Association between Modified Cardiometabolic Index and Incident Cardiovascular Disease in Middle-Aged and Elderly Chinese Individuals with Abnormal Glucose Metabolism

Background: The cardiometabolic index (CMI) was developed ten years ago as a composite indicator combining measures of obesity (waist-to-height ratio) and dyslipidemia (triglyceride/HDL-C ratio). Prior studies have demonstrated its ability to predict both the occurrence and mortality of cardiovascular disease. Extending this line of inquiry, the current investigation examines how a modified cardiometabolic index (MCMI) with CVD risk specifically among middle-aged and older individuals exhibiting abnormal glucose metabolism. Methods: A total of 3420 participants from the China Health and Retirement Longitudinal Study (CHARLS) were included. MCMI levels were measured at baseline and categorized into quartiles. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between MCMI and incident CVD, with adjustment for demographic, socioeconomic, and clinical confounders. Restricted cubic spline analysis was employed to examine the dose-response relationship. Results: During a median follow-up of 10 years, 705 incident CVD cases were documented. Kaplan-Meier analysis showed significantly higher cumulative incidence of CVD with increasing MCMI quartiles (log-rank P < 0.01). In fully adjusted models, each unit increase in MCMI was associated with a 21% higher risk of CVD (HR = 1.21, 95% CI: 1.09 - 1.34, P < 0.001). Participants in the highest MCMI quartile (Q4) had a 40% increased risk compared to those in the lowest quartile (Q1) (HR = 1.40, 95% CI: 1.12 - 1.77, P = 0.004). Restricted cubic spline analysis revealed a linear relationship (P for nonlinear = 0.778). The positive association remained consistent across subgroups. Conclusions: Higher MCMI levels are independently associated with an increased risk of incident CVD in a dose-response manner. These findings highlight the importance of monitoring and managing MCMI for CVD prevention in middle-aged and older adults.