The association between modified cardiometabolic index and cardiovascular disease risk in adults with early cardiovascular-kidney-metabolic syndrome: a prospective cohort study

Cardiovascular-Kidney-Metabolic (CKM) syndrome highlights the interconnections between cardiovascular disease (CVD), chronic kidney disease (CKD), and type 2 diabetes (DM). The modified Cardiometabolic Index (MCMI), which integrates measures of insulin resistance, abdominal obesity, dyslipidemia, and blood glucose, may better reflect metabolic and cardiovascular risk than the original index. However, its association with cardiovascular and cerebrovascular disease risk in individuals with early CKM syndrome (stages 0–3) remains unclear. This longitudinal study utilized data from 6,953 participants in stages 0–3 of CKM syndrome from the China Health and Retirement Longitudinal Study (CHARLS). The MCMI was calculated at baseline. Participants were followed for a median of 7.8 years to track the incidence of cardiovascular disease, heart disease, and stroke. Cox proportional hazards models were employed to analyze the association between MCMI levels and the risk of these outcomes, adjusting for various sociodemographic, lifestyle, and clinical factors. During follow-up, 1,534 participants developed CVD. Higher MCMI levels were significantly associated with increased risks of overall CVD and stroke. In fully adjusted models, each unit increase in MCMI was associated with a 21% and 47% higher risk of CVD and stroke, respectively. Participants in the highest MCMI quartile had a 55% higher risk of CVD and a 2.55-fold higher risk of stroke compared to the lowest quartile. The association with heart disease was weaker and became non-significant after full adjustment. Dose-response analyses revealed nonlinear relationships for CVD and stroke. Subgroup and sensitivity analyses confirmed the robustness of these findings. MCMI is independently associated with an increased risk of overall CVD and stroke in individuals with early-stage CKM syndrome; its association with heart disease is weak, with statistical significance only observed in the highest MCMI quartile and partially attenuated by adjustment for traditional metabolic and cardiovascular risk factors. MCMI serves as a practical indicator for cardiovascular risk stratification, offering a valuable tool for early prevention and management of CVD and stroke in the preclinical phases of CKM syndrome.