A Novel Metabolic Inflammation Index for Cardiovascular Prognosis: Evidence From Three International Cohorts in Middle‐Aged and Older Adults
Authors' conclusion
eMII is a cross-population predictor of CVD, highlighting metabolic impairment as a key factor through which inflammation drives cardiovascular risk.
Study context
- Population
- Middle-aged and older adults in three international cohorts (ELSA, CHARLS, HRS); mean age 61.68 ± 9.67 yearsELSA, CHARLS, HRS cohorts
- Participants
- 14,168 participants
- Exposure
- Highest vs lowest eMII quartile
- Outcome
- Long-term CVD risk
Methodological detailsderivation cohort (ELSA), two external validation cohorts (CHARLS, HRS), multivariate Cox regression
- Derivation cohort (ELSA)
- Two external validation cohorts (CHARLS, HRS)
- Multivariate Cox regression
Main finding
As reported in the abstract
CVD risk by eMII quartile
Hazard ratio
1.66
P < 0.001
ELSA
Hazard ratio
2.28
P < 0.001
CHARLS
Hazard ratio
1.83
P < 0.001
HRS
Observational data: associations, not effects.
Further findings
Low estimated glucose disposal rate (eGDR), elevated hs-CRP and combined status
- All associated with increased cardiovascular disease (CVD) risk; highest risk with both poor metabolic function and high inflammation
- Fully adjusted Cox models
Proportion of inflammation-CVD association mediated by eGDR
- ELSA
- 41.14%
- CHARLS
- 46.50%
- HRS
- 75.47%
- Exploratory mediation analysis
Risk prediction with eMII added to traditional models
- Potential for improving CV risk prediction; more noticeable reclassification benefit in CHARLS
Original publication
A Novel Metabolic Inflammation Index for Cardiovascular Prognosis: Evidence From Three International Cohorts in Middle‐Aged and Older Adults. Diabetes Obes Metab. Published 1 September 2026. doi:10.
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