Modified cardiometabolic index and the risk of new-onset chronic diseases: a nationwide prospective cohort study.

backgroundMetabolic syndrome, characterized by a clustering of cardiometabolic risk factors, is a key driver of chronic diseases. The Cardiometabolic Index (CMI) is a useful metric, but its exclusion of hyperglycemia—a cornerstone of metabolic dysregulation—limits its scope. A Modified Cardiometabolic Index (MCMI) incorporating glucose has been proposed, but its long-term predictive value for incident type 2 diabetes, cardiovascular disease, and subsequent multimorbidity has not been prospectively validated. We aimed to evaluate the MCMI as a predictor for these outcomes and compare its performance against the original CMI.

methodsThis study included 8,251 participants aged ≥ 45 years from the China Health and Retirement Longitudinal Study. The MCMI was calculated at baseline (2011) using waist-to-height ratio, the triglyceride to HDL-C ratio, and fasting blood glucose. Multivariable Cox proportional hazards models were used to assess the associations between the MCMI (as both a continuous variable and in quartiles) and the incidence of 13 chronic diseases over a median follow-up of 7.0 years. The predictive accuracy of the MCMI and CMI was compared using the area under the receiver operating characteristic curve (AUC) and the DeLong test.

resultsA higher baseline MCMI was significantly associated with an increased risk of developing type 2 diabetes (HR 1.15, 95% CI 1.12–1.18), hypertension (HR 1.12, 95% CI 1.09–1.15), dyslipidemia (HR 1.11, 95% CI 1.08–1.14), heart disease (HR 1.09, 95% CI 1.03–1.16), and stroke (HR 1.13, 95% CI 1.07–1.19), with significant dose-response relationships observed across quartiles. The MCMI was also associated with progression to multimorbidity, showing a stronger association with the development of a second chronic disease (HR 1.22, 95% CI 1.13–1.31) than a first (HR 1.09, 95% CI 1.03–1.16). Compared to the CMI, the MCMI demonstrated significantly superior predictive accuracy for type 2 diabetes (AUC 0.663 vs. 0.647), hypertension (AUC 0.747 vs. 0.742), stroke (AUC 0.692 vs. 0.686), and dyslipidemia (AUC 0.657 vs. 0.650) (all P < 0.001).

conclusionsIn this large, nationally representative cohort, the MCMI was a robust and independent predictor of incident cardiometabolic diseases and the development of multimorbidity. Its superior predictive accuracy over the original CMI supports its utility as a simple, low-cost, and more effective tool for stratifying cardiometabolic risk and guiding early prevention, particularly for type 2 diabetes and related cardiovascular events, in clinical and public health settings.