The joint effect of cardiometabolic index and high-sensitivity C-reactive protein on incident cardiovascular disease: A prospective cohort study.

BACKGROUND AND AIM: The combined role of the cardiometabolic index (CMI), a marker of visceral obesity and dyslipidemia, and high-sensitivity C-reactive protein (hsCRP), an inflammatory marker, in predicting cardiovascular disease (CVD) risk remains unexplored. This study investigates their synergistic effect on new-onset CVD.

METHODS AND

RESULTS

In this prospective cohort of 7856 CVD-free adults from CHARLS study, participants were categorized by median CMI and hsCRP (cutoff: 2 mg/L). Over a median 7-year follow-up, 1502 CVD incidents occurred. Compared with the low CMI and low hsCRP reference group, individuals with both high CMI and high hsCRP showed the highest risks of CVD (HR 1.54, 95 % CI 1.33-1.78), stroke (HR 2.27, 95 % CI 1.74-2.97), and heart disease (HR 1.37, 95 % CI 1.15-1.63), although multiplicative and additive interaction tests were not statistically significant. Mediation analyses indicated that blood pressure measures, and fasting glucose for heart disease, partially mediated CMI's association with outcomes. A bidirectional mediation relationship was observed between CMI and hsCRP for stroke risk. These findings remained consistent in sensitivity analyses, including competing risk models, subgroup analyses across population strata, and analyses using multiple imputation or an alternative hsCRP cutoff (3 mg/L).

CONCLUSION

The joint elevation of CMI and hsCRP identifies individuals at the highest risk of CVD, stroke, and heart disease, underscoring the combined contribution of metabolic and inflammatory pathways to cardiovascular pathogenesis. This supports the integration of both markers for early risk stratification.