Association of cholesterol-HDL-glucose waist-to-height ratio and TyG-WHtR with incident cardiometabolic multimorbidity: a prospective cohort study from CHARLS

Cardiometabolic multimorbidity (CMM) is an increasing global health burden driven by complex metabolic disturbances. The triglyceride–glucose waist-to-height ratio (TyG-WHtR) has been reported as a useful marker for CMM risk, while the cholesterol–HDL–glucose waist-to-height ratio (CHG-WHtR) may capture broader lipid and glycemic abnormalities. This study compared the associations with and predictive performance of TyG-WHtR and CHG-WHtR for incident CMM. This prospective cohort study used data from the China Health and Retirement Longitudinal Study and included 7,339 adults aged ≥ 45 years without CMM at baseline. Multivariable Cox regression models were used to assess the associations of TyG-WHtR and CHG-WHtR with CMM risk. Kaplan–Meier curves, restricted cubic splines, time-dependent receiver operating characteristic curves, net reclassification index (NRI), and integrated discrimination improvement (IDI) were used to evaluate dose-response relationships and predictive performance. During 9 years of follow-up, 700 participants (9.54%) developed CMM. In fully adjusted models, both TyG-WHtR (HR 1.53, 95% CI 1.39–1.70) and CHG-WHtR (HR 2.14, 95% CI 1.83–2.51) were independently associated with increased CMM risk. Restricted cubic spline analyses showed nonlinear positive associations for both indices. Compared with TyG-WHtR, CHG-WHtR showed higher effect estimates for the association with CMM and numerically higher NRI and IDI values; its AUCs were modestly higher at 4, 7, and 9 years but not at 2 years, although the absolute differences were small. CHG-WHtR is independently associated with incident CMM and may provide complementary information for CMM risk stratification.