What is the clinical evidence from this study?

Study design: Cohort. Population: Adults with impaired glucose metabolism including diabetes and prediabetes without baseline hypertension or stroke (n=4207). Intervention: Cardiovascular Metabolic Index (CMI) vs. Lower quartile or stable low-level group of CMI. Primary outcome: Incidence of new-onset hypertension and stroke (OR 1.27 for hypertension per unit CMI increase, OR 1.31 for stroke per unit CMI increase, 95% CI Hypertension 1.15–1.40, Stroke 1.05–1.67, p=Hypertension 4.46E-06, Stroke 2.32E-02).

What question did this study set out to answer?

The study aims to determine whether the cardiovascular metabolic index (CMI) can predict hypertension and stroke risk in individuals with impaired glucose metabolism.

February 26, 2026Open Access

Rising cardiovascular metabolic indices are associated with hypertension and stroke risk in individuals with abnormal glucose metabolism: A prospective cohort study

Key Result

Higher Cardiovascular Metabolic Index increased hypertension risk by 27% (OR 1.27) and stroke risk by 31% (OR 1.31) in adults with impaired glucose metabolism over 3 years.

Key Points

The study aims to determine whether the cardiovascular metabolic index (CMI) can predict hypertension and stroke risk in individuals with impaired glucose metabolism.
Used K-means clustering to categorize CMI changes into three groups.
Applied multivariate logistic regression to assess associations between CMI and hypertension/stroke incidence.
Employed restricted cubic spline regression models for nonlinear relationship exploration.
Conducted ROC curve analysis to evaluate CMI's predictive ability for hypertension and stroke.
Observed 746 new cases of hypertension and 144 stroke events during follow-up.
CMI significantly increased the risk of hypertension (OR = 1.27) and stroke (OR = 1.31).
Higher CMI quartiles were associated with increased risks of hypertension and stroke.
Nonlinear relationship found between CMI and hypertension risk.
ROC curves indicated AUC values of 0.73 for hypertension and 0.67 for stroke.

Study Design

Type

Cohort (n=4,207)

Multicenter

Yes

Structured PICO

Does an elevated Cardiovascular Metabolic Index (CMI) increase the risk of hypertension and stroke in individuals with impaired glucose metabolism?

Population

4,207 participants with impaired glucose metabolism (diabetes or prediabetes), mean age 61.7 years, 54.5% female, from China (CHARLS cohort). Excluded individuals with baseline hypertension or stroke.

Intervention

Elevated Cardiovascular Metabolic Index (CMI) and cumulative CMI

Comparator

Lower quartiles or stable low trajectories of Cardiovascular Metabolic Index (CMI)

Outcome

Incidence of new-onset hypertension and stroke at the 2018 follow-up endpointhard clinical

Elevated Cardiovascular Metabolic Index (CMI) is significantly associated with an increased risk of future hypertension and stroke in individuals with impaired glucose metabolism, highlighting its potential utility for risk stratification.

Main Result

Effect estimate: OR 1.27 for hypertension per unit CMI increase, OR 1.31 for stroke per unit CMI increase (95% CI Hypertension 1.15–1.40, Stroke 1.05–1.67)

p-value: p=Hypertension 4.46E-06, Stroke 2.32E-02

Limitations

Stroke incidence was low, possibly reducing power to detect associations with stroke.
Observational cohort design cannot establish causality.
CMI measured by surrogate indices, not direct visceral fat or lipid function measurements.
Study population is predominantly Chinese older adults, limiting generalizability.

Abstract

The Cardiovascular Metabolic Index (CMI) has emerged as a robust indicator for predicting metabolic diseases. However, the extent to which CMI can forecast the future risk of cardiovascular disease among individuals with impaired glucose metabolism—specifically those with diabetes and prediabetes—remains uncertain. This uncertainty is particularly concerning given the substantial burden of cardiovascular complications that these populations face. To address this critical gap in knowledge and to provide actionable insights for targeted prevention and management strategies, we undertook this study. By doing so, we aimed to elucidate whether CMI can serve as a reliable predictor in this high-risk group of individuals with impaired glucose metabolism, thereby informing more effective and personalized approaches to managing cardiovascular risk. We included patients with impaired glucose metabolism in our baseline cohort and utilized K-means clustering to categorize changes in CMI into three distinct groups. We then applied a multivariate logistic regression model to assess the association between CMI, cumulative CMI, and changes in CMI with the incidence of hypertension and stroke within this population. This statistical approach enabled us to control for multiple confounding variables, thereby providing a more accurate assessment of the predictive power of CMI-related metrics. Furthermore, to explore potential nonlinear relationships between CMI and cumulative CMI with the occurrence of hypertension and stroke events, we employed restricted cubic spline (RCS) regression models. Finally, we utilized ROC curve analysis to evaluate the predictive ability of CMI and cumulative CMI for future risks of hypertension and stroke in individuals with impaired glucose metabolism. During the follow-up period from 2015 to 2018, we monitored 4,207 participants with impaired glucose metabolism and observed 746 new cases of hypertension and 144 stroke events. After meticulously adjusting for multiple potential confounding factors, our analysis revealed that the CMI significantly increases the risk of hypertension (OR = 1.27, 95% CI: 1.15–1.40) and stroke (OR = 1.31, 95% CI: 1.05–1.67) in this population. Compared with the first quartile of CMI, both the third and fourth quartiles were associated with heightened risks of hypertension and stroke. While cumulative CMI and its quartiles were linked to hypertension, no significant association was found with stroke. A nonlinear relationship was observed between CMI and hypertension risk (p = 0.017). Participants with moderate CMI levels (OR: 1.44, 95% CI: 1.21–1.71) and high CMI levels (OR: 2.69, 95% CI: 1.66–4.31) had significantly higher risks of hypertension than those with stable CMI levels. ROC curves showed AUC values of 0.73 and 0.67 for CMI in predicting hypertension and stroke, respectively. Elevated levels of the CMI are associated with an increased risk of hypertension and stroke among individuals with impaired glucose metabolism. Maintaining low CMI levels may help mitigate the risk of hypertension in these populations. Given that CMI can be easily measured in community settings, clinicians can utilize it for risk stratification and develop personalized prevention strategies. These strategies may help reduce the burden of future complications such as hypertension and stroke in patients with impaired glucose metabolism.

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