Total Cholesterol, High-Density Lipoprotein, and Glucose (CHG) index and risk of stroke in middle-aged and elderly Chinese adults: a nationwide prospective cohort study

Current literature lacks reliable evidence on the association between Total Cholesterol, High-Density Lipoprotein, and Glucose (CHG) and stroke incidence. Therefore, this study aims to investigate the potential association between CHG and stroke risk in a middle-aged and elderly Chinese population. This is a prospective cohort study, and the data is derived from the China Health and Retirement Longitudinal Study. Cox proportional hazards regression models were utilized to explore relationships between CHG and stroke incidence. To identify potential nonlinear relationships, Cox proportional hazards regression models with restricted cubic spline functions were constructed. Additionally, Receiver Operating Characteristic (ROC) curves were developed to explore the predictive ability of CHG for stroke. This study included a total of 10,396 participants, with female accounting for 53.27%. Through five survey cycles from 2011 to 2020, 953 (9.17%) incident strokes occurred. After multivariate adjustment, Cox regression modeling showed that each 1-unit increase in CHG was associated with a 33.5% increased risk of stroke (HR 1.335; 95% CI 1.063–1.677). A nonlinear relationship was identified, with an inflection point at CHG = 4.556. On the left side of that point, each unit increase in CHG was associated with a statistically nonsignificant increase of 12.4% in stroke risk (HR = 1.126; 95% CI: 0.691–1.835), while on the right side of the point, it was linked to a 58.0% increase in risk (HR = 1.580; 95% CI: 1.097–2.274). Additionally, in predicting stroke risk, the AUC value for CHG (0.5737) was higher than that of TyG (0.5679), TC/HDL-c (0.5619), FPG (0.5513), HDL-c (0.5424), and TC (0.5334). This study found that CHG is positively related to stroke risk and exhibits a non-linear relationship, with a turning point at 4.556. CHG may serve as an early marker for high-risk populations, and proactive monitoring and interventions, including lifestyle changes and management of other metabolic indicators for those with CHG above 4.556, may help lower stroke risk.