Associations of a nutrition–inflammation index and vascular aging with mortality in adults with diabetes or prediabetes and cardiovascular disease

Abstract Background Adults with prediabetes or diabetes and cardiovascular disease (CVD) face a substantial burden of premature mortality. Chronic inflammation, malnutrition and vascular aging are key pathways linking dysglycaemia and CVD to adverse outcomes. The Advanced Lung Cancer Inflammation Index (ALI) reflects systemic inflammation and nutritional status, while estimated pulse wave velocity (ePWV) serves as a surrogate of vascular aging. However, their independent and joint associations with mortality in dysglycemic adults with CVD remain unclear. Methods NHANES 1999–2018 data comprising 101,316 participants were analyzed. After exclusions, adults ≥ 20 years with prediabetes/diabetes and CVD were included ( n = 1,992). ALI and ePWV were analysed as continuous variables and cross-classified using maximally selected cut-points. Survey-weighted Cox models, restricted cubic splines and subgroup/sensitivity analyses were applied. Time-dependent receiver operating characteristic curves and C-indices were used to compare prognostic discrimination. Results Higher ALI was inversely associated with all-cause, cardiovascular, and premature mortality, whereas higher ePWV was positively associated with all-cause and cardiovascular mortality. Per 10-unit increment in ALI, fully adjusted hazard ratios (HRs) were 0.899 (95% CI 0.872–0.928) for all-cause mortality, 0.938 (0.885–0.995) for cardiovascular mortality, and 0.889 (0.837–0.945) for premature mortality. For ePWV, the corresponding HRs per 1 m/s increment were 1.139 (1.072–1.211) for all-cause mortality and 1.216 (1.102–1.341) for cardiovascular mortality. In joint analyses, combined ALI–ePWV categories showed a risk gradient: participants with high ALI/low ePWV had the lowest risks of all-cause mortality (HR 0.382, 95% CI 0.280–0.520), cardiovascular mortality (HR 0.379, 95% CI 0.228–0.630), and premature mortality (HR 0.402, 95% CI 0.245–0.659) compared with those with low ALI/high ePWV. Conclusions ALI and ePWV provide complementary information on systemic inflammation–nutrition status and vascular ageing, and their combined categories define distinct risk strata for mortality in adults with dysglycaemia and CVD. Their combined categories may help characterize mortality-risk heterogeneity and inform future risk-assessment studies in this high-risk population.