Associations between cardiometabolic index and heart failure prevalence in hypertensive population: evidence from the NHANES 2009-2018

Introduction: Objectives: this cross-sectional study investigated the association between the Cardiometabolic Index (CMI) and heart failure (HF) prevalence in hypertensive individuals. Methods: this cross-sectional study analyzed dataset from the National Health and Nutrition Examination Survey (NHANES) 2009-2018, focusing on hypertensive adults with complete information on CMI and HF prevalence, employed CMI based on the following formula: [waist circumference (cm)/height (cm)] × [TG (mmol/L)/HDL-C (mmol/L)]. The relationships between CMI and HF prevalence were assessed using weighted multivariable logistic regression and subgroup analysis. Additionally, the threshold effect was determined by applying a two-piece linear regression model. Results: a total of 3,706 subjects with hypertension were enrolled, with heart failure being reported in 6.77 % of cases. A positive relationship was observed between CMI and HF prevalence. In the fully adjusted model, a one-unit rise in CMI corresponded to a 14 % increased likelihood of HF (OR = 1.14, 95 % CI: 1.03-1.26). Subjects in the top CMI tertile were 49 % more likely to progress to HF than those in the bottom tertile (OR = 1.49, 95 % CI: 1.01-2.21). We did not detect statistically significant interactions across subgroups. An inverted U-shaped correlation was identified between CMI and HF prevalence. The breakpoint was identified at 6.00. On the left of the breakpoint, a positive relationship between CMI and HF prevalence (OR = 1.56, 95 % CI: 1.35-1.79) was observed. Conclusions: these findings suggest a positive association between elevated CMI levels and a higher prevalence of HF in hypertensive adults.