Cardiometabolic Index, BMI, Waist Circumference, and Cardiometabolic Multimorbidity Risk in Older Adults

<b>Background/Objectives:</b> The cardiometabolic index (CMI) is a simple anthropometric-metabolic indicator that has recently gained attention as a marker of cardiometabolic risk. This study compared the associations and predictive utility of CMI, body mass index (BMI), and waist circumference (WC) for cardiometabolic multimorbidity (CMM). <b>Methods:</b> Data were drawn from 3348 adults (mean age 63.5 years; 45.1% male) in the English Longitudinal Study of Ageing who were free of hypertension, coronary heart disease, diabetes, and stroke at wave 4 (2008-2009). CMI was calculated using the triglyceride-to-HDL-cholesterol ratio and the waist-to-height ratio. Incident CMM at wave 10 (2021-2023) was defined as the presence of ≥2 of these conditions: hypertension, cardiovascular disease, diabetes, or stroke. Odds ratios (ORs) with 95% confidence intervals (CIs) and measures of discrimination were estimated. <b>Results:</b> During 12-15 years of follow-up, 197 CMM cases were recorded. CMI, BMI, and WC were each linearly related to CMM. Higher CMI was associated with increased CMM risk (per 1-SD increase: OR 1.25, 95% CI 1.08-1.44; highest vs. lowest tertile: OR 1.88, 95% CI 1.09-3.25), with similar effect sizes for BMI. WC showed stronger associations (per 1-SD increase: OR 1.46, 95% CI 1.25-1.71; highest vs. lowest tertile: OR 2.16, 95% CI 1.35-3.44). Adding CMI to a base model resulted in a small, non-significant improvement in discrimination (ΔC-index = 0.0032; <i>p</i> = 0.55) but significantly improved model fit (-2 log-likelihood <i>p</i> = 0.004), with comparable effects for BMI and greater improvements for WC. <b>Conclusions:</b> In this older UK cohort, higher CMI levels were associated with increased long-term risk of CMM but did not outperform traditional adiposity measures such as BMI and WC.