The synergistic pattern of metabolic -inflammatory dynamic trajectories jointly predicts cardiovascular risk in Chinese middle -aged and older adults: a prospective cohort study

Background The interplay between metabolic dysregulation and chronic inflammation is pivotal in the development of cardiovascular disease. However, the joint prognostic value of their dynamic trajectories remains unclear. Current risk assessment predominantly relies on single -timepoint, static measurements, which fail to capture their temporal evolution and synergistic interactions. This study aimed to investigate the synergistic pattern derived from the dynamic trajectories of metabolism and inflammation for predicting major adverse cardiovascular events(MACE) . Methods This prospective cohort study included 4,968 Chinese middle -aged and older adults free of baseline cardiovascular disease from the China Health and Retirement Longitudinal Study(CHARLS).The triglyceride -glucose -body mass index and high -sensitivity C -reactive protein were used to define metabolic and inflammatory status,respectively.Their dynamic trajectories(sustained low,high -to -low,low -to -high,sustained high)from two timepoints were constructed and combined into seven synergistic patterns.The primary outcome was incident MACE(a composite of cardiovascular death,myocardial infarction,stroke,or revascularization).Cox proportional hazards models were used to calculate hazard ratios.The incremental predictive value was assessed using the C -statistic,net reclassification improvement,and integrated discrimination improvement.Subgroup and sensitivity analyses were performed. Results Over a median follow -up of 5.25 years, 1,087 events occurred. Compared to the sustained low metabolic -inflammatory pattern, the sustained high pattern was associated with the highest risk of MACE (fully -adjusted HR = 1.64, 95% CI: 1.31–2.03). A significant age interaction was observed (P for interaction = 0.027), with a stronger association in participants aged < 60 years (HR = 1.93, 95% CI: 1.38–2.72) than in those ≥ 60 years. The inclusion of the synergistic pattern into a model containing traditional risk factors significantly improved risk prediction (NRI = 0.046, IDI = 0.029). Conclusions The synergistic pattern of metabolic -inflammatory dynamic trajectories, especially the sustained high pattern, is an independent risk factor for MACE in Chinese middle -aged and older adults, with greater predictive utility in younger individuals. This novel approach provides a dynamic perspective for precise cardiovascular risk stratification.