Association of cardiometabolic index with prevalence of stroke, all-cause and cardiovascular mortality: a prospective cohort study

Q: What are the key findings of this study?

Individuals in the highest Cardiometabolic Index quartile had significantly higher odds of overall stroke (OR 1.54) and a 13% increased risk of all-cause mortality compared to the lowest quartile.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Stroke (n=147897). Intervention: Highest Cardiometabolic Index (CMI) quartile (Q4) vs. Lowest CMI quartile (Q1). Primary outcome: Overall stroke (OR 1.54, 95% CI 1.44-1.65, p=<0.001).

Q: What does this research mean for the field?

Individuals in the highest Cardiometabolic Index quartile have significantly higher odds of overall stroke and an increased risk of all-cause and cardiovascular mortality compared to those in the lowest quartile. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the associations between the cardiometabolic index and stroke prevalence, all-cause mortality, and cardiovascular mortality.

J Q Zhao; Yuanmeng Tian; Li Jing; Han Yan; Jun Liu; Baoyan Zhang; Wanru Tang; Qian Wu; Shuang Li; G Li; Zhihua Yin; Liying Xing

doi:10.1186/s12889-026-27671-z

May 9, 2026BMC Public HealthOpen Access

Association of cardiometabolic index with prevalence of stroke, all-cause and cardiovascular mortality: a prospective cohort study

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Key result

Highest Cardiometabolic Index quartile linked to ~54% higher stroke odds and increased all-cause mortality.

OR 1.54
95% CI 1.44-1.65
P<0.001
n=147,897

Figures

Why the study?

Does a higher Cardiometabolic Index increase the risk of stroke prevalence and all-cause, cardiovascular, and stroke mortality in adults aged ≥40 years?

Key Points

To evaluate the associations between the cardiometabolic index and stroke prevalence, all-cause mortality, and cardiovascular mortality.
Prospective cohort study analyzing 147,897 participants aged 40 years or older recruited through multistage, stratified, and cluster random sampling between 2017 and 2023.
Assessed outcomes over a median follow-up of 4.75 years using multivariable logistic regression, multivariable Cox regression models, and restricted cubic splines.
Compared to the lowest quartile (Q1), participants in the highest cardiometabolic index quartile (Q4) exhibited higher odds of overall stroke (OR 1.54, 95% CI 1.44–1.65), ischemic stroke (OR 1.59, 95% CI 1.47–1.71), and hemorrhagic stroke (OR 1.25, 95% CI 1.04–1.51).
Individuals in Q4 had significantly greater risks of all-cause mortality (HR 1.13, 95% CI 1.05–1.21), cardiovascular mortality (HR 1.21, 95% CI 1.10–1.34), and stroke mortality (HR 1.32, 95% CI 1.14–1.53) relative to Q1.
Restricted cubic splines confirmed significant overall and non-linear associations between the cardiometabolic index and all stroke and mortality endpoints (P-overall < 0.05, P-non-linear < 0.05).

Study Design

Type

Cohort (n=147,897)

Multicenter

Yes

Structured PICO

Does a higher Cardiometabolic Index increase the risk of stroke prevalence and all-cause, cardiovascular, and stroke mortality in adults aged ≥40 years?

P

Population

147,897 adults aged ≥40 years from northeast China (Liaoning Province), mean age 59.56, 39.8% male. Excluded individuals who were pregnant, had severe cognitive or intellectual impairment, missing data, or a history of malignant tumours.

I

Intervention

High Cardiometabolic Index (CMI), evaluated as a continuous variable and by highest quartile (Q4: >0.89)

C

Comparator

Lowest Cardiometabolic Index quartile (Q1: ≤0.34)

O

Outcome

Prevalence of stroke, all-cause mortality, cardiovascular disease (CVD) mortality, and stroke mortality over a median follow-up of 4.75 yearshard clinical

Main Result

Effect estimate: OR 1.54 (95% CI 1.44-1.65)

p-value: p=<0.001

An elevated Cardiometabolic Index is independently associated with a higher prevalence of stroke and increased risks of all-cause, cardiovascular, and stroke-specific mortality, suggesting its utility as a screening tool for primary prevention.

Limitations

CMI primarily captures metabolic and adiposity-related pathways and does not encompass other important stroke mechanisms, such as cardioembolic sources or atrial fibrillation.
Limited number of hemorrhagic stroke events may have led to unstable estimates
Cannot exclude the possibility of overadjustment or collider bias
CMI primarily captures metabolic and adiposity-related pathways and does not encompass other important stroke mechanisms such as cardioembolic sources or atrial fibrillation

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Answers are grounded in this paper and cite their sources.

Implication

May support CMI in stroke risk assessment; leaves open modifiability pending randomized intervention trials.

Abstract

The association of the Cardiometabolic Index for stroke risk remains insufficiently explored. This study aimed to examine the associations of the CMI with the prevalence of stroke, as well as all-cause and cardiovascular mortality. This prospective cohort study employed a multistage, stratified, and cluster random sampling method to recruit 147,897 participants aged 40 years or older from 2017 to 2023. Multivariable logistic regression, Cox regression analysis and restricted cubic splines (RCS) were utilized to examine the associations of CMI with prevalence of stroke, all-cause mortality, and CVD mortality. The prevalence of stroke was 5.4%, with ischemic stroke at 4.8% and hemorrhagic stroke at 0.7%. Over a median follow-up of 4.75 years, 7,150 all-cause deaths, 3,701 cardiovascular deaths, and 1,598 stroke-related deaths were recorded. Multivariable logistic regression analysis demonstrated that, compared to the lowest quartile (Q1), individuals in the highest CMI quartile (Q4) had significantly higher odds of overall stroke (OR 1.54, 95% CI 1.44–1.65), ischemic stroke (OR 1.59, 95% CI 1.47–1.71), and hemorrhagic stroke (OR 1.25, 95% CI 1.04–1.51). Similarly, multivariable Cox regression analysis showed that individuals in Q4, relative to those in Q1, had a 13% increased risk of all-cause mortality (HR 1.13, 95% CI 1.05–1.21), a 21% increased risk of CVD mortality (HR 1.21, 95% CI 1.10–1.34), and a 32% increased risk of stroke mortality (HR 1.32, 95% CI 1.14–1.53).Restricted cubic spline analyses confirmed significant overall and non-linear associations between CMI and both stroke prevalence and mortality (P-overall < 0.05, P-non-linear < 0.05). CMI was significantly associated with stroke prevalence, all-cause mortality, and cardiovascular as well as stroke-specific mortality. These findings indicate that CMI could serve as a useful tool for identifying high-risk individuals, potentially informing targeted preventive strategies.

Discussion

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Cite This Study

Zhao et al. (2026) conducted a cohort in Stroke (n=147,897). Highest Cardiometabolic Index (CMI) quartile (Q4) vs. Lowest CMI quartile (Q1) was evaluated on Overall stroke (OR 1.54, 95% CI 1.44-1.65, p=<0.001). Individuals in the highest Cardiometabolic Index quartile had significantly higher odds of overall stroke (OR 1.54) and a 13% increased risk of all-cause mortality compared to the lowest quartile.

synapsesocial.com/papers/6a0172813a9f334c28272b59 https://doi.org/10.1186/s12889-026-27671-z

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Association of cardiometabolic index with prevalence of stroke, all-cause and cardiovascular mortality: a prospective cohort study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Association of cardiometabolic index with prevalence of stroke, all-cause and cardiovascular mortality: a prospective cohort study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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