Association of cumulative TCBI exposure with incident stroke in cardiovascular kidney metabolic syndrome stages 0 to 3

Abstract Stroke continues to impose a substantial global health burden, particularly among individuals with cardiovascular–kidney–metabolic (CKM) syndrome. Single measurements may not fully reflect metabolic exposure over time. This investigation assessed the associations of cumulative TCBI exposure and two-time-point TCBI patterns with incident stroke among individuals with CKM stages 0–3. This study sought to evaluate how cumulative and temporal changes in the TCBI relate to stroke occurrence across CKM stages by analyzing 4475 CHARLS participants aged 45 years or older, assessing TCBI at two occasions, categorizing longitudinal pattern via K-means clustering, and employing multivariable logistic regression combined with restricted cubic spline modeling. Higher cumulative TCBI (CumTCBI) and membership in the high-level two-time-point pattern group were associated with greater odds of incident stroke. In the fully adjusted model, each 1-unit increase in CumTCBI was associated with 12% higher odds (OR = 1.12, 95% CI 1.07–1.17). The corresponding OR for the high-level versus low-level pattern group was 1.66 (95% CI 1.32–2.08). The association was nonlinear, with an exploratory change point near 27.83, and remained directionally consistent in sensitivity analyses. Higher CumTCBI and high-level two-time-point TCBI patterns were associated with incident stroke among middle-aged and older adults classified as CKM stages 0–3. These findings represent epidemiological associations and do not establish the clinical utility of TCBI for individual risk stratification.