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The combination of elevated Cardiometabolic Index (CMI) and high-sensitivity C-reactive protein (hs-CRP) significantly increases the risk of new-onset stroke in middle-aged and older adults. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 8, 2025Open Access

The combined effects of cardiometabolic index and high-sensitivity C-reactive protein on the risk of new onset stroke in a Chinese national prospective longitudinal cohort study

Structured PICO

Does the combination of elevated Cardiometabolic Index and hs-CRP increase the risk of new-onset stroke in middle-aged and older Chinese adults?

Population

8,973 stroke-free adults aged 45 years or older from the China Longitudinal Study on Health and Retirement (CHARLS), mean age 59.12, 46.5% male, from 450 communities across China.

Intervention

Higher quartiles of Cardiometabolic Index (CMI) and elevated high-sensitivity C-reactive protein (hs-CRP ≥ 2 mg/L)

Comparator

Lower quartiles of Cardiometabolic Index (CMI) and low high-sensitivity C-reactive protein (hs-CRP < 2 mg/L)

Outcome

Occurrence of new-onset stroke events (self-reported)hard clinical

The combination of elevated Cardiometabolic Index and hs-CRP is significantly associated with an increased risk of new-onset stroke, highlighting their potential utility in risk stratification.

Abstract

BACKGROUND: The Cardiometabolic Index (CMI) represents a novel anthropometric measurement, which combines characteristics of adiposity and lipids. Since obesity, lipid metabolism, and inflammation may collectively facilitate the occurrence of stroke, we hypothesize that a combination of elevated levels of the CMI and high-sensitivity C-reactive protein (hs-CRP) increases the risk of future stroke among middle-aged and older Chinese adults. METHODS: This study included 8,973 participants aged 45 years or older from the China Longitudinal Study on Health and Retirement (CHARLS), who were stroke-free and underwent baseline evaluations between 2011 and 2012, with followed-up at 2013, 2015 and 2018. The exposures were CMI and hs-CRP, with CMI calculated using the formula waist circumference (cm)/height (cm) × triglycerides (mmol/L)/HDL-C (mmol/L). The primary outcome was the occurrence of new-onset stroke events. Cox proportional hazards models and restricted cubic spline (RCS) analyses were conducted to examine the associations between CMI, hs-CRP, and their combined effects on stroke risk. Sensitivity analysis was further implemented to verify the robustness of the results. RESULTS: A total of 629 participants (7.01%) suffered new-onset stroke during follow-up. The risk for stroke increased with each elevating quartile of baseline CMI levels, with adjusted HRs and 95% CIs being 1.27 (0.98-1.66), 1.41 (1.08-1.83), and 1.46 (1.09-1.96) for Q2, Q3, and Q4, respectively. Moreover, participants with levels of hs-CRP ≥ 2 mg/L also had significantly higher stroke incidence compared to those with CRP levels < 2 mg/L (adjusted HR 1.24, 95% CI 1.05-1.47, p = 0.012). Specifically, those concurrently with the highest CMI quartile and levels of hs-CRP ≥ 2 mg/L had the highest risk of stroke (adjusted HR 1.90, 95% CI 1.32-2.74). The subsequent sensitivity analyses yielded consistent results, further corroborating the initial findings. CONCLUSIONS: The combination of CMI and hs-CRP exhibited a significant association with stroke risk among middle-aged and older Chinese adults, highlighting the importance of joint assessments of these biomarkers for refining risk stratification and enhancing primary prevention strategies for stroke.

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