National Cohort Study on Cardiometabolic Index and Incident Stroke in Middle-Aged and Older Adults in China

The Cardiometabolic Index (CMI), a novel marker integrating central obesity and lipid metabolism, serves as a comprehensive indicator of metabolic health. While CMI has been linked to metabolic disorders like diabetes and cardiovascular diseases, its role in predicting stroke risk remains unclear. This study examines the association between CMI and stroke risk in Chinese adults aged 45 and older, highlighting its potential as a predictive tool for public health. Data from the China Health and Retirement Longitudinal Study (CHARLS) were analyzed. Participants were divided into CMI quartiles. Stroke incidence was the primary endpoint. Cox proportional hazards models evaluated the CMI-stroke risk association. Kaplan-Meier curves compared stroke incidence across quartiles, while restricted cubic splines (RCS) assessed non-linear trends. Subgroup analyses verified robustness. Among 7,821 participants (47% male), 418 strokes (5.3%) occurred over a mean follow-up of 7 years. Higher CMI was significantly associated with increased stroke risk [HR, 1.153 (95% CI: 1.048-1.269), P = 0.004]. RCS revealed a non-linear rise in stroke risk with increasing CMI (P for nonlinearity = 0.005). No significant interactions were observed between CMI and subgroups (all P > 0.05). Elevated CMI correlates with higher stroke risk in middle-aged and older Chinese adults. Incorporating CMI into routine assessments could improve early stroke prevention strategies, addressing the increasing burden of cerebrovascular disease in aging populations.