Association of cholesterol, high-density lipoprotein, and glucose index and its modified indices with the risk of stroke: insights from CHARLS

OBJECTIVE: Cholesterol, High-density lipoprotein, and Glucose (CHG) index has recently been proposed as a marker of metabolic dysfunction. However, the association of CHG and CHG modified indices with the risk of stroke remains unclear. METHODS: We analyzed 8908 participants aged 45 years or older from the CHARLS. Baseline CHG and its modified forms (CHG-WC, CHG-BMI, CHG-BRI, CHG-WWI, CHG-WHtR, CHG-ABSI, and CHG-CVAI) were collected. Kaplan-Meier curves, Cox proportional hazards models, and restricted cubic spline (RCS) analyses were applied to assess associations with incident stroke. RESULTS: During a 9-year follow-up period, 828 (9.3%) participants had occurred strokes. Our analysis found a significant positive association between CHG, CHG-WC, CHG-BMI, CHG-BRI, CHG-WWI, CHG-WHtR, CHG-ABSI, CHG-CVAI, with stroke risk. The adjusted HR for the highest quartile compared to the lowest were: CHG 1.57 (95% CI:1.18-2.10), CHG-WC 1.72 (95% CI:1.34-2.20), CHG-BMI 1.62 (95% CI:1.26-2.08), CHG-BRI 1.65 (95% CI:1.29-2.10), CHG-WWI 1.71 (95% CI:1.32-2.23), CHG-WHtR 1.67 (95% CI:1.29-2.16), CHG-ABSI 1.41 (95% CI:1.10-1.80), and CHG-CVAI 1.99 (95% CI:1.54-2.57), with CHG-CVAI showing strongest associations. The RCS revealed a significant linear association between CHG, CHG-WC, CHG-BMI, and CHG-CVAI with the risk of stroke, whereas CHG-BRI, CHG-WWI, CHG-WHtR, and CHG-ABSI showed significant nonlinear associations with stroke risk. According to ROC analysis, CHG-CVAI had the highest predictive power for stroke risk (C-index:0.618). CONCLUSIONS: Elevated CHG and its modified indices were strongly associated with stroke risk in middle-aged and older Chinese populations. CHG-related indices combined with obesity measures may help enhance the identification of individuals at higher risk of stroke.