Cardiovascular

Association between metabolic-inflammatory indices and new-onset stroke: A longitudinal study based on CHARLS.

Feng X, Xiao C, Zhong S, Qin C • Medicine • 2026

PubMed 42937778 DOI 10.1097/MD.0000000000051291
TL;DR

CTI, BRI, and PHR were significantly and positively associated with new-onset stroke, with CTI showing the strongest association among the evaluated indicators, while ABSI showed no significant association.

Key Findings

Results

Over 7 years of follow-up, 545 of 7365 participants aged 45 years and older developed incident stroke.

  • Data came from the CHARLS 2011 and 2018 waves.
  • The analytic follow-up cohort included 7365 individuals aged 45 and older.
  • Associations were examined using logistic regression models, with subgroup analyses stratified by gender and smoothed curve fitting for nonlinearity.
Results

Higher CTI (C-reactive protein-triglyceride glucose index) was strongly associated with increased risk of new-onset stroke, and it showed the strongest association of the four indicators.

  • In the fully adjusted model, the highest CTI quartile (Q4) versus the lowest (Q1) had an OR of 2.054 (95% CI: 1.546-2.729).
  • The positive association held across all 3 logistic regression models.
Results

Higher BRI (body roundness index) was associated with increased stroke risk.

  • In the fully adjusted model, BRI Q4 versus Q1 had an OR of 1.721 (95% CI: 1.296-2.284).
  • The positive association held across all 3 logistic regression models.
Results

Higher PHR (platelet-to-HDL-cholesterol ratio) was associated with increased stroke risk.

  • In the fully adjusted model, PHR Q4 versus Q1 had an OR of 1.562 (95% CI: 1.215-2.009).
  • The positive association held across all 3 logistic regression models.
Results

CTI had a nonlinear relationship with stroke risk, with a data-derived inflection point at CTI = 8.806.

  • Below the inflection point, higher CTI was significantly associated with increased stroke risk (OR = 1.925, 95% CI: 1.469-2.523).
  • The nonlinear relationship was explored with smoothed curve fitting.
Results

The positive association between CTI and stroke risk was consistent in both men and women.

  • Gender-stratified analyses confirmed a consistent positive association between CTI and stroke risk in both sexes.
Results

ABSI (a body shape index) showed no significant association with incident stroke.

  • This contrasted with the positive associations seen for CTI, BRI, and PHR.
  • Models were adjusted for confounders and sensitivity analyses were performed to assess robustness.

What This Means

This study followed 7,365 Chinese adults aged 45 and older for about seven years, using data from a large national aging survey (CHARLS). It looked at four measures that combine information about metabolism, inflammation, and body shape to see whether they were linked to a new stroke. During follow-up, 545 people had a stroke. Three of the four measures were linked to higher stroke risk. People with the highest levels of a measure combining C-reactive protein (an inflammation marker) with triglyceride and glucose levels (CTI) had roughly twice the odds of stroke compared with those with the lowest levels. Higher body roundness (BRI) and a higher platelet-to-HDL-cholesterol ratio (PHR) were also linked to higher odds. A body shape index (ABSI) was not linked to stroke. CTI's link was strongest, appeared in both men and women, and was nonlinear: the rise in risk was clearest below a CTI value of about 8.8. This research suggests that indices combining inflammation, blood sugar, blood fat, and body shape may help identify people at higher risk of stroke. Because this is an observational study, it shows associations rather than proving cause, and the findings apply to a middle-aged and older Chinese population.

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Citation

Feng X, Xiao C, Zhong S, Qin C. (2026). Association between metabolic-inflammatory indices and new-onset stroke: A longitudinal study based on CHARLS.. Medicine. https://doi.org/10.1097/MD.0000000000051291