Longitudinal Changes in Triglyceride Glucose–Chinese Visceral Adiposity Index and Incident Cardiovascular Disease in Chinese Adults Aged 45 Years and Older: A Prospective Cohort Study from CHARLS with GBD 2021 Context

BACKGROUND: Cardiovascular disease (CVD) remains a leading cause of disease burden in China, with metabolic risk factors continuing to play a major role. We aimed to examine whether baseline triglyceride glucose-Chinese visceral adiposity index (TyG-CVAI), cumulative average TyG-CVAI, and longitudinal changes in TyG-CVAI were associated with incident CVD among Chinese adults aged 45 years and older, using estimates from the Global Burden of Disease (GBD) 2021 study to contextualize the population-level burden. METHODS: We first used data from the GBD 2021 study to describe temporal trends in CVD burden and the contribution of major risk factors in China. We then analyzed data from the China Health and Retirement Longitudinal Study (CHARLS). A total of 6963 participants contributed to the baseline TyG-CVAI analyses, and 3298 participants with repeated measurements were included in the longitudinal change analyses. Participants were grouped into three clusters by k-means clustering based on repeated TyG-CVAI measurements over time. Cox proportional hazards models adjusted for major CVD risk factors identified from GBD 2021 were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident CVD. Restricted cubic spline models were applied to assess dose-response relationships. Robustness was evaluated through subgroup and sensitivity analyses. RESULTS: From 1990 to 2021, the burden of CVD attributable to metabolic risks in China showed limited improvement. Disability-adjusted life years attributable to high low-density lipoprotein cholesterol and high fasting plasma glucose changed only modestly, whereas the burden attributable to high body mass index increased over time. In the CHARLS cohort, higher baseline TyG-CVAI remained associated with a greater risk of incident CVD (HR, 1.17; 95% CI: [1.11, 1.24]), and similar associations were observed for cumulative average TyG-CVAI. Compared with participants with persistently low TyG-CVAI, those with stable medium and stable high TyG-CVAI trajectories had significantly higher risks of incident CVD, with HRs of 1.22 (95% CI: 1.01-1.49) and 1.45 (95% CI: 1.16-1.81), respectively. CONCLUSIONS: Baseline TyG-CVAI, cumulative exposure, and longitudinal changes of TyG-CVAI were all associated with incident CVD in Chinese adults aged 45 years and older. Persistently elevated TyG-CVAI over time was associated with a higher risk of CVD.