Association between the combined cholesterol, high-density lipoprotein, glucose index and frailty index and new-onset cardiovascular disease in individuals with cardiovascular-kidney-metabolic syndrome stages 0–3: evidence from China Health and Retirement Longitudinal Study (CHARLS)
Main finding · New-onset CVDResult — go to the resultHazard ratio 1.56 95% CI 1.41–1.72Authors' conclusion
Higher CHG-FI was independently associated with increased risks of new-onset CVD, heart disease, and stroke among middle-aged and older adults with early-stage CKM syndrome. Participants with both high CHG and high FI had the greatest risk of new-onset CVD, although this pattern did not reflect a statistically significant multiplicative or additive interaction. CHG-FI showed statistically significant but modest discriminative performance, and the incremental improvements beyond comparator indices and clinical covariates were limited in magnitude.
Study context
- Population
- Middle-aged and older adults with cardiovascular-kidney-metabolic (CKM) syndrome stages 0–3, China Health and Retirement Longitudinal Study (CHARLS, 2011–2020)
- Participants
- 4,603 participants
- Exposure
- Per one-unit increase in CHG-FI; highest vs lowest CHG-FI quartile
- Outcome
- New-onset CVD (heart disease or stroke during follow-up)
- Follow-up
- Median 9 years
Methodological detailslongitudinal, multivariable Cox proportional hazards models
- Longitudinal
- Multivariable Cox proportional hazards models
Main finding
New-onset CVD
Hazard ratio
1.56
95% CI 1.41–1.72
Per one-unit increase in CHG-FI, as printed
As reported in the abstract
- Participants developing new-onset cardiovascular disease (CVD)
- 1,189 (25.8%)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | HR (95% CI) | |
|---|---|---|
| New-onset heart diseaseFully adjusted | 1.59 (1.42–1.77) | |
| New-onset strokeFully adjusted | 1.56 (1.32–1.83) | |
| 0.512Hazard ratio (log scale) |
Joint exposure: high CHG and high frailty index (FI), new-onset CVD
| HR (95% CI) | ||
|---|---|---|
| High CHG and high FI | 2.05 (1.71–2.47) | |
| 0.512Hazard ratio (log scale) |
- No statistically significant multiplicative or additive interaction
Discrimination (AUC) of CHG-FI
- AUC for new-onset CVD
- 0.624
- AUC for new-onset heart disease
- 0.622
- Statistically outperformed CHG, FI, TyG, atherogenic index of plasma (AIP) and metabolic score for insulin resistance (METS-IR) for both outcomes; absolute discrimination modest
Reclassification for new-onset CVD (net reclassification improvement (NRI), integrated discrimination improvement (IDI))
- NRI vs CHG
- 13.85%
- NRI vs TyG
- 9.16%
- NRI vs AIP
- 11.02%
- NRI vs METS-IR
- 20.90%
- IDI improvement vs all reference indices
- 0.20 to 0.48%
- Adding CHG-FI to fully adjusted base model: significant but limited improvement, small absolute gains over FI alone
Original publication
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