Correlation between the modified cardiometabolic index and the incidence of cardiovascular disease in a population with cardiovascular-kidney-metabolic syndrome stages 0–3: a nationwide prospective cohort study

The global burden of cardiovascular disease (CVD) is substantial, particularly among individuals with cardiovascular-kidney-metabolic (CKM) syndrome. This study aimed to examine the relationship between the modified cardiometabolic index (MCMI), which integrates fasting plasma glucose (FPG) with traditional lipid and adiposity measures, and the risk of developing new-onset CVD in individuals with stage 0-3 CKM syndrome. This prospective cohort study used data from the China Health and Retirement Longitudinal Study (CHARLS). A total of 5,786 participants at baseline (2011-2012), aged ≥ 45 years and without pre-existing CVD, were included in the study. The MCMI was calculated as ln[TG × FPG / HDL-C] × WC / height. Multivariable logistic regression models were employed to estimate odds ratio (OR) and 95% confidence interval (CI) for the association between baseline MCMI, cumulative MCMI (cumMCMI), and CVD risk, utilizing three models with adjustments for confounders. Dose-response relationships were examined using restricted cubic splines (RCS). The predictive capabilities were assessed using the area under the receiver operating characteristic (ROC) curve. Subgroup and sensitivity analyses, including the exclusion of early-onset CVD and stratification by CKM stages, were conducted. During the seven-year follow-up period, 1,060 incident cases of CVD were recorded among the 5,786 participants included in the analysis. After comprehensive adjustment, a higher baseline MCMI was significantly correlated with an increased risk of CVD (per interquartile range (IQR) increase: OR = 1.17, 95% CI: 1.06-1.28, P = 0.001). A distinct dose-response relationship was evident, with participants in the highest quartile exhibiting a 60% greater risk (OR = 1.60, 95% CI: 1.29-1.98, P < 0.001) than those in the lowest quartile. The RCS analysis confirmed a significant linear association. Similarly, cumMCMI was positively associated with CVD risk. Subgroup analyses demonstrated consistent associations across all subgroups, without significant interactions. Sensitivity analyses corroborated the primary findings, revealing consistent results after excluding early events, and a particularly strong association with stage 3 CKM syndrome. The MCMI serves as an independent and linear risk indicator for the onset of CVD in individuals with stages 0-3 CKM syndrome. Comprising straightforward, cost-effective, and standardized measurements, the MCMI offers substantial public health value as a practical screening tool. It facilitates the early identification of high-risk individuals, thereby enabling targeted prevention strategies and optimized resource allocation in community and primary care settings.