Abstract
Background Early identification of individuals at high risk for hypertension development is crucial for implementing timely preventive strategies. Metabolic indices such as the cholesterol-glucose (CHG) index, atherogenic index of plasma (AIP), and triglyceride-glucose (TyG) index have emerged as potential biomarkers for metabolic and cardiovascular disorders. However, their comparative predictive value for new-onset hypertension in prehypertensive individuals remains unclear.
Methods This prospective cohort study utilized data from the China Health and Retirement Longitudinal Study (CHARLS), including 2,859 adults with prehypertension followed from 2011 to 2015. Participants were stratified based on progression to incident hypertension. Baseline characteristics and metabolic indices were evaluated. Multivariable logistic regression models, restricted cubic spline (RCS) analyses, receiver operating characteristic (ROC) curves, and subgroup analyses were conducted to assess the associations between CHG, AIP, and TyG indices and the risk of developing hypertension.
Results During the 4-year follow-up, 31.34% (896/2,859) of participants developed new-onset hypertension. All three metabolic indices were independently associated with an increased risk of hypertension after multivariable adjustment. The CHG index demonstrated the strongest association (odds ratio [OR]: 1.96, 95% confidence interval [CI]: 1.45–2.66, P < 0.001), followed by the TyG index (OR: 1.31, 95% CI: 1.07–1.60, P = 0.010). RCS analysis revealed a significant nonlinear relationship between the CHG index and hypertension risk (P for nonlinear = 0.042), whereas AIP and TyG showed linear trends. ROC analysis indicated that the CHG index had the highest discriminatory ability for predicting hypertension (fully adjusted area under the curve [AUC] = 0.7010), outperforming both AIP (AUC = 0.6997) and TyG (AUC = 0.6980). Subgroup analyses showed that the association between the CHG index and incident hypertension was significantly stronger among individuals with lower educational attainment (illiterate), those aged 60–70 or ≥70 years, and widowed individuals (P for interaction < 0.05).
Conclusion Among prehypertensive individuals, higher baseline levels of CHG, AIP, and TyG indices are significantly associated with an increased risk of developing hypertension. The CHG index demonstrates superior predictive performance and may serve as a valuable tool for early risk stratification and targeted intervention in clinical practice.
Competing Interest Statement
The authors have declared no competing interest.
Clinical Trial
This study is a population-based observational cohort study aimed at evaluating the association between metabolic indices and the risk of new-onset hypertension. According to the International Committee of Medical Journal Editors (ICMJE) guidelines, observational studies typically do not require registration in international trial registries because they do not involve interventions or randomization. The study has been approved by the Ethics Review Committee of Peking University (IRB00001052-11015) and adheres to the principles outlined in the Declaration of Helsinki. All participants provided written informed consent prior to enrollment. Furthermore, the data for this study were sourced from the China Health and Retirement Longitudinal Study (CHARLS), a large, publicly available database whose data collection and management processes have undergone rigorous ethical and scientific scrutiny. Therefore, while the study was not prospectively registered, it was conducted following recognized ethical standards and best practices for observational research, ensuring high standards of participant protection and data integrity.
Funding Statement
Funding Information: Financial support for this study was provided by the National Natural Science Foundation of China (Grant ID: 82200401) and by the Qingdao Municipal Science and Technology Bureau?s Science and Technology Beneficial Demonstration Guidance Special Fund project (Award Number: 20-3-4-54-nsh). Haichu Yu was the principal investigator for the project funded by the Qingdao Municipal Science and Technology Bureau.
Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
The CHARLS study was approved by the Institutional Review Board at Peking University (IRB00001052-11015), in accordance with the principles outlined in the Declaration of Helsinki. All participants provided written informed consent prior to enrollment. This study followed the STROBE guidelines for reporting observational research, ensuring methodological rigor and transparency throughout the study design, implementation, and reporting.
I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.
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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.
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Data Availability
This study utilized data from the China Health and Retirement Longitudinal Study, which is accessible to researchers at http://charls.pku.edu.cn/.
