Association between the cardiometabolic index and all-cause and cardiovascular mortality in diabetes and prediabetes
Ying Wang1, Keith C Ferdinand2, Carmine Gazzaruso3
1Department of Clinical Laboratory, Beijing Tongzhou District Hospital of Integrated Traditional Chinese and Western Medicine, Beijing, China.
Insights
The cardiometabolic index (CMI) predicts mortality risk in adults with diabetes or prediabetes. Higher CMI levels are linked to increased all-cause and cardiovascular disease mortality, with a U-shaped association observed.
Area of Science:
- Cardiovascular Health
- Metabolic Syndrome
- Epidemiology
Background:
- The association between the cardiometabolic index (CMI) and mortality in individuals with diabetes or prediabetes is not well-established.
- Cardiovascular disease (CVD) remains a leading cause of mortality in these populations.
Purpose of the Study:
- To investigate the relationship between baseline cardiometabolic index (CMI) and all-cause mortality.
- To examine the association between baseline CMI and cardiovascular disease (CVD) mortality.
- To assess the predictive value of CMI for mortality risk in U.S. adults with diabetes or prediabetes.
Main Methods:
- A cohort study utilizing data from 17,992 U.S. adults (aged ≥18) with diabetes or prediabetes from NHANES (2003-2018).
- Kaplan-Meier curves, Cox proportional hazards models, and restricted cubic spline (RCS) analyses were employed.
- Subgroup and sensitivity analyses were performed to ensure the robustness of findings.
Main Results:
- Over 137,687 person-years, 2,718 all-cause deaths and 891 CVD deaths occurred.
- Multivariate analysis revealed a positive association between CMI and risks of all-cause and CVD mortality.
- RCS analysis indicated an approximately U-shaped relationship between CMI and both all-cause and CVD mortality (P<0.001 and P=0.03, respectively).
- Significant interactions were found between CMI and mortality based on age, sex, smoking status, and diabetes status.
Conclusions:
- The cardiometabolic index (CMI) is a valuable predictor of all-cause and CVD mortality in U.S. adults with diabetes and prediabetes.
- The observed U-shaped relationship between CMI and mortality underscores its potential utility in risk stratification for this population.
- CMI may serve as a robust indicator for identifying individuals at higher risk of long-term mortality.
Background:
The association between the cardiometabolic index (CMI) and mortality in individuals with diabetes or prediabetes remains unclear. This study sought to explore the association between the baseline CMI and all-cause mortality and cardiovascular disease (CVD) mortality in United States (U.S.) adults with diabetes or prediabetes.
Methods:
This cohort study examined the data of 17,992 individuals, aged 18 years and older, with diabetes and prediabetes, who had participated in the National Health and Nutrition Examination Survey (NHANES; 2003-2018). Kaplan-Meier curve, Cox proportional hazards model, and restricted cubic spline (RCS) curve analyses were conducted to explore the relationship between the CMI and all-cause mortality and CVD mortality. Subgroup and sensitivity analyses were conducted to check the robustness of the main findings.
Results:
During 137,687 person-years of follow-up (median: 7.4 years), a total of 2,718 all-cause deaths and 891 CVD-related deaths were recorded. In the multivariate adjusted models, the CMI was positively associated with the risk of all-cause mortality and CVD mortality. Specifically, the hazard ratio (HR) estimates for all-cause death and 95% confidence intervals (CIs) for the low to high CMI quartiles were 1.00 (reference), 1.056 (0.875-1.274), 1.156 (0.912-1.464), and 1.42 (1.080-1.867), respectively. While the CVD mortality HRs were 1.00 (reference), 1.041 (0.768-1.41), 1.077 (0.771-1.503), and 1.29 (0.836-1.99), respectively. The RCS analysis showed that the baseline CMI was approximately U-shaped in relation to all-cause mortality (Pnonlinear<0.001) and CVD mortality (Pnonlinear=0.03) in the participants with diabetes and prediabetes. The subgroup analysis revealed a clear interaction between the CMI and all-cause mortality based on age and sex (P=0.01 and P=0.003, respectively). It also revealed a significant interaction between the CMI and CVD mortality based on smoking status and diabetes status (P=0.02 and P=0.01, respectively).
Conclusions:
The CMI demonstrated predictive value for the risk of all-cause mortality and CVD mortality among U.S. participants with prediabetes and diabetes. The relationship between the CMI and long-term mortality exhibited an approximately U-shaped pattern, highlighting its potential as a robust indicator for mortality risk stratification in this population.
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