Cumulative exposure and longitudinal exposure pattern of C-reactive protein-triglyceride-glucose index combined with Chinese visceral adiposity index (CTI-CVAI) and the risk of new-onset cardiovascular disease in middle-aged and older Chinese adults: a prospective cohort study based on the China Health and Retirement Longitudinal Survey (CHARLS)
Main finding · New-onset CVDResult — go to the resultHazard ratio 1.63 95% CI 1.33–2.00Authors' conclusion
Elevated cumulative CTI-CVAI exposure and unfavorable longitudinal patterns are independently associated with increased CVD risk in middle-aged and older Chinese adults. CTI-CVAI provides incremental predictive value beyond obesity and insulin resistance alone, supporting its potential as an adjunctive screening tool in primary care.
Study context
- Population
- Middle-aged and older Chinese adults, CHARLSlongitudinal analysis
- Participants
- 3,803 participants
- Exposure
- Cumulative CTI-CVAI exposure
- Outcome
- New-onset CVD
- Follow-up
- Median 56.6 months
Methodological detailstwo-stage design (cross-sectional screening + longitudinal validation), landmark time 2015
- Two-stage design (cross-sectional screening + longitudinal validation)
- Landmark time 2015
Main finding
As reported in the abstract
Hazard ratio
1.63
95% CI 1.33–2.00
Highest tertilevs Lowest tertile
HR 1.63 (95% CI 1.33–2.00)
- Cardiovascular disease (CVD) risk per 1-SD increase in CumCTI-CVAI, HR
- 1.09 (95% CI 1.04-1.14, P < 0.001)
- Nonlinear dose-response relationship (P < 0.001); inflection point
- 6192.15
Observational data: associations, not effects.
Secondary outcomes
| Outcome | HR |
|---|---|
| Longitudinal exposure patterns (K-means): high-stable vs low-stableHigh-stable vs Low-stable · CVD · three patterns: low-stable, moderate-stable, high-stable | 1.68 |
| Longitudinal exposure patterns (K-means): high-stable vs low-stableHigh-stable vs Low-stable · heart disease · three patterns: low-stable, moderate-stable, high-stable | 1.43 |
| Longitudinal exposure patterns (K-means): high-stable vs low-stableHigh-stable vs Low-stable · stroke · three patterns: low-stable, moderate-stable, high-stable | 2.33 |
Heart disease and stroke per 1-SD increase in CumCTI-CVAI
- Heart disease, HR
- 1.07 (95% CI 1.01-1.14)
- Stroke, HR
- 1.16 (95% CI 1.06-1.27)
Reclassification: adding inflammation to TyG-CVAI
- IDI from 0.018 to 0.090, P < 0.001
Discrimination
- Cross-sectional AUC of CTI-CVAI
- 0.617
- Nomogram (age, lung disease, CumCTI-CVAI) AUCs
- 0.618-0.638
- Cross-sectional n = 9,475
Original publication
Cumulative exposure and longitudinal exposure pattern of C-reactive protein-triglyceride-glucose index combined with Chinese visceral adiposity index (CTI-CVAI) and the risk of new-onset cardiovascular disease in middle-aged and older Chinese adults: a prospective cohort study based on the China Health and Retirement Longitudinal Survey (CHARLS). Cardiovasc Diabetol. Published 20 June 2026. doi:10.
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