Abstract
BACKGROUND: Stroke is a leading global health challenge, significantly burdening individuals and healthcare systems. The Cardiometabolic Index (CMI), a novel metric combining triglycerides, HDL cholesterol, and waist-to-height ratio, has shown promise in predicting metabolic diseases but its relationship with stroke risk is underexplored. METHODS: This study analyzed data from 9,079 participants in the China Health and Retirement Longitudinal Study (CHARLS). Participants were stratified by CMI quintiles with the following ranges: Q1 (0.074-0.602), Q2 (0.602-0.935), Q3 (0.935-1.402), Q4 (1.402-2.327), and Q5 (2.327-74.326). Stroke incidence over a 7.8-year follow-up period was assessed. Cox proportional hazard models and restricted cubic spline regression were used to evaluate the association between baseline CMI and stroke risk, adjusting for confounders. RESULTS: Higher CMI levels were significantly associated with increased stroke risk, with a 21% higher risk per 1-unit increase in CMI after adjustment (HR: 1.21, 95% CI: 1.11-1.32). Stroke incidence showed a dose-response relationship, particularly above a CMI threshold of 1.6. CONCLUSION: Elevated CMI is a strong independent predictor of stroke risk, highlighting its potential as a clinical tool for early risk stratification and prevention. Further large-scale studies are needed to validate its utility.