Metabolic status modifies the predictive value of the C-reactive protein–triglyceride–glucose Index–waist-to-height ratio for major adverse cardiovascular and cerebrovascular events: a prospective cohort study from the China Health and Retirement Longitudinal Study (CHARLS)
Authors' conclusion
The predictive value of CTI-WHtR for MACCE is modified by metabolic status (operationalized as glycemic status) in both magnitude and functional form. CTI-WHtR demonstrates a statistically significant, linear association with MACCE in normoglycemic individuals (complete-case HR 1.26; multiple imputation HR 1.13), while the dose-response transforms to an inverted-U shape in T2D.
Study context
- Population
- Participants free of CVD at baseline, China Health and Retirement Longitudinal Study (CHARLS, 2011–2020)1,467 major adverse cardiovascular and cerebrovascular events (MACCE) events
- Participants
- 6,993 participants
- Exposure
- Association of CTI-WHtR with MACCE across normal glucose tolerance (NGT), prediabetes and T2D
- NGTn = 2,916
- Prediabetesn = 3,106
- T2Dn = 971
- Outcome
- MACCE
- Follow-up
- Mean 8.0 ± 2.0 years
Methodological detailsstratified by glycemic status, multiple imputation sensitivity analysis
- Stratified by glycemic status
- Multiple imputation sensitivity analysis
Main finding
As reported in the abstract
MACCE per SD increase in CTI-WHtR, fully adjusted incl. BMI
| Group | HR |
|---|---|
| NGT | 1.26 (95% CI 1.11-1.43), P = 0.0003 |
| Prediabetes | 1.04, P = 0.43 |
| T2D | 1.06, P = 0.49 |
HR
NGT1.26 (95% CI 1.11-1.43), P = 0.0003
Prediabetes1.04, P = 0.43
T2D1.06, P = 0.49
- Prediabetes vs NGT: P = 0.027 — suggestive evidence of effect modification
- Overall interaction likelihood ratio test
- P = 0.057
Observational data: associations, not effects.
Further findings
- Multiple imputation (N = 14,606), NGT
- 1.13 (95% CI 1.04-1.24), P = 0.0068 · pooled HR
Dose-response (restricted cubic spline (RCS))
- Linear dose-response in NGT (all P-non-linearity)
- > 0.25
- Non-linear inverted-U shape in T2D (P-non-linearity)
- 0.017
Head-to-head comparison of eight metabolic indices (C-index)
- CTI-based indices achieved higher C-indices in NGT; TyG-based indices performed better in T2D
Original publication
Metabolic status modifies the predictive value of the C-reactive protein–triglyceride–glucose Index–waist-to-height ratio for major adverse cardiovascular and cerebrovascular events: a prospective cohort study from the China Health and Retirement Longitudinal Study (CHARLS). Cardiovasc Diabetol. Published 26 April 2026. doi:10.
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