Prevalence estimates of the insulin resistance and associated prevalence of heart failure among United Status adults

Abstract

Background: The triglyceride glucose (TyG) index, a metric for estimating insulin resistance (IR), is linked with cardiovascular disease (CVD) morbidity and mortality among the population regardless of diabetic status. However, IR prevalence and the association between the TyG index and heart failure (HF) in Americans is unclear.

Methods: The Nation Health and Nutrition Examination Survey (NHANES) (2009-2018) dataset was used. IR was defined by homeostatic model assessment of insulin resistance (HOMA-IR) > 2.0 and 1.5. The TyG index was calculated as Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. A weighted logistic regression was applied to evaluate the association between the TyG index and the prevalence of HF.

Results: This study comprised 12,388 people, including 322 (2.6%) individuals with HF. The average prevalence of IR was found to be 13.9% and 22.7% for cutoff values greater than 2.0 and 1.5, respectively. HOMA-IR and the TyG index showed a moderate correlation (r = 0.30). There is a significant positive association between the TyG index and HF prevalence (per 1-unit increment; adjusted OR [aOR]: 1.34; 95% confidence interval [CI]: 1.02-1.76). Patients with higher TyG values were associated with a prevalence of HF (OR:1.41; 95% CI: 1.01,1.95) (quartiles 4 vs 1-3). The TyG index is associated with a higher prevalence of dyslipidemia, coronary heart disease, and hypertension but not a stroke (cerebrovascular disease).

Conclusions: Our results show that IR does not considerably increase from 2008 to 2018 in American adults. A moderate correlation is noted between HOMA-IR and the TyG index. TyG index is associated with the prevalence of HF, as were other cardiovascular diseases.

Keywords: Heart failure; Homeostatic model assessment of insulin resistance; Insulin resistance; Nation health and nutrition examination survey; Triglyceride glucose index.

Fig. 1

Study selection from the National Health and Nutrition Examination Survey 2009–2018, workflow, and major findings of the present study. Abbreviations: NHANES: National Health and Nutrition Examination Survey; IR: insulin resistance; TyG index: triglyceride-glucose index; HOMA-IR: homeostatic model assessment of insulin resistance

Fig. 2

The odds ratio and the histogram of the probability distribution for heart failure according to the triglyceride-glucose index. The red curve with a light black dotted line indicates the adjusted OR with a 95% CI for HF according to the TyG index with a reference of 8.5. The number of knots for the cubic spline curves was three in the model. Adjustment factors included age, sex, race, marital, BMI, education status, LDL-C, eGFR, UA, diabetes mellitus, hypertension, stroke, CKD, dyslipidemia, family monthly poverty level category, moderate PA, sedentary, and current smoking. Abbreviations: OR: odds ratio; CI: confidence interval; HF: heart failure; TyG: triglyceride-glucose index; BMI: body mass index; LDL-C: low-density lipoprotein cholesterol; UA: uric acid; CKD: chronic kidney dysfunction; eGFR: estimated glomerular filtration rate; PA: physical activity

Fig. 3

The prevalence of insulin resistance, and the changing trend of homeostatic model assessment of insulin resistance and triglyceride-glucose index in adult Americans from the Nation Health and Nutrition Examination Survey 2009–2018. A-B: The prevalence of IR was defined as having a HOMA-IR greater than 2.0 (A) or 1.5 (B). C: An overview of the five NHANES cycles (2009–2018) that show the changing trend of the TyG index and HOMA-IR mean values. D: The correlation between the TyG index and HOMA-IR. Abbreviations: IR: insulin resistance; TyG index: triglyceride-glucose index; HOMA-IR: homeostatic model assessment of insulin resistance

Fig. 4

The association between the triglyceride-glucose index (Q4 vs. Q1-Q3) and heart failure in various subgroups after adjustments. The adjusted confounders were age, sex, race, marital status, BMI, education status, LDL-C, eGFR, UA, diabetes mellitus, hypertension, dyslipidemia, stroke, CKD, family monthly poverty level category, moderate PA, sedentary, current smoking (confounders were not adjusted if they were listed as a stratified factor in subgroups). Abbreviations: HF: heart failure; BMI: body mass index; TyG index: triglyceride-glucose index; LDL-C: low-density lipoprotein cholesterol; CKD: chronic kidney dysfunction; UA: uric acid; eGFR: estimated glomerular filtration rate; PA: physical activity