TOPLINE

A US cohort study involving patients with type 2 diabetes (T2D) found that a higher cardiometabolic index (CMI) — a composite marker of central adiposity (waist‑to‑height ratio) and lipid metabolism (triglyceride to high-density lipoprotein cholesterol ratio) — was independently and linearly associated with an increased risk for all‑cause and cardiovascular mortality.

METHODOLOGY

• Previous studies had shown an association between CMI and metabolic syndrome, metabolic dysfunction-associated fatty liver disease, hypertension, arteriosclerosis, and higher all-cause mortality in older adults, but the prognostic value of CMI for all-cause and cardiovascular mortality in comparatively younger patients with T2D remained unclear.
• Researchers conducted a prospective cohort study to examine the association between CMI and long-term all-cause and cardiovascular mortality in patients with T2D.
• They analyzed the data of 2188 patients (mean age, 51.1 years; 47% women) with T2D from National Health and Nutrition Examination Survey, 1999-2018; based on the optimal cutoff for survival association of 1.84, they stratified participants into higher CMI (CMI > 1.84; n = 366) and lower CMI (CMI ≤ 1.84; n = 1822) groups.
• CMI was calculated as the ratio of triglycerides to high-density lipoprotein cholesterol, multiplied by waist-to-height ratio. All-cause and cardiovascular mortality were assessed by linking participant records to the National Death Index and using diagnosis codes for cause of death.
• The association between CMI and the risk for mortality was assessed over a mean follow-up duration of 8.62 years.

TAKEAWAY

• During the follow-up period, 294 (13.4%) patients with T2D died, with 84 (3.8%) dying from cardiovascular causes.
• A higher CMI level was independently associated with an increased risk for all-cause mortality (adjusted hazard ratio [aHR], 1.67; P = .005) and cardiovascular mortality (aHR, 2.03; P = .020).
• Restricted cubic spline analysis revealed a linear relationship between CMI and all-cause mortality (P for nonlinearity = .219) and cardiovascular mortality (P for nonlinearity = .186). In terms of predicting risk for mortality, CMI outperformed waist-to-height ratio and fasting insulin and was noninferior to glucose or A1c.
• Subgroup analyses indicated the association between higher CMI and all‑cause mortality was stronger in men, individuals with obesity or hypertension, never‑smokers, and those with no or low‑to‑moderate alcohol intake; for cardiovascular mortality the association was stronger in men, never‑smokers, those with low‑to‑moderate alcohol intake, and those with hypertension.

IN PRACTICE

“[The study] observed significant findings that the higher CMI level correlated with mortality risk among young individuals with diabetes mellitus and served as a comprehensive and effective prognostic indicator for long-term health,” the authors wrote.

SOURCE

This study was led by Aihua Li, Xiangya Hospital, Central South University, and Ziying Zhou, Xiangya Hospital, both from Changsha, China. It was published online in PLOS One.

LIMITATIONS

The study may have unmeasured confounding factors despite adjusting for several covariates. The observational nature of the study prevented the establishment of causality between CMI and mortality outcomes. 

DISCLOSURES

This study did not receive any specific funding. No relevant conflicts of interest were disclosed by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.