremental value as a supplementary parameter to existing TyG-derived metrics. These findings support the use of the TyG-WWI as a promising tool for HF risk stratification with practical clinical utility. However, further validation in large-scale prospective cohorts is warranted to confirm its long-term predictive value and generalizability across diverse populations.