Longitudinal inflammatory-metabolic-adiposity burden and incident heart failure across cardiovascular-kidney-metabolic stages: a prospective cohort study
Authors' conclusion
Longitudinal CTGW trajectories and cumulative burden are independently associated with incident heart failure in a nonlinear dose-response manner, with the association amplified across advancing CKM stages, supporting the CTGW composite index as a potential integrative biomarker for heart failure risk stratification.
Study context
- Population
- Adults aged ≥50 years from the English Longitudinal Study of Ageing, free of HF at Wave 2 (2004–2005), followed through Wave 8 (2016–2017)
- Participants
- 1,946 adults
- Exposure
- CTGW trajectories and cumulative CTGW burden
- Low-stablen = 697reference
- Moderate-metabolicn = 943
- High-inflammatoryn = 306
- Outcome
- Incident HF
- Follow-up
- Median spanning 12 years
Methodological detailsgroup-based multi-trajectory modeling, Cox proportional hazards regression with sequential adjustment, restricted cubic spline analyses
- Group-based multi-trajectory modeling
- Cox proportional hazards regression with sequential adjustment
- Restricted cubic spline analyses
Main finding
As reported in the abstract
Incident HF by CTGW trajectory (fully adjusted) · median follow-up 12 years
Each group vs low-stableHazard ratio (95% CI)P value
High-inflammatory
2.69(1.46–4.93)
P = 0.001Moderate-metabolic
1.96(1.17–3.29)
P = 0.011- Developed incident HF (all participants)
- 113 (5.8%)
Observational data: associations, not effects.
Further findings
Incident HF by cumulative CTGW burden
| HR (95% CI) | P value | ||
|---|---|---|---|
| Highest quartile | 2.35 (1.31–4.24) | P = 0.004; P for trend < 0.001 | |
| 0.20.5125Hazard ratio (log scale) |
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Incident HF by cumulative CTGW burdenPer SD increase · 19% higher risk | 1.19 (1.04–1.36) | P = 0.014 | |
| 0.512Hazard ratio (log scale) |
Incident HF by cumulative CTGW burden, cardiovascular-kidney-metabolic (CKM) Stage 3-4
| HR (95% CI) | P value | ||
|---|---|---|---|
| CKM Stage 3-4 | 2.37 (1.24–4.53) | P = 0.009 | |
| 0.20.5125Hazard ratio (log scale) |
- Incident HF by cumulative CTGW burden — Nonlinear dose-response relationship; risk threshold ≈8.2
- P for nonlinearity = 0.032
- Incident HF by cumulative CTGW burden, CKM Stage 3-4 — Significant effect modification by CKM stage
- P for interaction = 0.031
Subgroups by age, sex, BMI, comorbidity
- Consistent effect directions without significant interactions
Original publication
Longitudinal inflammatory-metabolic-adiposity burden and incident heart failure across cardiovascular-kidney-metabolic stages: a prospective cohort study. Cardiovasc Diabetol. Published 26 July 2026. doi:10.
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