High triglyceride-to-high-density lipoprotein cholesterol ratio predicts poor prognosis in new-onset heart failure: a retrospective study

Abstract

Background: There is limited research on the relationship between the triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio and outcomes in new-onset heart failure (HF). Therefore, this study aimed to explore the association between TG/HDL-C ratio and clinical outcomes in these patients. Methods: A retrospective cohort of 614 adults with new-onset HF hospitalized at The First Affiliated Hospital of Nanchang University between July 2021 and December 2022 was analyzed. The primary endpoint was major adverse cardiovascular events (MACE), defined as cardiovascular (CV) death and HF rehospitalizations within 12 months after discharge. Kaplan–Meier (K–M) curves, restricted cubic spline (RCS) analysis, and Cox regression evaluated the association between TG/HDL-C ratio and MACE risk. Results: Patients were divided into four quartiles (Quartile 1, 2,3 and 4) based on their TG/HDL-C ratios. The mean age was 68.94 ± 14.34 years, with 59.12% male. The mean left ventricular ejection fraction (LVEF) was 46.59 ± 10.89%, with 45.11% having an LVEF ≤ 40%. During the 12-month follow-up, 156 patients experienced MACE, comprising 18 CV deaths and 138 HF rehospitalizations. The Quartile 4 group had the highest MACE risk incidence compared to other groups (P < 0.001). K–M analysis confirmed that the Quartile 4 group was associated with an increased cumulative incidence of MACE, HF rehospitalization, and CV death (all P < 0.001). RCS analysis revealed a positive nonlinear relationship between the TG/HDL-C ratio and MACE risk (P for nonlinear = 0.026), with a sharp risk increase above a ratio of 1.08. After adjustment, TG/HDL-C ratio was independently associated with MACE (HR: 1.44, 95% CI: 1.29–1.60). Compared to Quartile 1, adjusted HRs were significantly higher in Quartiles 2, 3, and 4 (all P < 0.005). Conclusions: The TG/HDL-C ratio is independently associated with 12-month MACE risk in new-onset HF patients. It may serve as a simple, cost-effective marker to improve early risk stratification and guide closer monitoring and tailored management in this high-risk population.