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September 3, 2026Cardiology ResearchOpen Access

Elevated cholesterol-HDL-glucose index is linked to ~46% higher stroke risk in non-diabetic adults.

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Why the study?

The association between the cholesterol-HDL-glucose index and stroke risk, particularly in individuals without diabetes, remains unclear.

Does a higher Cholesterol-HDL-Glucose (CHG) index increase the risk of stroke in middle-aged and elderly adults without diabetes?

Population

Middle-aged and elderly adults without diabetes (8,376 in CHARLS and 5,057 in NHANES)

Comparison

CHG index quartiles 2 to 4 vs quartile 1

Design

Two national cohort studies

Follow-up

9.0 years follow-up period in CHARLS

Key result

An elevated cholesterol-HDL-glucose index was independently associated with an increased risk of stroke in middle-aged and elderly adults without diabetes, with the highest quartile showing a 46.3% higher risk (HR 1.463) compared to the lowest quartile.

Authors

YJYu JingBLBen LinCGChen Yang Ge

Discussion

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Overview

CHG index was associated with higher stroke risk in nondiabetic adults; leaves open its added value for stratification or need for prospective validation.

Key Points

  • To examine the association between the cholesterol–HDL–glucose (CHG) index and the risk of stroke among middle-aged and elderly adults without diabetes.
  • Analyzed data from two prospective cohorts: the China Health and Retirement Longitudinal Study (CHARLS, n = 8,376, 2011–2020) and the National Health and Nutrition Examination Survey (NHANES, n = 5,057, 2011–2018).
  • Evaluated incident stroke risk using multivariable Cox proportional hazard regression, restricted cubic spline models for non-linearity, ROC curves, and mediation analysis via HbA1c.
  • In the CHARLS cohort, 651 participants (7.77%) developed stroke over 9.0 years, with adjusted hazard ratios of 1.378 (95% CI: 1.073–1.771), 1.447 (95% CI: 1.137–1.842), and 1.463 (95% CI: 1.147–1.868) for CHG index quartiles 2, 3, and 4 versus quartile 1.
  • Restricted cubic spline analysis showed a significant linear relationship (P-nonlinearity > 0.05), and HbA1c mediated 13.33% of the association between the CHG index and stroke risk.
  • Validation in the NHANES cohort (n = 5,057) confirmed a significant positive correlation and stroke predictive ability comparable to the triglyceride–glucose (TyG) index.

Study Design

Type

Cohort (n=8,376)

Multicenter

Yes

Structured PICO

Does a higher Cholesterol-HDL-Glucose (CHG) index increase the risk of stroke in middle-aged and elderly adults without diabetes?

P
Population
8,376 middle-aged and elderly Chinese adults without diabetes, free of prior stroke, followed for up to 9.0 years.
E
Exposure
Higher Cholesterol-HDL-Glucose (CHG) index (analyzed as quartiles and continuous variable)
C
Comparator
Lowest quartile of CHG index (Q1)
O
Outcome
Incidence of stroke eventshard clinical

Main Result

Hazard Ratio: 1.463 (95% CI 1.147–1.868)

Absolute Event Rate: 10.18% vs 5.36%

p-value: p=0.002

The CHG index is a significant, independent predictor of incident stroke in middle-aged and older adults without diabetes, performing comparably to the TyG index.

Limitations

  • Stroke outcome was determined based on self-reported physician diagnosis, introducing potential recall bias and misclassification.
  • Basic stroke information restricts in-depth analysis of specific stroke subtypes.
  • Limited number of stroke events for some detailed subgroup analyses.
  • Direct generalizability to other ethnic populations may be constrained.
  • Absence of detailed information regarding drug classes and dosages may result in residual confounding.
  • Only evaluated baseline CHG index, ignoring continuous variations over time.

Cite This Study

Jing et al. (2026) conducted a cohort in Stroke risk in adults without diabetes (n=8,376). Cholesterol-HDL-glucose (CHG) index vs. Lowest quartile of CHG index was evaluated on Incidence of stroke (HR 1.463, 95% CI 1.147-1.868, p=0.002). An elevated cholesterol-HDL-glucose index was independently associated with an increased risk of stroke in middle-aged and elderly adults without diabetes, with the highest quartile showing a 46.3% higher risk (HR 1.463) compared to the lowest quartile.

synapsesocial.com/papers/6a993503636c6408cfa7ccdchttps://doi.org/10.14740/cr2258
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