Triglyceride Surrogate Indices Linked to Heart Rate Variability in Diabetes Study

Higher values across four triglyceride-related metabolic surrogate indices are inversely associated with vagally mediated heart rate variability in adults with type 2 diabetes, according to cross-sectional research published in Cardiovascular Diabetology.

The cross-sectional investigation examined 1,501 eligible adult participants with type 2 diabetes to evaluate the clinical utility of readily accessible surrogate markers of metabolic dysfunction.

Researchers assessed four specific indices: the triglyceride-glucose index, the triglyceride-to-high-density lipoprotein cholesterol ratio, the C-reactive protein-triglyceride-glucose index, and the waist circumference-adjusted triglyceride-glucose index.

The study evaluated these surrogate markers against short-term vagal heart rate variability measures, including log-transformed root mean square of successive differences and log-transformed high-frequency power, as well as confirmed cardiovascular autonomic neuropathy.

Confirmed cardiovascular autonomic neuropathy required at least two abnormal findings among three completed cardiovascular autonomic reflex tests, evaluated using Hansen age- and sex-specific lower fifth-percentile reference equations; among the 1,461 participants with complete reflex test data, 398 individuals (27.2%) met the criteria for confirmed neuropathy.

In multivariable linear regression models, all four metabolic indices demonstrated statistically significant inverse associations with both log-transformed root mean square of successive differences and log-transformed high-frequency power in the primary adjusted analysis (all P < 0.001).

After additional adjustment for resting heart rate, seven of the eight associations remained statistically significant, whereas the association between the waist circumference-adjusted triglyceride-glucose index and log-transformed root mean square of successive differences was attenuated (P = 0.080).

Multivariable logistic regression demonstrated that the C-reactive protein-triglyceride-glucose index (odds ratio 1.22 per 1-SD increase; 95% CI, 1.03–1.45; P = 0.023) and the waist circumference-adjusted triglyceride-glucose index (odds ratio 1.21 per 1-SD increase; 95% CI, 1.03–1.44; P = 0.024) were associated with confirmed cardiovascular autonomic neuropathy, whereas the triglyceride-glucose index and triglyceride-to-high-density lipoprotein cholesterol ratio were not.

Receiver operating characteristic curve analyses revealed modest discrimination for confirmed cardiovascular autonomic neuropathy, with area under the curve values ranging from 0.549 to 0.575 and no significant pairwise differences following Holm correction, indicating that while these indices serve as metabolic correlates of lower heart rate variability, their limited stand-alone discriminatory performance does not support their use as independent screening or diagnostic tools without prospective external validation.

Subject of Research: Triglyceride-related metabolic surrogate indices and cardiovascular autonomic neuropathy in type 2 diabetes

Article Title: Associations of four triglyceride-related metabolic surrogate indices with heart rate variability and confirmed cardiovascular autonomic neuropathy in type 2 diabetes: a cross-sectional study

Article References: Wang, T., Chen, B., Zhao, S., Fang, Q., Wu, J., Shen, S., Li, C., Wang, W., & Bi, Y. (2026). Associations of four triglyceride-related metabolic surrogate indices with heart rate variability and confirmed cardiovascular autonomic neuropathy in type 2 diabetes: a cross-sectional study. Cardiovascular Diabetology. https://doi.org/10.1186/s12933-026-03429-0

Image Credits: AI Generated

DOI: 10.1186/s12933-026-03429-0

Keywords: type 2 diabetes, cardiovascular autonomic neuropathy, heart rate variability, triglyceride-glucose index, metabolic surrogate indices, cardiovascular autonomic reflex tests, cross-sectional study, diabetic neuropathy, Associations, four, triglyceride-related, metabolic