Wang Xiaoyan, Wen Pengfei, Liao Yun, Wu Tao, Zeng Lin, Huang Yuxing, Song Xiaomei, Xiong Zhen, Deng Lisha, Li Dingjun, Miao Shuchuan
Department of Clinical Nutrition, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China.
Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China.
Cardiovasc Diabetol. 2025 Jun 14;24(1):254. doi: 10.1186/s12933-025-02784-8.
The association between the atherogenic index of plasma (AIP), its modified indices (such as AIP-waist circumference [AIP-WC], AIP-waist-to-height ratio [AIP-WHtR], AIP-body mass index[AIP-BMI]), and incident stroke in individuals with cardiovascular-kidney-metabolic (CKM) stages 0-3 remains understudied. This study investigated these associations and their utility for risk stratification.
Data from 3697 China Health and Retirement Longitudinal Study (CHARLS) participants (≥ 45 years, CKM stages 0-3) were analyzed. Baseline, cumulative, and changes in AIP and its modified indices (AIP-WC, AIP-WHtR, AIP-BMI) were calculated. Logistic regression, Delong's test, integrated discrimination improvement (IDI), weighted quantile sum (WQS) regression, and mediation analysis were used to assess associations, predictive performance, component contributions, and mediation effects.
Stroke occurred in 4.8% of participants. Under the fully adjusted Model 3: The third level of AIP, AIP-WHtR, AIP-WC, and AIP-BMI showed increased risks (ORs 1.58 [95% CI 1.05-2.38], 1.99 [95% CI 1.31-3.02], 1.99 [95% CI 1.31-3.02], and 1.92 [95% CI 1.26-2.92], respectively); The third level of cumulative AIP, AIP-WHtR, AIP-WC, and AIP-BMI showed elevated risks (ORs 1.79 [95% CI 1.19-2.69], 2.07 [95% CI 1.37-3.13], 2.01 [95% CI 1.33-3.04], and 1.92 [95% CI 1.27-2.89], respectively); The third category of AIP, AIP-WHtR, AIP-WC, and AIP-BMI changes showed risk increases of 2.28 (95% CI 1.46-3.55), 2.39 (95% CI 1.50-3.79), 2.56 (95% CI 1.61-4.07), and 2.22 (95% CI 1.38-3.56). Modified AIP indices (especially AIP-WHtR) demonstrated superior predictive ability than AIP alone. The association was amplified in advanced CKM (stages 2-3) but not significant in early CKM (stages 0-1). Triglycerides (TG) primarily drove the AIP-WHtR-stroke risk, which was partially mediated by estimated pulse wave velocity (ePWV) (6.48%).
AIP and its modified indices, especially AIP-WHtR, are significantly associated with incident stroke in CKM stages 0-3. Dynamically monitoring changes in these indices is crucial for stroke risk assessment and stratification, particularly in advanced CKM. TG primarily drives this risk, while ePWV partially mediates the AIP-WHtR-stroke link.
血浆致动脉粥样硬化指数（AIP）及其修正指数（如AIP-腰围[AIP-WC]、AIP-腰高比[AIP-WHtR]、AIP-体重指数[AIP-BMI]）与心血管-肾脏-代谢（CKM）0-3期个体发生卒中之间的关联仍未得到充分研究。本研究调查了这些关联及其在风险分层中的效用。
分析了来自中国健康与养老追踪调查（CHARLS）的3697名参与者（≥45岁，CKM 0-3期）的数据。计算了AIP及其修正指数（AIP-WC、AIP-WHtR、AIP-BMI）的基线值、累积值和变化值。采用逻辑回归、德龙检验、综合判别改善（IDI）、加权分位数和（WQS）回归以及中介分析来评估关联、预测性能、成分贡献和中介效应。
4.8%的参与者发生了卒中。在完全调整的模型3下：AIP、AIP-WHtR、AIP-WC和AIP-BMI的第三水平显示风险增加（OR分别为1.58[95%CI 1.05-2.38]、1.99[95%CI 1.31-3.02]、1.99[95%CI 1.31-3.02]和1.92[95%CI 1.26-2.92]）；累积AIP、AIP-WHtR、AIP-WC和AIP-BMI的第三水平显示风险升高（OR分别为1.79[95%CI 1.19-2.69]、2.07[95%CI 1.37-3.13]、2.01[95%CI 1.33-3.04]和1.92[95%CI 1.27-2.89]）；AIP、AIP-WHtR、AIP-WC和AIP-BMI变化的第三类别显示风险分别增加2.28（95%CI 1.46-3.55）、2.39（95%CI 1.50-3.79）、2.56（95%CI 1.61-4.07）和2.22（95%CI 1.38-3.56）。修正的AIP指数（尤其是AIP-WHtR）显示出比单独的AIP更强的预测能力。这种关联在晚期CKM（2-3期）中增强，但在早期CKM（0-1期）中不显著。甘油三酯（TG）是AIP-WHtR-卒中风险的主要驱动因素，估计脉搏波速度（ePWV）部分介导了这种关联（6.48%）。
AIP及其修正指数，尤其是AIP-WHtR，与CKM 0-3期个体发生卒中显著相关。动态监测这些指数的变化对于卒中风险评估和分层至关重要，尤其是在晚期CKM中。TG是这种风险的主要驱动因素，而ePWV部分介导了AIP-WHtR与卒中的联系。
