Association between Cumulative Exposure to Cardiometabolic Index and Risk of Heart Failure: A Prospective Cohort Study

Background High cardiometabolic index (CMI) is a risk factor for heart failure (HF), but the long-term impact of cumulative CMI exposure on incident HF remains unclear. We examined the association between cumulative CMI and HF risk in a large prospective cohort. Methods A total of 44,773 participants (mean age 53.1±11.9 years; 78.6% men) from the Kailuan Study who attended three health examinations in 2006, 2008, and 2010 and were free of cardiovascular disease or cancer at baseline were included. Cumulative CMI was calculated as the weighted sum of mean CMI across time intervals and categorized into quartiles. Incident HF was identified through medical records and death registries until December 31, 2022. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results Over a median follow-up of 12.0 years (IQR 11.7–12.3), 1,018 HF events occurred. Compared with the lowest quartile, adjusted HRs (95% CIs) were 1.18 (0.95–1.50), 1.32 (1.05–1.65), and 1.40 (1.11–1.76) for Q2–Q4 (P for trend < 0.001). A significant interaction was observed between cumulative CMI and diabetes (P = 0.043), but not with age, sex, or hypertension. Sensitivity analyses yielded consistent results. Conclusions High cumulative CMI was independently associated with increased HF risk. Long-term monitoring and maintenance of an optimal CMI level may aid in early identification and prevention of HF in the general population.