What question did this study set out to answer?

To assess the association of the CHG index with adverse outcomes in individuals with previous myocardial infarction.

February 26, 2026Open Access

The cholesterol, high-density lipoprotein, and glucose (CHG) index as a novel metabolic marker for predicting adverse outcomes in myocardial infarction survivors: insights from two large prospective cohorts

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: prior myocardial infarction (n=23322). Intervention: Cholesterol, high-density lipoprotein, and glucose (CHG) index vs. Lowest quartile (Q1) of CHG index. Primary outcome: All-cause mortality and cardiovascular mortality in UK Biobank; Major adverse cardiovascular events (MACE) and hard endpoint in Fuwai Hospital cohort (HR 1.39 for all-cause mortality (Q4 vs Q1, UK Biobank), HR 1.42 for cardiovascular mortality (Q4 vs Q1, UK Biobank), HR 1.37 for MACE (Q4 vs Q1, Fuwai Hospital), HR 1.87 for hard endpoint (Q4 vs Q1, Fuwai Hospital), 95% CI 95% CI 1.33–1.41 for all-cause mortality, 1.14–1.74 for cardiovascular mortality, 1.17–1.61 for MACE, 1.24–2.81 for hard endpoint, p=<0.001 for all-cause mortality and MACE, 0.001 for cardiovascular mortality, 0.003 for hard endpoint).

Key Result

The CHG index in the highest quartile increased all-cause mortality by 39% and cardiovascular mortality by 42% in UK MI survivors over 13.4 years, and increased major adverse cardiovascular events by 37% and hard endpoint events by 87% in Chinese MI patients over 3.1 years.

Key Points

To assess the association of the CHG index with adverse outcomes in individuals with previous myocardial infarction.
Analyzed data from two large independent cohorts
Evaluated the association of the CHG index with adverse events
Assessed the discriminative power of the index for risk reclassification
The CHG index showed modest independent discriminative power for adverse events
It was associated with enhanced risk reclassification
Further validation is needed in clinical settings for secondary prevention

Study Design

Type

Cohort (n=23,322)

Multicenter

Yes

Structured PICO

Does a higher CHG index predict adverse cardiovascular outcomes and mortality in survivors of myocardial infarction?

Population

23,212 individuals with a history of prior myocardial infarction (16,959 from UK Biobank, median age 63, 76.0% male; 6,253 from Fuwai Hospital, median age 59.4, 85.6% male).

Intervention

Higher cholesterol, high-density lipoprotein, and glucose (CHG) index (evaluated as quartiles, specifically Q4)

Comparator

Lower CHG index (Q1) and the TyG index model

Outcome

UK Biobank: All-cause mortality and cardiovascular mortality at median 13.4 years follow-up. Fuwai Hospital: MACE (all-cause mortality, non-fatal MI, and ischemia-mediated revascularization) and hard endpoint (cardiovascular mortality and non-fatal MI) at median 3.1 years follow-up.composite

The CHG index is a novel, independent metabolic predictor of adverse cardiovascular events and mortality in post-MI patients, offering incremental prognostic value over the TyG index.

Main Result

Effect estimate: HR 1.39 for all-cause mortality (Q4 vs Q1, UK Biobank), HR 1.42 for cardiovascular mortality (Q4 vs Q1, UK Biobank), HR 1.37 for MACE (Q4 vs Q1, Fuwai Hospital), HR 1.87 for hard endpoint (Q4 vs Q1, Fuwai Hospital) (95% CI 95% CI 1.33–1.41 for all-cause mortality, 1.14–1.74 for cardiovascular mortality, 1.17–1.61 for MACE, 1.24–2.81 for hard endpoint)

p-value: p=<0.001 for all-cause mortality and MACE, 0.001 for cardiovascular mortality, 0.003 for hard endpoint

Limitations

Observational cohort design limits causal inference
Modest independent discriminative power of CHG index
Study populations predominantly male and middle aged
Results require further validation in prospective clinical trials

Abstract

In two large independent cohorts of individuals with prior MI, the CHG index was independently associated with risks of adverse events. While its independent discriminative power is modest, the index serves as a valuable adjunctive tool that enhances risk reclassification, warranting further validation in prospective clinical settings to confirm its utility in secondary prevention.

Bookmark

View Full Paper

Bookmark

View Full Paper

Cite This Study

Song et al. (Tue,) conducted a cohort in prior myocardial infarction (n=23,322). Cholesterol, high-density lipoprotein, and glucose (CHG) index vs. Lowest quartile (Q1) of CHG index was evaluated on All-cause mortality and cardiovascular mortality in UK Biobank; Major adverse cardiovascular events (MACE) and hard endpoint in Fuwai Hospital cohort (HR 1.39 for all-cause mortality (Q4 vs Q1, UK Biobank), HR 1.42 for cardiovascular mortality (Q4 vs Q1, UK Biobank), HR 1.37 for MACE (Q4 vs Q1, Fuwai Hospital), HR 1.87 for hard endpoint (Q4 vs Q1, Fuwai Hospital), 95% CI 95% CI 1.33–1.41 for all-cause mortality, 1.14–1.74 for cardiovascular mortality, 1.17–1.61 for MACE, 1.24–2.81 for hard endpoint, p=<0.001 for all-cause mortality and MACE, 0.001 for cardiovascular mortality, 0.003 for hard endpoint). The CHG index in the highest quartile increased all-cause mortality by 39% and cardiovascular mortality by 42% in UK MI survivors over 13.4 years, and increased major adverse cardiovascular events by 37% and hard endpoint events by 87% in Chinese MI patients over 3.1 years.

synapsesocial.com/papers/699fe24b95ddcd3a253e6250 https://doi.org/https://doi.org/10.1186/s12933-026-03104-4

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: