Association between triglyceride with all-cause mortality and cardiovascular outcomes in heart failure patients

Abstract

Abstract Background Remnant cholesterol, identified by triglyceride-rich lipoprotein, is increasingly acknowledged as a significant causal risk factor for ischemic heart diseases. The association with cause-specific outcomes in heart failure (HF) settings remains unexplored. This study aims to determine the association between triglyceride levels with all-cause mortality and cardiovascular outcomes in patients with HF. Methods Using a previously validated territory-wide clinical information registry, all eligible patients with HF (N = 127124) from 1996 to 2020 were enrolled. Triglyceride levels associated with risk of mortality were evaluated on a continuous scale using restricted cubic spline curves and by categories of triglyceride using Cox proportional hazards regression model with competing risks as appropriate. The primary outcomes were all-cause mortality and cardiovascular death (CVD). Secondary outcomes included ASCVD (a composite of myocardial infarction, unstable angina, arterial revascularization or ischemic stroke) and HF readmission or death. Results The mean age of the study population was 71.4±12.2 years and 65869 (51.8%) were male. Notably, when we investigated the association of triglyceride levels with admission or death for ASCVD, a positive relationship was seen in high triglyceride levels and ASCVD admission or death while neutral in low triglyceride levels. Conversely, when we investigated the association with readmission or death for HF, an inverse relationship was found where lower triglyceride levels were associated with higher risks of HF readmission. Together, the association between triglyceride levels and the risk of all-cause mortality and CVD was an U-shaped curve. The risk of all-cause mortality reached a nadir between triglyceride levels of 1.12 mmol/L and 3.28 mmol/L and was lowest at 1.95 mmol/L. Conclusion In the HF population, low and high levels of triglyceride were associated with increased risks of all-cause mortality and CVD compared with those with midrange levels. Triglyceride was positively associated with ASCVD while inversely associated with HF admission or death. The lowest risk of all-cause mortality was found at a triglyceride concentration of 1.95 mmol/L.TG and mortalityTG and CVD