Association between combined atherogenic and frailty index and cardiovascular events: evidence from the CHARLS cohort

Q: What are the key findings of this study?

Each 1-unit increment in the combined atherogenic and frailty index (AIP-FI) was significantly associated with a higher risk of cardiovascular disease (HR 2.95).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiovascular disease (n=6896). Intervention: Atherogenic index of plasma-frailty index (AIP-FI) vs. Lower AIP-FI levels. Primary outcome: Cardiovascular disease (CVD) events (HR 2.95, 95% CI 2.15-4.05, p=<0.001).

Q: What does this research mean for the field?

Higher Atherogenic Index of Plasma-Frailty Index (AIP-FI) is significantly associated with increased cardiovascular disease, stroke, and heart disease risk. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To investigate the association between the combined atherogenic index of plasma and frailty index (AIP-FI) and the risk of cardiovascular disease, stroke, and heart disease.

Guijun Huo; Yijia Chen; Yao Tang; Dayong Zhou

doi:10.1186/s12933-025-03051-6

December 31, 2025Cardiovascular DiabetologyOpen Access

Association between combined atherogenic and frailty index and cardiovascular events: evidence from the CHARLS cohort

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Key result

Higher combined atherogenic and frailty index is linked to ~3-fold higher CVD risk.

HR 2.95
95% CI 2.15-4.05
P<0.001
n=6,896

Figures

Why the study?

Does a higher combined atherogenic and frailty index (AIP-FI) predict an increased risk of cardiovascular disease, stroke, and heart disease in middle-aged and older adults?

Key Points

To investigate the association between the combined atherogenic index of plasma and frailty index (AIP-FI) and the risk of cardiovascular disease, stroke, and heart disease.
Prospective cohort study analyzing 6896 participants aged ≥ 45 years without baseline cardiovascular disease, stroke, or heart disease from the China Health and Retirement Longitudinal Study (CHARLS).
Multivariable Cox proportional hazard models and restricted cubic spline (RCS) analysis were used to assess risk over a median follow-up of 9 years.
During follow-up, 1648 (23.9%) cardiovascular disease events, 548 (7.9%) stroke events, and 1280 (18.6%) heart disease events were documented.
Each 1-unit increase in AIP-FI was significantly associated with higher risk of cardiovascular disease (HR: 2.95, 95% CI 2.15, 4.05; P < 0.001) and stroke (HR: 3.14, 95% CI 1.88, 5.26; P < 0.001) in fully adjusted models.
Restricted cubic spline analysis showed a significant positive nonlinear relationship between AIP-FI and the risk of cardiovascular disease, stroke, and heart disease (all P-overall < 0.05, all P for non-linear < 0.05).

Study Design

Type

Cohort (n=6,896)

Multicenter

Yes

Structured PICO

Does a higher combined atherogenic and frailty index (AIP-FI) predict an increased risk of cardiovascular disease, stroke, and heart disease in middle-aged and older adults?

P

Population

6,896 middle-aged and older Chinese adults aged ≥ 45 years without baseline cardiovascular disease, followed for a median of 9 years.

E

Exposure

Higher combined atherogenic index of plasma and frailty index (AIP-FI) score

C

Comparator

Lower AIP-FI score (lowest quartile as reference)

O

Outcome

Incident cardiovascular disease (CVD), stroke, and heart disease evaluated through self-reported physician diagnosis over a median follow-up of 9 yearshard clinical

Main Result

Hazard Ratio: 2.95 (95% CI 2.15–4.05)

p-value: p=<0.001

Limitations

Cross-sectional assessment of baseline AIP and FI precludes conclusions regarding temporal changes and cumulative exposure.
Stroke diagnoses were self-reported by participants based on evaluations from their healthcare providers, which may introduce misclassification bias.
Residual confounding from unmeasured factors such as diet quality, physical activity, and socioeconomic status cannot be excluded.
Unable to perform an a priori power calculation due to the fixed sample size of the CHARLS cohort.
Focus on middle-aged and elderly Chinese participants may limit extrapolation to other ethnic and age groups.

Implication

The combined atherogenic and frailty index (AIP-FI) is a strong, independent predictor of incident cardiovascular disease, stroke, and heart disease in middle-aged and older adults, offering a novel tool for risk stratification.

Abstract

OBJECTIVE: The atherogenic index of plasma (AIP) is a marker of atherosclerosis, while frailty reflects cumulative physiological decline. However, the combined impact of AIP-frailty index (AIP-FI) has not been adequately explored. This study aimed to investigate the association between AIP-FI and the risk of cardiovascular disease (CVD), stroke, and heart disease. METHODS: This prospective cohort study included 6896 participants aged ≥ 45 years from the China Health and Retirement Longitudinal Study (CHARLS) without CVD, stroke, or heart disease at baseline. The Cox proportional hazard models and restricted cubic spline (RCS) analysis were applied to explore the association between AIP-FI with the risk of CVD, stroke, and heart disease. RESULTS: During a median follow-up period of 9 years, 1648 (23.9%) of CVD events, 548 (7.9%) of stroke events, and 1280 (18.6%) of heart disease events were recorded. Cox regression analysis revealed that each 1-unit increment in the AIP-FI was significantly associated with higher risk of CVD (HR: 2.95, 95% CI 2.15, 4.05), stroke (HR: 3.14, 95% CI 1.88, 5.26), and heart disease (HR: 2.72, 95% CI 1.06, 1.89, 3.92). The RCS revealed a significant positive nonlinear relationship between AIP-FI with the risk of CVD, stroke, and heart disease (all P-overall < 0.05, and all P for non-linear < 0.05). CONCLUSIONS: Our study demonstrated that higher AIP-FI was significantly associated with increased risk of CVD, stroke, and heart disease. By integrating metabolic and frailty information, AIP-FI offers an effective and accessible tool for cardiovascular risk assessment, supporting earlier prevention and intervention strategies in the middle-aged and elderly Chinese populations.

Discussion

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Cite This Study

Huo et al. (2025) conducted a cohort in Cardiovascular disease (n=6,896). Atherogenic index of plasma-frailty index (AIP-FI) vs. Lower AIP-FI levels was evaluated on Cardiovascular disease (CVD) events (HR 2.95, 95% CI 2.15-4.05, p=<0.001). Each 1-unit increment in the combined atherogenic and frailty index (AIP-FI) was significantly associated with a higher risk of cardiovascular disease (HR 2.95).

synapsesocial.com/papers/6963220791e05aa366cb8708 https://doi.org/10.1186/s12933-025-03051-6

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Association between combined atherogenic and frailty index and cardiovascular events: evidence from the CHARLS cohort

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Association between combined atherogenic and frailty index and cardiovascular events: evidence from the CHARLS cohort

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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