Development and Evaluation of the Atherosclerosis and Metabolic Risk Score Using Data from the National Health and Nutrition Examination Survey

Background: Metabolic disorders are major contributors to cardiovascular morbidity and premature mortality worldwide. Conventional clinical assessment approaches typically evaluate individual metabolic parameters separately and may not adequately capture the complex interactions among metabolic pathways. Objectives: To develop and evaluate the atherosclerosis and metabolic risk score (AMRS), a composite logarithmic index integrating anthropometric, biochemical, and demographic variables to quantify metabolic burden and classify individuals with metabolic abnormalities.Materials and Methods: A cross-sectional design included 8,402 adults aged 18-85 years from the public-use database of the NHANES [National Health and Nutrition Examination Survey] (2016-2017). The AMRS was calculated as a log-linear combination of nine clinical variables including: age, sex, body mass index (BMI), systolic and diastolic blood pressure (SBP, DBP), triglycerides (TG), total cholesterol (TC), fasting blood glucose (FBG), and HbA1c. Model performance was assessed using ROC curve analysis, subgroup analysis, risk stratification using percentiles, and chi-squared tests. To test the discriminative power of the model, sensitivity analyses were conducted by excluding one outcome-defining variable at a time from the AMRS formula. An external validation was also performed using an independent NHANES 2013-2014 cohort.Results: AMRS demonstrated good discrimination against glycemic abnormalities and moderate discrimination for lipid and blood pressure disorders. Area under curve values were 0.81 for hyperglycemia, 0.81 for elevated HbA1c, 0.73 for hypertriglyceridemia, 0.71 for hypercholesterolemia, and 0.72 for hypertension. Sensitivity analyses demonstrated that the score retained moderate discriminatory ability even after the removal of outcome-defining variables. External validation showed consistent discrimination across outcomes.Conclusion: The AMRS provides an integrated quantitative measure of cardiometabolic burden by combining multiple metabolic domains into a single composite index. The score demonstrated stable discrimination and robustness across analyses and may support population-level metabolic risk stratification and classification of metabolic burden.