Optimizing early triage for subclinical cardiovascular-kidney-metabolic syndrome: longitudinal associations, incremental value, and clinical utility of nine insulin resistance surrogates
Authors' conclusion
TyG-WC and TyG-WHtR are the most robust, independent predictors of incident CKM stage 3. They offer a highly actionable, scenario-adaptable screening strategy: TyG-WC serves as an ultra-accessible "first-pass" filter for large-scale public health triage, while TyG-WHtR provides a calibrated prognostic anchor for high-threshold, individualized clinical decision-making.
Study context
- Population
- Adults initially at Cardiovascular-kidney-metabolic (CKM) stages 0–2, China Health and Retirement Longitudinal Study
- Participants
- 2,958 adults
- Exposure
- Nine non-insulin-based insulin resistance surrogate indices for predicting progression to CKM stage 3
- Outcome
- Progression to CKM stage 3
Methodological detailsChina Health and Retirement Longitudinal Study
- China Health and Retirement Longitudinal Study
Main finding
As reported in the abstract
Participants progressed to CKM stage 3
497
16.8%
TyG-WHtR, OR per 1-SD increment
1.86
TyG-WC, OR per 1-SD increment
1.82
Observational data: associations, not effects.
Further findings
Incremental predictive value over basic model
- TyG-WHtR net reclassification improvement (NRI) (P < 0.001)
- 0.524
- TyG-WC NRI (P < 0.001)
- 0.512
- Adding TyG-WHtR or TyG-WC significantly increased AUC and gave the largest integrated discrimination improvement (IDI) improvements
Decision curve analysis
- Models with TyG-WC or TyG-WHtR gave the highest net clinical benefit across threshold probabilities; robust in four sensitivity analyses
Original publication
Optimizing early triage for subclinical cardiovascular-kidney-metabolic syndrome: longitudinal associations, incremental value, and clinical utility of nine insulin resistance surrogates. Cardiovasc Diabetol. Published 21 June 2026. doi:10.
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