Associations of cumulative exposure and dynamic trajectories of cholesterol-HDL-glucose (CHG) index with cardiovascular disease in middle-aged and older Chinese adults: a longitudinal analysis.

Higher cumulative CHG (cuCHG) was associated with significantly increased CVD risk in a dose-dependent manner.

• Compared with the lowest quartile (Q1), participants in the highest quartile (Q4) had a 22% increased risk of CVD (HR = 1.22, 95% CI: 1.06–1.40, P = 0.005, adjusted P = 0.007).
• CVD risk increased progressively across ascending cuCHG quartiles (P for trend < 0.05).
• RCS analysis demonstrated a linear association between cuCHG and CVD risk (for overall, P < 0.001).
• cuCHG was calculated as: cuCHG = (CHG2012 + CHG2015) / time interval (2012–2015).

K-means clustering identified three distinct dynamic CHG trajectories among study participants.

• The three clusters were classified as: a moderate-decreasing trajectory (Cluster 1), a high-risk slowly increasing trajectory (Cluster 2), and a stable reference group (Cluster 3).
• K-means clustering analysis was used to classify dynamic CHG changes across the 2012–2015 measurement period.
• The stable reference group (Cluster 3) served as the comparator for hazard ratio calculations.

Participants in the high-risk slowly increasing CHG trajectory had a significantly higher risk of CVD compared to the stable reference group.

• Cluster 2 (high-risk slowly increasing trajectory) had HR = 1.28, 95% CI: 1.10–1.49, P = 0.002 compared to Cluster 3 (stable reference group).
• Cluster 1 (moderate-decreasing trajectory) was not significantly associated with CVD risk (HR = 1.09, 95% CI: 0.98–1.21, P = 0.126).
• Cox proportional hazards regression models were used to evaluate associations between CHG trajectories and CVD risk.

A total of 6,171 participants aged 45 and older were included, with 1,136 (18.4%) experiencing incident CVD over the follow-up period.

• Participants were recruited from the China Health and Retirement Longitudinal Study (CHARLS).
• CVD was defined as self-reported description.
• The study followed participants from 2012 to 2015 for CHG measurements, with subsequent follow-up for CVD incidence.
• The study population was restricted to middle-aged and older Chinese adults aged 45 years and older.

The CHG index was evaluated as a novel composite index for metabolic disorders and their relationship to cardiovascular disease risk.

• The CHG index incorporates cholesterol, high-density lipoprotein (HDL), and glucose measurements.
• The CHG index has been proposed as a potential index for metabolic disorders, but research on CHG changes and CVD was previously limited.
• Both cumulative exposure (cuCHG) and dynamic trajectory approaches were used to characterize CHG exposure over time.

The study found that monitoring long-term CHG changes and maintaining relatively stable levels may help prevent CVD in middle-aged and older adults.

• Participants with consistently high-risk CHG levels (Cluster 2) had significantly increased CVD risk (HR = 1.28, 95% CI: 1.10–1.49).
• The moderate-decreasing trajectory was not significantly associated with elevated CVD risk (HR = 1.09, 95% CI: 0.98–1.21, P = 0.126), suggesting that decreasing CHG levels may attenuate risk.
• The authors recommend monitoring long-term CHG changes in clinical practice as a preventive strategy for CVD.