BMC cardiovascular disorders · 2026
Association of cholesterol, high-density lipoprotein, and glucose index and modified indices in predicting cardiovascular diseases incidence among population with cardiovascular-kidney-metabolic syndrome stages 0-3: a nationwide prospective cohort study.
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Zhao Zhen, Du Pengchong, Jian Manning, Liu Yuanyuan, Pan Hongyi, Liu Qing
Аннотация
BACKGROUND: Cardiovascular-kidney-metabolic (CKM) syndrome, characterized by the interplay of metabolic risk factors, chronic kidney disease, and cardiovascular dysfunction, is a key driver of cardiovascular disease (CVD) incidence. The cholesterol, high-density lipoprotein, and glucose (CHG) index, which integrates total cholesterol, high-density lipoprotein, and fasting blood glucose, and its modified indices (combined with obesity indicators) have potential for CVD risk prediction. However, their role across CKM stages 0-3 remains unclear.
METHODS: A nationwide prospective cohort study included 5,404 participants with CKM stages 0-3, screened from 17,708 individuals screened between 2011 and 2020. CHG index and modified indices (CHG-BMI, CHG-Wc, CHG-WHtR) were calculated. Logistic regression, restricted cubic spline (RCS) analysis, subgroup analysis, and sensitivity analysis were used to evaluate associations with CVD incidence and identify exploratory threshold association.
RESULTS: During follow-up, 25.5% of participants developed CVD. CHG and modified indices were independently associated with increased CVD risk (all P < 0.001). In fully adjusted models, CHG as continuous data showed a 28% higher risk (OR = 1.28, 95% CI: 1.06-1.58) of outcome, and CHG-WHtR was 54% higher (OR = 1.28, 95% CI: 1.16-2.04). Meanwhile, the highest quartile (Q4) of CHG-WHtR was associated with a 43% higher risk (OR = 1.43, 95% CI: 1.03-1.98) compared to Q1, while CHG-BMI (OR = 1.68, 95% CI: 1.22-2.31) showed stronger associations. RCS analysis identified exploratory inflection points like CHG ≥ 5.15 and CHG-WHtR ≥ 2.41, above which CVD risk significantly increased (P < 0.005) and validated by bootstrap sampling. Subgroup analysis confirmed consistent associations across age, gender, and CKM stages subpopulations. Multiple sensitivity analysis supported the robustness of these associations across CKM stages.
CONCLUSION: CHG index and its modified indices, particularly CHG-WHtR and CHG-Wc, are valuable indicators associated with reported incident CVD across CKM stages 0-3. Their stage-specific associations and exploratory threshold association support their utility in risk stratification for CKM syndrome.
METHODS: A nationwide prospective cohort study included 5,404 participants with CKM stages 0-3, screened from 17,708 individuals screened between 2011 and 2020. CHG index and modified indices (CHG-BMI, CHG-Wc, CHG-WHtR) were calculated. Logistic regression, restricted cubic spline (RCS) analysis, subgroup analysis, and sensitivity analysis were used to evaluate associations with CVD incidence and identify exploratory threshold association.
RESULTS: During follow-up, 25.5% of participants developed CVD. CHG and modified indices were independently associated with increased CVD risk (all P < 0.001). In fully adjusted models, CHG as continuous data showed a 28% higher risk (OR = 1.28, 95% CI: 1.06-1.58) of outcome, and CHG-WHtR was 54% higher (OR = 1.28, 95% CI: 1.16-2.04). Meanwhile, the highest quartile (Q4) of CHG-WHtR was associated with a 43% higher risk (OR = 1.43, 95% CI: 1.03-1.98) compared to Q1, while CHG-BMI (OR = 1.68, 95% CI: 1.22-2.31) showed stronger associations. RCS analysis identified exploratory inflection points like CHG ≥ 5.15 and CHG-WHtR ≥ 2.41, above which CVD risk significantly increased (P < 0.005) and validated by bootstrap sampling. Subgroup analysis confirmed consistent associations across age, gender, and CKM stages subpopulations. Multiple sensitivity analysis supported the robustness of these associations across CKM stages.
CONCLUSION: CHG index and its modified indices, particularly CHG-WHtR and CHG-Wc, are valuable indicators associated with reported incident CVD across CKM stages 0-3. Their stage-specific associations and exploratory threshold association support their utility in risk stratification for CKM syndrome.