Associations Between the CHG Index, Its Modified Versions, and Incident Stroke in Early-Stage CKM Syndrome: A Nationwide Cohort Study

Background Cardiovascular-kidney-metabolic (CKM) syndrome is a major health burden. Stroke, the third leading cause of death globally, is strongly linked to insulin resistance (IR). The novel cholesterol, high-density lipoprotein (HDL), and glucose (CHG) index has been shown to have superior diagnostic accuracy for diabetes, but its association with stroke in early CKM syndrome (stages 0–3) is unclear. Methods This nationwide prospective cohort study included 6,836 adults with CKM syndrome stages 0–3 from the CHARLS (2011–2020). Multivariable Cox models assessed associations between baseline CHG indices (and modified variants) and incident stroke. Dose-response relationships were evaluated using restricted cubic splines (RCS) and Kaplan-Meier analysis. Results Over a 9-year follow-up period, 575 incident stroke cases were documented. Per 1-SD increase, the CHG index (HR = 1.18, 95% CI:1.07–1.29), CHG-WC (HR = 1.15, 1.05–1.26), and CHG-WHtR (HR = 1.12, 1.03–1.22) were independently associated with stroke. Quartile analysis revealed the strongest association for CHG-WHtR (Q4 vs. Q1: HR = 1.59, 95% CI: 1.19–2.11). Dose-response relationships were linear. Subgroup analyses indicated enhanced predictive utility in participants aged < 60 years and those with CKM stage 3. No significant association was observed between CHG-BMI and stroke incidence. Conclusion The​​ CHG index and its derivatives incorporating abdominal obesity indices (WC and WHtR) ​​robustly predict​​ incident stroke in early-stage CKM syndrome; their clinical adoption may enhance early detection and prevention of stroke events in ​​populations with vulnerable metabolism​.