Association of combined waist-to-height ratio and systolic blood pressure categories with incident cardiovascular disease in middle-aged and older adults

Cardiovascular disease (CVD) is the leading cause of global mortality. Early identification of individuals at higher risk of CVD is important for prevention and management. Traditional cardiovascular risk assessment approaches often require laboratory testing and related infrastructure, which may limit their implementation in community settings. This prospective cohort study examined the association of combined waist-to-height ratio (WHtR) and systolic blood pressure (SBP) categories with incident CVD in middle-aged and older adults. We analyzed 6,770 adults aged ≥ 45 years without baseline CVD from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2018). Participants were categorized by WHtR (≥ 0.5/<0.5) and SBP (≥ 140/<140 mmHg). Cox proportional hazards models were used to assess associations with incident CVD, adjusting for sociodemographic, lifestyle, and metabolic covariates. Over 7 years of follow-up, 1,384 CVD events occurred. Elevated WHtR alone (HR = 1.271, 95% CI: 1.111–1.455) and elevated SBP alone (HR = 1.392, 95% CI: 1.240–1.564) were each associated with a higher risk of incident CVD. Participants with concurrent elevations in WHtR and SBP had a 68.2% higher risk of incident CVD (HR = 1.682, 95% CI: 1.417–1.996) compared with those with normal values. These associations remained consistent across subgroup and sensitivity analyses. Combined WHtR and SBP categories may offer a simple, low-cost approach for community-based cardiovascular risk stratification in middle-aged and older adults. Requiring only a tape measure and a sphygmomanometer, this approach may help identify individuals at higher risk of incident CVD in settings where laboratory testing is less accessible.