Association of Composite Metabolic Indices With Incident Carotid Plaque: A Chinese Cohort Study

BACKGROUND: Composite metabolic indices are key drivers of carotid plaque (CP) formation. This study aimed to evaluate and compare the predictive performance of 12 composite metabolic indices for incident CP in a large Chinese cohort. METHODS: This retrospective cohort study enrolled 10 407 participants free of CP at baseline from the DHMC (Dalian Health Management Cohort). The primary outcome was incident CP, diagnosed via carotid ultrasound. Cox proportional hazards regression models were used to assess the association between 12 indices-the triglyceride-glucose index (TyG), TyG-body mass index, TyG-waist circumference, TyG-waist-to-height ratio, body mass index, weight-adjusted-waist index, body roundness index, lipid accumulation product, visceral adiposity index, cardiometabolic index, lipoprotein combined index, and atherogenic index of plasma-and incident CP. Time-dependent receiver operating characteristic curves were employed to compare their predictive performance. Subgroup analyses were performed to validate the findings. RESULTS: During a median follow-up of 2.4 years, 1832 participants (17.6%) developed CP. After adjustment for potential confounders, all composite metabolic indices were significantly associated with incident CP. Among these indices, the lipoprotein combined index exhibited the strongest association and the best predictive performance. Time-dependent receiver operating characteristic analyses further confirmed that lipoprotein combined index consistently achieved the highest predictive accuracy throughout the follow-up period. CONCLUSIONS: Among 12 metabolic indices, LCI emerged as the strongest predictor for CP development in this Asian cohort, supporting its use as a simple, noninvasive tool to identify high-risk individuals for subclinical atherosclerosis and improve atherosclerotic cardiovascular disease primary prevention.