{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:06:15Z","timestamp":1790139975011,"version":"4.0.1"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Patients with chronic heart failure (CHF) and atrial fibrillation (AF) are at high risk of thromboembolic events. Although the CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      -VASc score is widely used for risk stratification, it may not fully capture metabolic dysfunction. Whether insulin resistance (IR) surrogate indices provide incremental information beyond the CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      -VASc score in patients with CHF and AF remains unclear.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort study included 4,474 patients with CHF and AF. IR surrogate indices were calculated, and thromboembolic events were defined as ischemic stroke or systemic embolism (IS\/SE). Multivariable Cox regression models assessed the associations between these indices and thromboembolic risk. Their incremental value beyond the CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      -VASc score for 4-year IS\/SE risk was evaluated using discrimination, reclassification, and clinical utility measures, with stratification by AF type.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During a median follow-up of 4.00 years, 349 IS\/SE events occurred. After multivariable adjustment, the hazard ratios per 1-SD increase were 1.27 (95% confidence interval, 1.13\u20131.43) for the TyG index, 1.41 (1.28\u20131.56) for the TyG-BMI index, 1.27 (1.20\u20131.34) for METS-IR, and 1.13 (1.08\u20131.19) for the TG\/HDL-C ratio (all P &amp;lt; 0.001). Risk increased progressively across tertiles of each index, and the associations remained consistent in competing-risk analyses. Adding METS-IR or the TyG-BMI index to the CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      -VASc score significantly increased the AUC from 0.637 to 0.682 and 0.673, respectively, and improved reclassification. Decision curve analysis showed greater net benefit for models incorporating IR surrogate indices, particularly METS-IR and the TyG-BMI index. The incremental predictive improvements appeared more evident in patients with non-paroxysmal AF.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      IR surrogate indices were independently associated with IS\/SE in patients with CHF and AF. METS-IR and the TyG-BMI index provided the most consistent incremental information beyond the CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      -VASc score, with more evident improvements observed in patients with non-paroxysmal AF.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1954348","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:43:55Z","timestamp":1790138635000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Incremental value of insulin resistance surrogate indices beyond the CHA2DS2-VASc score for predicting thromboembolic events in patients with chronic heart failure and atrial fibrillation"],"prefix":"10.3389","volume":"17","author":[{"given":"Yingli","family":"Xie","sequence":"first","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology","place":["Luoyang, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanhui","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology","place":["Luoyang, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"You","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology","place":["Luoyang, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huifeng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology","place":["Luoyang, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s11897-024-00691-9","article-title":"Atrial fibrillation in heart failure: Novel insights, challenges, and treatment opportunities","volume":"22","author":"Bidaoui","year":"2024","journal-title":"Curr Heart Fail Rep"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14176044","article-title":"Heart failure and stroke: A narrative review","volume":"14","author":"Katano","year":"2025","journal-title":"J Clin Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1161\/cir.0000000000001193","article-title":"2023 ACC\/AHA\/ACCP\/HRS guideline for the diagnosis and management of atrial fibrillation: A report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"149","author":"Joglar","year":"2024","journal-title":"Circulation"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1093\/eurjpc\/zwab018","article-title":"Utility of the CHA2DS2-VASc score for predicting ischaemic stroke in patients with or without atrial fibrillation: A systematic review and meta-analysis","volume":"29","author":"Siddiqi","year":"2022","journal-title":"Eur J Prev Cardiol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.1092431","article-title":"Insulin resistance in ischemic stroke: Mechanisms and therapeutic approaches","volume":"13","author":"Ding","year":"2022","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2020-001217","article-title":"Causal associations of insulin resistance with coronary artery disease and ischemic stroke: A Mendelian randomization analysis","volume":"8","author":"Chen","year":"2020","journal-title":"BMJ Open Diabetes Res Care"},{"key":"B7","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1186\/s12933-019-0928-8","article-title":"Atrial fibrillation and its arrhythmogenesis associated with insulin resistance","volume":"18","author":"Chan","year":"2019","journal-title":"Cardiovasc Diabetol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2010-0288","article-title":"The product of triglycerides and glucose, a simple measure of insulin sensitivity. 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