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. 2024 Jun 20;23(1):212.
doi: 10.1186/s12933-024-02251-w.

Is systemic inflammation a missing link between cardiometabolic index with mortality? Evidence from a large population-based study

Bin Xu #  1   2 , Qian Wu #  3   4 , Rui La  5 , Lingchen Lu  6 , Fuad A Abdu  1 , Guoqing Yin  1 , Wen Zhang  1 , Wenquan Ding  5 , Yicheng Ling  5 , Zhiyuan He  5 , Wenliang Che  7
Affiliations

Is systemic inflammation a missing link between cardiometabolic index with mortality? Evidence from a large population-based study

Bin Xu et al. Cardiovasc Diabetol. .

Abstract

Background: This study sought to elucidate the associations of cardiometabolic index (CMI), as a metabolism-related index, with all-cause and cardiovascular mortality among the older population. Utilizing data from the National Health and Nutrition Examination Survey (NHANES), we further explored the potential mediating effect of inflammation within these associations.

Methods: A cohort of 3029 participants aged over 65 years old, spanning six NHANES cycles from 2005 to 2016, was enrolled and assessed. The primary endpoints of the study included all-cause mortality and cardiovascular mortality utilizing data from National Center for Health Statistics (NCHS). Cox regression model and subgroup analysis were conducted to assess the associations of CMI with all-cause and cardiovascular mortality. The mediating effect of inflammation-related indicators including leukocyte, neutrophil, lymphocyte, systemic immune-inflammation index (SII), neutrophil to lymphocyte ratio (NLR) were evaluated to investigate the potential mechanism of the associations between CMI and mortality through mediation package in R 4.2.2.

Results: The mean CMI among the enrolled participants was 0.74±0.66, with an average age of 73.28±5.50 years. After an average follow-up period of 89.20 months, there were 1,015 instances of all-cause deaths and 348 cardiovascular deaths documented. In the multivariable-adjusted model, CMI was positively related to all-cause mortality (Hazard Ratio (HR)=1.11, 95% CI=1.01-1.21). Mediation analysis indicated that leukocytes and neutrophils mediated 6.6% and 13.9% of the association of CMI with all-cause mortality.

Conclusion: Elevated CMI is positively associated with all-cause mortality in the older adults. The association appeared to be partially mediated through inflammatory pathways, indicating that CMI may serve as a valuable indicator for poor prognosis among the older population.

Keywords: Cardiometabolic index; Cardiovascular disease; Inflammation; Mortality; National Health and Nutrition Examination Survey.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of study participants
Fig. 2
Fig. 2
Kaplan–Meier curves of the survival rate of participants with CMI tertiles (A All-cause mortality, B Cardiovascular mortality)
Fig. 3
Fig. 3
Subgroup analysis of associations between CMI and all-cause mortality
Fig. 4
Fig. 4
Subgroup analysis of associations between CMI and cardiovascular mortality
Fig. 5
Fig. 5
Analysis of the mediation by leukocytes (A) and neutrophils (B) of the associations of CMI with all-cause mortality
See this image and copyright information in PMC

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