Triglyceride–cholesterol–body weight index and incident cardiovascular disease in cardiovascular-kidney-metabolic syndrome stages 0–3: a CHARLS cohort study

The triglyceride-cholesterol-body weight index (TCBI) integrates serum triglycerides, total cholesterol, and body weight in a single nutritional-metabolic measure. Using data from the China Health and Retirement Longitudinal Study (CHARLS), we examined whether TCBI was associated with incident cardiovascular disease (CVD) among middle-aged and older Chinese adults classified into cardiovascular-kidney-metabolic (CKM) syndrome stages 0–3. The prospective analysis included 8,030 participants; cumulative-exposure and pattern analyses used a landmark cohort of 4,583 participants. In fully adjusted Cox models, each one-unit increase in log-TCBI was associated with a 15% higher CVD hazard (HR 1.15, 95% CI 1.07–1.23) at baseline and an 8% higher hazard (HR 1.08, 95% CI 1.04–1.13) for cumulative exposure; both dose–response relationships were nonlinear. K-means clustering separated participants into persistently high, moderate, and low groups; the low group had less CVD than the high group (HR 0.69, 95% CI 0.59–0.82, P < 0.001). Findings were consistent in Fine-Gray competing-risk and sensitivity analyses. Higher baseline and cumulative TCBI were associated with greater CVD risk among adults with CKM stages 0–3, suggesting that repeated TCBI assessment may add information for risk stratification.