First Comparative Evaluation of TyG‐ABSI Versus Traditional TyG‐Related Indices for Cardiovascular Disease and Mortality Prediction in Hypertensive Patients

Hypertension contributes substantially to the global burden of cardiovascular disease (CVD) and mortality. TyG-ABSI is a novel composite marker integrating insulin resistance and central obesity, both closely related to hypertensive pathophysiology. However, its predictive value in hypertensive populations remains unclear. This study investigated the association between TyG-ABSI and CVD and mortality among hypertensive adults and compared its predictive ability with traditional TyG-related indices. Data were obtained from the NHANES cycles from 2003 to 2018, including 7,775 participants with hypertension (mean age 56.68 ± 0.26 years; 50.42% male). Weighted Cox proportional hazards models and logistic regression were used to analyze associations with mortality outcomes and CVD, respectively. Kaplan-Meier curves and restricted cubic spline analyses were also conducted. Model performance was evaluated using ROC curves, continuous NRI, and IDI, with subgroup and sensitivity analyses assessing robustness. TyG-ABSI was significantly associated with increased risks of CVD, all-cause mortality, and cardiovascular mortality. Each 1-unit increase in TyG-ABSI was linked to a 38% higher risk of CVD (OR 1.38, 95% CI: 1.15-1.67), 84% higher all-cause mortality (HR 1.84, 95% CI: 1.51-2.24), and 83% higher cardiovascular mortality (HR 1.83, 95% CI: 1.37-2.45). Dose-response relationships were observed in tertile analyses and RCS models. Compared with traditional TyG-related indices, TyG-ABSI showed better predictive performance with higher AUC and significant improvements in NRI and IDI. These findings suggest that TyG-ABSI may serve as an effective tool for risk stratification in hypertensive patients.