Modified cardiometabolic index and stroke risk: Evidence from the CHARLS cohort

Q: What are the key findings of this study?

Higher modified cardiometabolic index levels were independently associated with an increased risk of incident stroke.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Stroke risk (n=8167). Intervention: Modified cardiometabolic index (MCMI) vs. Lower MCMI levels. Primary outcome: Incident stroke (HR 1.32, 95% CI 1.20-1.46, p=<0.001).

Q: What does this research mean for the field?

Higher modified cardiometabolic index levels are associated with an increased risk of incident stroke in a non-linear manner. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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

To examine the longitudinal relationship between the modified cardiometabolic index and the risk of incident stroke.

Xianhong Wu; Shiqin Chen; Tian Lv; Zhichao Zhou

doi:10.1097/md.0000000000050148

August 7, 2026MedicineOpen Access

Modified cardiometabolic index and stroke risk: Evidence from the CHARLS cohort

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Key result

Higher modified cardiometabolic index linked to ~32% increased incident stroke risk per unit increase.

HR 1.32
95% CI 1.20-1.46
P<0.001
n=8,167

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Why the study?

The association between the modified cardiometabolic index and stroke risk remains unclear.

Does a higher modified cardiometabolic index (MCMI) increase the risk of incident stroke in Chinese adults aged 45 and older?

Key Points

To examine the longitudinal relationship between the modified cardiometabolic index and the risk of incident stroke.
Analyzed prospective cohort data from 8167 participants (54.6% female, mean age 59.1 years) in the China Health and Retirement Longitudinal Study enrolled in 2011 and followed over 9 years through 2020.
Calculated MCMI as ln[triglycerides × fasting blood glucose/ high-density lipoprotein cholesterol] × waist circumference/ height and identified incident stroke via self-reported physician diagnosis.
Evaluated associations using multivariable Cox proportional hazards models, restricted cubic spline analysis, and time-dependent receiver operating characteristic curves compared against the cardiometabolic index.
Over 9 years of follow-up, 753 incident strokes occurred; higher MCMI was significantly associated with stroke risk after full covariate adjustment (HR = 1.32, 95% CI: 1.20–1.46 per one-unit increase).
Compared to the lowest quartile (103 events), stroke risk was highest in the fourth quartile (275 events; HR = 2.30, 95% CI: 1.80–2.94; P for trend < .001).
Restricted cubic spline modeling showed a nonlinear association (P for nonlinearity = 0.002) with a threshold at 3.5, below which risk increased substantially (HR = 1.68, 95% CI: 1.42–1.99; P < .001) and above which it plateaued (HR = 0.92, 95% CI: 0.73–1.17; P = .502).

Study Design

Type

Cohort (n=8,167)

Multicenter

Yes

Structured PICO

Does a higher modified cardiometabolic index (MCMI) increase the risk of incident stroke in Chinese adults aged 45 and older?

P

Population

8,167 adults aged 45 years or older from China, free of prior stroke, followed for 9 years to assess incident stroke risk.

E

Exposure

Higher modified cardiometabolic index (MCMI) levels

C

Comparator

Lower modified cardiometabolic index (MCMI) levels (e.g., lowest quartile)

O

Outcome

First reported diagnosis of stroke (self-reported physician-diagnosed) between 2011 and 2020hard clinical

Main Result

Hazard Ratio: 1.32 (95% CI 1.2–1.46)

p-value: p=<0.001

Higher modified cardiometabolic index (MCMI) is independently associated with an increased risk of incident stroke and offers modestly better predictive performance than the standard cardiometabolic index.

Limitations

Self-reported stroke diagnosis without clinical verification
Lack of stroke subtype information
Potential residual confounding
Selection bias from excluding participants with incomplete data
Competing risk of death not accounted for
Lack of external validation in non-Chinese populations
Stroke diagnosis was based on self-reported questionnaires without clinical verification.
Information on stroke subtypes (ischemic or hemorrhagic) was unavailable.
Residual confounding from unmeasured variables cannot be excluded.
A substantial proportion of participants was excluded due to incomplete data.
The competing risk of death was not explicitly accounted for in the analysis.
Lack of external validation and restriction to a Chinese population.

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Answers are grounded in this paper and cite their sources.

Implication

MCMI may aid stroke risk stratification in Chinese adults ≥45 years; extends cardiometabolic index evidence but remains hypothesis-generating.

Abstract

The association between the modified cardiometabolic index (MCMI) and stroke risk remains unclear. This study aimed to investigate the relationship between MCMI and incident stroke. A total of 8167 participants from the China Health and Retirement Longitudinal Study (baseline 2011) were included. MCMI was calculated as ln[triglycerides × fasting blood glucose/ high-density lipoprotein cholesterol] × waist circumference/ height. Incident stroke was defined as self-reported physician-diagnosed stroke during follow-up through 2020. Cox proportional hazards regression, restricted cubic spline (RCS) modeling, and subgroup analyses were performed to examine the association. Time-dependent receiver operating characteristic (ROC) analysis was used to compare the predictive performance of MCMI with that of the cardiometabolic index (CMI). Over 9 years of follow-up, higher MCMI levels were associated with increased stroke risk (hazard ratio [HR] = 1.32, 95% confidence interval [CI]: 1.20–1.46). Quartile analyses confirmed this trend, with the highest quartile showing the greatest risk compared with the lowest (HR = 2.30, 95% CI: 1.80–2.94). RCS analysis revealed a nonlinear relationship (P for nonlinearity = 0.002). Subgroup analyses suggested potential heterogeneity across marital status and residential location. ROC analysis showed that the MCMI consistently yielded higher AUC values than the CMI at 3 years (0.72 vs 0.70), 5 years (0.75 vs 0.73), 7 years (0.77 vs 0.75), and 8 years (0.72 vs 0.70), with all DeLong’s test P-values < 0.05. Higher MCMI levels were positively associated with stroke risk. Although MCMI demonstrated slightly better predictive performance than CMI, the improvement was limited. These findings support an association rather than direct clinical applicability. Additional large-scale prospective studies and validation analyses are required before its routine use in clinical risk stratification can be considered.

Discussion

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Cite This Study

Wu et al. (2026) conducted a cohort in Stroke risk (n=8,167). Modified cardiometabolic index (MCMI) vs. Lower MCMI levels was evaluated on Incident stroke (HR 1.32, 95% CI 1.20-1.46, p=<0.001). Higher modified cardiometabolic index levels were independently associated with an increased risk of incident stroke.

synapsesocial.com/papers/6a7793186789de8d0af74c1b https://doi.org/10.1097/md.0000000000050148

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Modified cardiometabolic index and stroke risk: Evidence from the CHARLS cohort

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Modified cardiometabolic index and stroke risk: Evidence from the CHARLS cohort

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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