Triglyceride-glucose index normalized by waist circumference and life's simple 7 to identify high-risk hypertensive patients in primary care.

Abstract

Hypertension affects over one billion adults and remains the leading contributor to global cardiovascular mortality. The triglyceride-glucose index normalized by waist circumference (TyG-WC) is emerging as a surrogate measure of insulin resistance and visceral adiposity, both associated with metabolic disorders and higher cardiovascular risk. Ideal cardiovascular health metrics (CVHM) from the American Heart Association's Life's Simple 7 (LS7) are strongly associated with reduced cardiovascular risk. Previous analyses from this cohort also demonstrated significant associations between LS7-derived CVHM and adverse clinical outcomes. However, it remains unclear whether TyG-WC provides additional and complementary prognostic information beyond LS7 in hypertensive patients. Therefore, the prognostic value of assessing the TyG-WC index together with the LS7 score to identify high-risk hypertensive patients in primary care remains largely unexplored. We conducted a longitudinal cohort study of 243 hypertensive adults from a primary-care center in Tenerife, Spain. Baseline TyG-WC index, LS7 metrics, anthropometric variables, biochemical parameters, and comorbidities were recorded. Outcomes included hypertension-mediated organ damage (HMOD) and related comorbidities (HRC), all-cause hospitalization, and mortality. Participants were followed for a minimum of two years, with HMOD-HRC, all-cause hospitalization, and all-cause mortality data updated through September 2025. Logistic regression analyses evaluated the independent associations of TyG-WC and CVHM with the adverse composite outcome (HMOD-HRC, hospitalization, and death). Higher TyG-WC quartiles were associated with the composite outcome: OR 2.23 (Q2), 2.96 (Q3), and 5.12 (Q4) versus Q1. Associations between CVHM scores and clinical outcomes were consistent with previous findings from this cohort. Only 10.7% of participants achieved 4-5 ideal LS7 metrics, whereas 41.2% had 0-1. Higher CVHM scores were also associated with lower body mass index, waist-to-height ratio, fasting glucose, triglycerides, hs-CRP, and with a lower prevalence of diabetes and cardiovascular disease. TyG-WC increased progressively across poorer CVHM categories. Elevated TyG-WC independently predicted HMOD-HRC, hospitalization, and all-cause mortality. The associations observed for LS7-derived cardiovascular health metrics were consistent with previous reports from this cohort. Assessing both TyG-WC and LS7 may strengthen cardiometabolic risk stratification in hypertensive primary-care populations.