CHG index and ePWV jointly predict cardiovascular disease risk: findings from the CHARLS cohort

Cardiovascular disease (CVD) remains the leading cause of mortality worldwide, posing a significant burden on public health systems. Identifying novel biomarkers to improve risk stratification is crucial for effective primary prevention. The cholesterol, high-density lipoprotein, and glucose (CHG) index and estimated pulse-wave velocity (ePWV) reflect metabolic dysregulation and vascular damage, respectively. However, their combined predictive value for CVD risk remains unexplored. This study aimed to investigate the associations of CHG index and ePWV with incident CVD and evaluate whether their combination improves risk prediction. This prospective cohort study utilized data from the China Health and Retirement Longitudinal Study (CHARLS). Participants aged ≥ 45 years without CVD at baseline were included. CHG index and ePWV were calculated using baseline measurements of lipid profiles, fasting glucose, and blood pressure. CVD incidence was ascertained through follow-up questionnaires. Cox proportional hazards models, restricted cubic splines, and receiver operating characteristic (ROC) curves were employed to assess associations, nonlinear relationships, and predictive performance. A total of 5,431 participants were enrolled, with 1,428 incident CVD cases during follow-up. Both CHG index (HR = 1.40, 95% CI: 1.25–1.57) and ePWV (HR = 1.11, 95% CI: 1.08–1.13) were independently associated with CVD risk. Participants with both high CHG and high ePWV exhibited the highest risk (HR = 2.12, 95% CI: 1.83–2.44). Restricted cubic splines revealed a linear association for CHG index and a nonlinear association for ePWV with CVD risk. The combination of CHG index and ePWV demonstrated superior predictive performance (AUC = 0.611) compared to CHG index alone (AUC = 0.555) or ePWV alone (AUC = 0.603). The CHG index and ePWV are independently and synergistically associated with CVD risk in Chinese adults aged ≥ 45 years. Their combination may serve as a novel and effective strategy for enhancing risk stratification in the primary prevention of CVD within this middle-aged and older population. Not applicable.