Predictive value of cholesterol, high-density lipoprotein, and glucose index-obesity-derived index for stroke: a cohort study

BACKGROUND: In clinical practice, integrating biochemical markers with anthropometric parameters has become a prevalent approach to optimizing disease forecasting. While the cholesterol-high-density lipoprotein-glucose index (CHG) has emerged as a novel metric for quantifying metabolic stress, its prognostic utility for stroke risk-especially when synergized with obesity-related measures-remains to be fully elucidated. This research systematically evaluates the predictive efficacy of CHG-based obesity indices for stroke, utilizing the traditional triglyceride-glucose (TyG) index as a benchmark for comparison. METHODS: Data for this prospective investigation were derived from the China Health and Retirement Longitudinal Study (CHARLS), encompassing 7,905 individuals aged 45 years who were stroke-free at study inception. A set of seven composite indicators-integrating the CHG index with various obesity metrics (specifically CHG-BMI, CHG-WC, CHG-WHtR, CHG-WWI, CHG-BRI, CHG-ABSI, and CHG-CVAI)-underwent rigorous evaluation.. The discriminative power was quantified via the area under the receiver operating characteristic curve (AUC) and net reclassification improvement. Statistical associations with incident stroke were modeled using multivariate logistic regression, longitudinal trajectory clustering, and restricted cubic splines. RESULTS: During follow-up, stroke was reported in 739/7905 (9.3%) participants. Among all CHG-derived indices, CHG-CVAI and CHG-WC demonstrated the best stroke prediction with an identical AUC value of 0.664 and outperformed TyG-related indices. After full adjustment for confounders, stroke risk for subjects in the highest quartile (Q4) of CHG-CVAI and CHG-WC was 2.44 times (OR = 2.44, 95% CI: 1.66-3.60) and 2.06 times (OR = 2.06, 95% CI: 1.43-2.95) higher compared to those in the Q1 quartile, respectively. Longitudinal analysis demonstrated that stroke risk significantly increased among individuals with high cumulative exposure levels or sustained high levels over time. CONCLUSIONS: In the middle-aged and older Chinese population, CHG-CVAI and CHG-WC are significantly and linearly associated with an elevated risk of incident stroke. The predictive accuracy of these markers surpasses that of TyG and its related indicators. Given these findings, routine surveillance of CHG-CVAI or CHG-WC levels is recommended to facilitate the early screening of susceptible individuals, enabling more effective targeted prevention strategies in healthcare and community settings.