Triglyceride glucose-weight-adjusted waist index as a cardiovascular mortality predictor: incremental value beyond the establishment of TyG-related indices
Authors' conclusion
The current study is the first to validate that the TyG-WWI is a reliable risk prediction tool for cardiovascular death in the general population and has greater predictive value than traditional TyG-related parameters. The results support its potential as a supplementary tool among TyG-derived markers for assessing cardiovascular death.
Study context
- Population
- Participants in National Health and Nutrition Examination Survey (NHANES) 1999–2018 (general population)854 CV deaths
- Participants
- 24,255 participants
- Exposure
- TyG-WWI vs TyG, TyG-WC and TyG-WHtR for predicting CV mortality
- Outcome
- Cardiovascular mortality
- Follow-up
- Median 9.67 years
Methodological detailsNHANES 1999-2018, weighted Cox proportional hazards models, restricted cubic splines, time-dependent ROC, net reclassification improvement (NRI) analyses
- NHANES 1999-2018
- Weighted Cox proportional hazards models
- Restricted cubic splines
- Time-dependent ROC
- NRI analyses
Main finding
As reported in the abstract
Cardiovascular mortality per SD increase (fully adjusted)
Hazard ratio (95% CI)
TyG-WWI
1.45(1.31–1.60)
TyG
1.24(1.12–1.38)
TyG-WC
1.39(1.27–1.53)
TyG-WHtR
1.43(1.30–1.58)
Per SD increase, as printed
Observational data: associations, not effects.
Further findings
| Outcome | TyG-WWI |
|---|---|
| Predictive performance (ROC, NRI) | |
| AUC (highest; traditional ROC) | 0.694 (95% CI 0.678-0.710) |
| Time-dependent AUC across follow-up time points | 0.706 to 0.751 |
- Predictive performance (ROC, NRI) — NRI with TyG-WWI vs TyG
- 10.4%
- Predictive performance (ROC, NRI) — NRI with TyG-WWI vs TyG-WC
- 9.4%
- Predictive performance (ROC, NRI) — NRI with TyG-WWI vs TyG-WHtR
- 9.1%
CV mortality per SD increase of other TyG-related indices
- Fully adjusted models
Dose-response (RCS)
- TyG-WWI: linear association with CV mortality, P-nonlinear
- 0.491
- TyG U-shaped; TyG-WC and TyG-WHtR L-shaped associations, all P-nonlinear
- < 0.05
- TyG-WWI quartiles showed a clear dose-response relationship
Predictive performance (ROC, NRI)
- Time-dependent AUC of TyG-WWI consistently greater than other TyG-related indices
Subgroup: younger adults (≤ 60 years)
- Stronger associations in younger adults (≤ 60 years), HR
- 2.03 (95% CI 1.78-2.32)
Original publication
Triglyceride glucose-weight-adjusted waist index as a cardiovascular mortality predictor: incremental value beyond the establishment of TyG-related indices. Cardiovasc Diabetol. Published 30 July 2025. doi:10.
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