Associations of baseline cumulative and trajectory patterns of the cholesterol HDL glucose index with incident cardiovascular disease

Background The cholesterol–HDL–glucose (CHG) index reflects metabolic stress related to insulin resistance. Evidence on whether baseline CHG, cumulative CHG (cuCHG), and long-term CHG trajectories predict incident cardiovascular disease (CVD) is limited. We investigated these associations in Chinese adults aged ≥45 years. Methods We analyzed 4,213 participants in the China Health and Retirement Longitudinal Study (2011–2020). Baseline CHG, cuCHG, and CHG trajectories (derived using K-means clustering) represented static, cumulative, and dynamic metabolic exposure. Incident CVD was physician-diagnosed. Cox models with restricted cubic splines estimated hazard ratios (HRs) and exposure–response relationships. Results Over 8.18 ± 1.56 years of follow-up, 938 participants developed CVD. Each one-unit increase in baseline CHG and cuCHG was associated with 38% and 13% higher CVD risk, respectively (HR = 1.38, 95% CI 1.17–1.62; HR = 1.13, 95% CI 1.06–1.21; both p < 0.001). CVD risk increased across CHG and cuCHG quartiles, with linear dose–response patterns. A persistently high CHG trajectory conferred the greatest CVD risk (HR = 1.46, 95% CI 1.12–1.90), and findings were robust in subgroup and sensitivity analyses. Conclusion Higher baseline CHG, greater cumulative cuCHG, and persistently elevated CHG trajectories were independently associated with increased incident CVD. Sustained metabolic stress reflected by long-term CHG elevation may have cumulative adverse cardiovascular effects. CHG-based dynamic indicators provide simple and clinically relevant measures for early CVD risk detection and prevention.Graphical AbstractRCS curves