Abstract
OBJECTIVE: The correlation between the triglyceride glucose-waist-to-height ratio (TyG-WHtR) and the risk of stroke has not been extensively explored. This research aimed to examine the correlation between TyG-WHtR and the occurrence of stroke among middle-aged and elderly individuals in the Chinese demographic. METHODS: This prospective study included 8618 subjects from the China Health and Retirement Longitudinal Study (CHARLS). Multivariate Cox regression models were applied to test the effect of TyG-WHtR on stroke. Nonlinear associations were examined using restricted cubic spline (RCS) models. RESULTS: The average age of the adults was 59.38 ± 9.28 years, with 3978 (46.16%) being male. During a median follow-up duration of seven years, stroke was diagnosed in 995 (11.55%) individuals. In a multivariable model, TyG-WHtR exhibited a significant positive association with stroke (HR: 1.20, 95%CI: 1.04–1.38, p = 0.0140). RCS models identified a nonlinear correlation (inflection point at TyG-WHtR = 4.87). For values below 4.87, TyG-WHtR was significantly related to stroke (HR: 1.45, 95%CI: 1.17–1.80, p = 0.0007). Above 4.87, no significant correlation remained (HR: 1.03, 95%CI: 0.85–1.25, p = 0.7530). CONCLUSION: Our research revealed a positive, non-linear association between the TyG-WHtR and stroke risk. Specifically, a significant positive association was observed when the TyG-WHtR was below 4.87. These findings provide valuable insights that could enhance clinical consultations and inform the optimization of stroke prevention strategies in middle-aged and older adults. CLINICAL TRIAL NUMBER: Not applicable. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12902-025-02126-5.