Association between the triglyceride glucose index:Chinese visceral adiposity index (TyG-CVAI) and new-onset cardiovascular disease in middle-aged and older adults-insights from the China Health and Retirement Longitudinal Study (CHARLS).

Among 7977 participants free of CVD at baseline, 1221 ultimately developed CVD during follow-up.

• Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS), a large national prospective cohort.
• Participants were middle-aged and older Chinese adults lacking CVD at baseline.
• The primary endpoint was incidence of new-onset CVD.
• Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

Kaplan-Meier analysis showed a significantly higher cumulative incidence of CVD with increasing TyG-CVAI quartiles.

• Log-rank P < 0.001 across TyG-CVAI quartiles.
• TyG-CVAI was calculated by combining the triglyceride-glucose (TyG) index and the Chinese visceral adiposity index (CVAI).
• Participants were categorized into four quartiles based on TyG-CVAI values.

Participants in the highest TyG-CVAI quartile (Q4) had a significantly higher CVD risk compared to those in the lowest quartile (Q1) after full adjustment.

• HR = 1.64 (95% CI 1.35–2.00) for Q4 versus Q1.
• Adjustment included demographic, lifestyle, and cardiometabolic risk factors.
• This association was independent of established cardiovascular risk factors.

Restricted cubic spline (RCS) analysis revealed a significant nonlinear association between TyG-CVAI and CVD risk, with a threshold at 778.62.

• Below the threshold of 778.62, no significant association between TyG-CVAI and CVD risk was observed.
• Above the threshold, each unit increase in the TyG-CVAI conferred a 47% higher CVD risk (HR 1.47, 95% CI 1.31–1.64; P < 0.001).
• The nonlinearity of the relationship was statistically significant.

The TyG-CVAI outperformed both the TyG index alone and the CVAI alone in predicting CVD risk based on ROC curve analysis.

• AUC for TyG-CVAI = 0.6315.
• AUC for TyG index alone = 0.5938.
• AUC for CVAI alone = 0.5851.
• Predictive performance was evaluated using receiver operating characteristic (ROC) curve analysis.

Insulin resistance and visceral adiposity are established pathophysiological drivers of CVD, and the TyG index and CVAI are respective indicators of these conditions.

• The TyG index serves as an indicator of insulin resistance.
• The Chinese visceral adiposity index (CVAI) serves as an indicator of visceral adiposity.
• The TyG-CVAI combines these two indicators into a single integrated measure.
• Prior to this study, the association of TyG-CVAI with new-onset CVD risk in the general population remained unclear.