Key result
Higher cumulative cardiometabolic index linked to ~28% greater incident CVD risk in CKM syndrome.
Why the study?
The role of the cardiometabolic index across cardiovascular-kidney-metabolic syndrome stages 0–3 and its potential synergy with depressive symptoms remained unclear.
Does a higher cardiometabolic index and depressive symptoms increase the risk of incident cardiovascular disease in adults with CKM stages 0-3?
Cohort (n=5,556)
Yes
Does a higher cardiometabolic index and depressive symptoms increase the risk of incident cardiovascular disease in adults with CKM stages 0-3?
In adults with early-stage cardiovascular-kidney-metabolic syndrome, a higher cumulative cardiometabolic index and depressive symptoms are independently and jointly associated with an increased risk of incident cardiovascular disease.
May aid CKM risk stratification; extends cumulative cardiometabolic associations but leaves open causal validation and intervention trials.
The progressive nature of cardiovascular-kidney-metabolic syndrome (CKM) allows early intervention during stages 0–3. However, the role of the cardiometabolic index (CMI) across CKM stages 0–3 and its potential synergy with depressive symptoms remain unclear. We followed 5,556 CHARLS participants (aged ≥ 45, CKM stages 0–3) for 7 years. Higher CMI and cumulative average CMI (CumCMI) were independently associated with CVD (HR for Q4 vs. Q1: 1.27, P trend = 0.009; HR for high vs. low CumCMI: 1.28, P trend < 0.001). Nonlinear thresholds were 0.47 (CMI) and 2.08 (CumCMI). Among 2,595 participants with complete depressive symptoms data, those with high CumCMI alone (HR = 1.61) or depressive symptoms alone (HR = 1.43) had elevated risk, whereas those with both factors had the highest risk (HR = 2.08). Baseline AUC was 0.651; adding CMI alone yielded no improvement (0.651), whereas adding depressive symptoms alone raised it to 0.657; both together gave 0.657–0.658. However, additive interaction was not statistically significant, and the AUC improvement from adding depressive symptoms to a model already containing CMI was minimal (ΔAUC ≈ 0.007), suggesting that this combined indicator may be more suitable for population-level risk stratification than individual clinical prediction.
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Li et al. (2026) conducted a cohort in Cardiovascular-kidney-metabolic syndrome stages 0-3 (n=5,556). High cumulative cardiometabolic index (CumCMI) vs. Low cumulative cardiometabolic index was evaluated on Incident cardiovascular disease (HR 1.28, 95% CI 1.11-1.46, p=<0.001). Higher cumulative cardiometabolic index was independently associated with an increased risk of incident cardiovascular disease (HR 1.28) in adults with cardiovascular-kidney-metabolic syndrome stages 0-3.
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