Lipid-related Indices and Stroke Risk Among Middle-Aged and Older Chinese Adults: A Nationwide Cross-Sectional and Longitudinal Study.

BACKGROUND: For middle-aged and older adults in China, stroke is a critical public health concern. Traditional lipid parameters may insufficiently characterize atherogenic dyslipidemia and visceral adiposity, whereas lipid-related indices may improve the assessment of metabolic risk. This study explored links between eight lipid-related indices and both prevalent and incident stroke. METHODS: Data were obtained from CHARLS, including 9,417 participants for cross-sectional analyses and 7,722 non-stroke participants for longitudinal analyses. Multivariable logistic and Cox models were applied to examine prevalent and incident stroke. Dose-response relationships were evaluated using restricted cubic splines (RCS). Sensitivity and subgroup analyses tested robustness. RESULTS: In cross-sectional analyses, the highest quartiles of AIP, CVAI, LAP, NHHR, RCII, and VAI were significantly associated with prevalent stroke. The strongest association was observed for NHHR, with odds ratio (OR) of 2.23 (95% CI: 1.52-3.27, P < 0.001). RC and Non-HDL showed positive but nonsignificant trends. Nonlinear dose-response patterns were observed for most indices. In the longitudinal cohort, 140 participants developed stroke during follow-up. All eight indices were prospectively associated with incident stroke, with RCII showing the highest hazard ratio (HR) of 4.20 (95% CI: 2.35-7.52, P < 0.001). Dose-response curves were nonlinear for LAP, RC, RCII, and VAI, and approximately linear for AIP, CVAI, NHHR, and Non-HDL. CONCLUSIONS: Lipid-related indices reflecting atherogenic lipid burden and visceral adiposity were consistently associated with both prevalent and incident stroke. These indices, particularly RCII and NHHR, may serve as valuable markers for metabolic risk assessment and be associated with strategies for early stroke prevention.