Abstract
This study investigates the association between a novel index, TyG-WWI (triglyceride-glucose-weight-adjusted waist index), and cardiovascular outcomes and total mortality (TM) in patients with type 2 diabetes mellitus (T2DM), and evaluates its predictive value. Data from 10,092 participants in the ACCORD/ACCORDION trials were analyzed using Cox regression, restricted cubic splines (RCS), and smooth curve fitting (SCF). Subgroup and sensitivity analyses tested robustness. Predictive ability was assessed using area under curve (AUC), net reclassification index (NRI), and integrated discrimination improvement(IDI). Higher TyG-WWI was significantly associated with increased risk of major adverse cardiovascular events (MACEs), major coronary heart disease (CHD), congestive heart failure (CHF), and total mortality (TM). Per 1-SD increase in TyG-WWI, risks rose by 11% for MACEs, 8% for major-CHD, 28% for CHF, and 12% for TM. RCS and SCF identified a nonlinear association with TM, with a turning point observed at a TyG-WWI value of 96.574. Subgroup and sensitivity analyses confirmed result stability. TyG-WWI outperformed TyG alone in predictive accuracy. A significant positive linear association exists between TyG-WWI and adverse cardiovascular outcomes in T2DM patients, while a U-shaped relationship is observed with TM. TyG-WWI is an independent predictor of future cardiovascular outcomes and TM in T2DM patients.Trial registration number NCT00000620, Clinical Trial URLs: https://clinicaltrials.gov/ct2/show/NCT00000620 , Registration Date: 1999-10-27.