Associations between vascular aging and 12 lipid composite indices: A large cross-sectional study

Vascular aging is an important antecedent of cardiovascular disease (CVD), yet affordable, widely available biomarkers for its early detection remain limited. We aimed to compare the predictive value of 12 lipid composite indices for vascular aging in a large cross-sectional sample of adults from Shenzhen, China.

In this cross-sectional analysis of 5518 adults screened in Shenzhen (2021-2023), vascular aging (baPWV ≥ 1400 cm/s) was evaluated against 12 indices (TyG, TyG-BMI, RC, TG/HDL-C, AC, AIP, LCI, CRI-II, NHR, MHR, LHR, PHR) derived from routine laboratory and hematological data. Associations were assessed using multivariable logistic regression across four sequentially adjusted models. Restricted cubic spline (RCS) and two-piece linear models were used to evaluate dose-response relationships and thresholds. Receiver operating characteristic (ROC) analysis compared the discriminative performance of each index alone and in combination with age. Subgroup and interaction analyses examined effect modification by BMI, gender, age, hypertension, and diabetes.

All 12 indices remained independently associated with vascular aging after multivariable adjustment. In the fully adjusted model (Model 4), each 1-unit increase in TyG was associated with an odds ratio (OR) of 2.21 (95% CI, 1.88-2.58; P < 0.001), and individuals in the highest TyG quartile (Q4) had an OR of 4.27 (95% CI, 3.16-5.77) compared with Q1; other indices showed similar effects. RCS analyses revealed significant nonlinear positive associations for several indices, with risk increasing below these thresholds. Individually, the indices had modest discrimination (AUC range, 0.562-0.726), but adding age improved all models; the TyG + age model achieved the best performance (AUC, 0.850; 95% CI, 0.838-0.862). BMI, gender, and diabetes status significantly modified several associations.

Among the 12 lipid composite indices evaluated, TyG-especially when combined with age-demonstrated the strongest predictive value for vascular aging in this large Chinese population, suggesting it may serve as a low-incremental-cost preliminary screening marker. However, prospective validation and intervention trials are needed to confirm the threshold and to determine whether lowering TyG attenuates vascular aging and subsequent CVD risk.